Care service inspection report

Care service inspection report Full inspection Tom's Croft Care Home Service Bunachton Inverness Inspection completed on 25 May 2016

Service provided by: Common Thread Ltd Service provider number: SP2005007437 Care service number: CS2012308053 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 enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 29

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 3 Quality of environment Quality of staffing 4 Quality of management and leadership Adequate N/A Good N/A What the service does well - When there are concerns the organisation responds very quickly to ensure these are addressed. - Any additional training that staff require to have to refresh their skills and knowledge is arranged in a very speedy manner. - Staff developed very good relationships with young people and their families and this improved the outcomes for young people. - Staff really do encourage young people to attend school or attend the particular education package that is in place for young people. - Young people are encouraged and supported to maintain a healthy life style and eat a well-balanced diet. - Staff are enthusiastic about their work and this improves outcomes for young people. page 3 of 29

- Observation of staff interacting with young people showed that they had a very good relationship with young people. Several examples of good practice were identified during the course of this inspection. What the service could do better - Staffs' understanding in relation to any training that is carried out, specifically with regards to child protection, needs to be monitored to ensure this is embedded in every day practice. - The Care Plans for young people should not be changed without discussion and agreement from the placing social worker. - Risk assessments for young people should be reviewed to ensure all aspects of safe caring are taken into consideration. - The current IT systems relating to recording are cumbersome. This needs to be reviewed in order that staff are not spending long periods of their time inputting data which is often being duplicated. - The Care Plans for young people need to be reviewed as they were clearly written for professionals and not for young people. The Care Plans are too long and are repetitive. - Any in-house training that is carried out needs to be done so in accordance with best practice and consideration of any ongoing legal issues. - When it is clear that prescribed medication is no longer required a referral needs to be made to the responsible GP for consideration. This should be done in consultation with the parent (if appropriate) or with the placing social workers. - A review of the current staffing arrangements at the Newton of Belivat house needs to be carried out. This is to ensure that at all times the staff on duty are experienced and that there are no gender issues. page 4 of 29

What the service has done since the last inspection - A full external review of the service provision had been carried out. This included various meetings with the placing authorities to gain their views about the way in which the service could be improved on. - A new senior management structure had been put in place and positive work was being carried out to improve the service provision. - Assessments prior to young people being accommodated were now more robust. The assessment process now considered if the service could provide the care being requested and also considered how new placements would affect young people currently in placement. - Care Plans were in the process of being reviewed. Inspection report - Stronger links had been made with education professionals and this had improved the outcomes for young people. - Staff training had been carried out and this included training in Child Sexual Exploitation (CSE). - Menus continued to be reviewed and involve young people when these are being planned. - A working file had been developed and this meant that all information about young people was current. - Staff training with regards to restraint had been carried out and this resulted in no incidents of physical restraint being used since the last inspection. Staff was more aware of alternative methods of de-escalation and this had resulted in a very positive outcome for young people. Conclusion We found at this inspection that the care and support provided to young people who were living at Tom's Croft and Newton of Belivat was, in the main, good. However, we also identified areas that required to be improved on. page 5 of 29

1 About the service we inspected Inspection report This service was registered with the Care Inspectorate on 02 October 2012. To provide a care home service to a maximum of three young people between the ages of 8 and 18 years. The service could also use one other named house to accommodate one young person on a permanent placement and one young person for a maximum of 12 weeks. Should the placement extend beyond the 12 week period then the service must inform the Care Inspectorate. Tom's Croft is a large modern build detached house set in significant grounds. There are no adjoining neighbours and it is in a very rural location. The accommodation consists of five bedrooms, two of the service bedrooms have en suite and there are a further two bathrooms. There is a large lounge, conservatory, large kitchen, dining room and utility room. The design of the property lends itself to the aims and objectives of the service to offer young people a small and family like environment where they can work on their difficulties and issues. Set in the grounds is a very large summer-house extension. It was reported at the time of registration that the service plans in the future to set up a school in these premises as the development of the services that Tom's Croft can offer. 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 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. page 6 of 29

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 3 - Adequate Quality of environment - N/A Quality of staffing - Grade 4 - 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 www.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of our offices. page 7 of 29

2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection This was a protracted inspection which was carried out by us between 1 April 2016 and 25 May 2016. We visited Tom's Croft between 11am and 3pm on 1 April 2016. We visited Tom's Croft between 1pm and 4pm on 4 April 2016. We visited Tom's Croft between 12pm and 5pm on 16 May 2016. We visited the house at Newton of Belivat between 11am and 3pm on 20 May 2016. We visited Tom's Croft 10.30am and 3pm on 25 May 2016 and provided formal feedback to one of the senior management team and the senior therapeutic Support Worker for Tom's Croft. Before the inspection visits we received a completed Annual Return and Self Assessment. We also received three questionnaires that had been returned to us by young people and we received nine completed questionnaires from staff who worked at Tom's Croft and Newton of Belivat. During the inspection we looked at various policies, procedures and other documents and this included: - Certificate of Registration with the Care Inspectorate - Employers Liability Insurance - Staffing Rotas - Accident Logs - Incident Logs - Records of unauthorised absences - Records of sanctions and any restraints - Medication records - Care Plans and files for all young people - Risk assessments - Daily contact records for young people page 8 of 29

- Communications book - Menus - Minutes of young people's meetings - Minutes of staff meetings - Records of supervision of staff - Staff training records - Policies and procedures relating to the protection of children to include Child Sexual Exploitation - Policies and procedures relating to the administration of medication - Policies and procedures relating to risk assessments. During the course of the inspection we spoke with all young people who were accommodated. We spoke with parents of young people. We spoke with staff who worked at both houses and with the manager of the homes and a senior member of the management team. We spoke with placing social workers, education professionals and Who Cares? Scotland Workers. We also carried out a tour of the home and joined young people at meal times. All of the aforementioned informed the content of this inspection report. 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 9 of 29

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 www.firescotland.gov.uk page 10 of 29

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. We received a completed self assessment. The service identified areas of strengths and areas for improvement. Although we were satisfied with the content of the self assessment it could have contained more examples of how outcomes had improved for young people. Taking the views of people using the care service into account During the course of this inspection we spoke with various people. We spoke with the young people accommodated. We spoke with parents. We spoke with placing social workers. We spoke with Who Care Scotland workers. We spoke with educational and other support agencies involved with the young people. Comments noted included the following: Young people told us: - "I am doing well here". - "Feel safe here". - "I like the food and we get a good choice". - "...can speak to the staff and think most of them are OK". - "I am happy here". - "I would much rather be at home but they are nice to me here". - "I am looking forward now where as before I wasn't". - "Staff always treat me nicely". - "Most of the staff are good crack". page 11 of 29

All of the young people who completed our questionnaires, which were sent back to us directly, strongly agreed that they were provided with choice. Staff helped them to go to activities and hobbies. Staff helped young people to stay in touch with people who are important to them. They could get the kind of food they asked for. Other comments were: "I can lock my door if I want"; "I feel protected from bullying;" "I feel protected from abuse"; "this is a nice place to stay"; "staff treat me fairly"; and "staff understand the things that are important to me". Parents told us: - "I am happy with the care... is getting". - "I have no concerns at all about the care... is getting". - "... is doing really well since being there". - "...get told about how... is getting on". - "I think the staff are very good and they are nice to me when I visit". - "... is doing well at school now and this is a big bonus". External Agencies we spoke with told us: - "I am made to feel welcome when I visit". - "I can get a room to meet young people when I visit". - "I am offered tea, coffee or something to eat when I visit". - "I get regular reports about how young people are doing and if there are concerns". - "... is doing really well and has settled into the home very well". - "Staff work very well with us and keep us informed about any changes on a daily basis". - "The school diary is always up to date". - "We work really well as a team and this works really well". - "It has been a very positive experience working with the staff at Tom's Croft". - "Team approach is used". - "Any issues are communicated to us by the staff". - "Along with the psychologist at Common Thread and the staff team we are able to discuss alternative methods of practice and this works". - "Staff attend any meetings about the young people". page 12 of 29

- "Staff work in a consistent way and this helps the young person to maintain boundaries". - "I know there have been changes to the management but staff have not been affected and continue to do a very good job". Taking carers' views into account See views of people using the service. page 13 of 29

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: 3 - Adequate 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 examined this statement after an examination of; the Self Assessment returned to the Care Inspectorate, the previous inspection report, service user questionnaires, placing agencies feedback and any notifications and complaints we received. We found at this inspection that the service was operating to a good standard. We identified the following strengths: - Young people who were living at Tom's Croft had their own individual Care Plan. The Care Plan reflected the individual needs and interest of each young person. - Each young person had a Keyworker and Co Keyworker who overseen their progress as set out in the Care Plan. - Young people were provided with an allowance for pocket-money, clothing, toiletries and activities each week. Young people could decide how to spend this (within reasonable boundaries). page 14 of 29

- Young people were involved when redecoration was carried out in the house or when new furnishings were purchased. - Young people were encouraged by staff to pursue their previous hobbies and interests and take up any new hobbies and interests. For example, horse riding and sailing. - Young people were encouraged and supported by staff to take part in community events. For example, local youth club and cadets. - Young people had the opportunity of devising an Activity Planner which incorporated daily and weekly activities of their own choice. All suggestions of activities, both individual and group, were encouraged to enable young people to reach their full potential. - Young people were fully involved in devising their own menu planners for the week. Young people were actively involved in the panning of meals, shopping and preparation of meals. - Staff encouraged healthy eating within the house. For example, by using local fresh organic produce when possible. - Young people were encouraged to say how they felt about their care. This was done both in the form of house meetings and informal contact with staff. - Young people were aware of how to make a complaint. Young people could access independent advocacy services if they wished for advice and guidance. - Risk assessments were carried out and reviewed on a regular basis to ensure young people could make choices in a way that was safe. There was a policy and procedure in place with regards to risk assessments in which staff were encouraged to 'enable' and 'not restrict'. - Through care was promoted with older young people living at Tom's croft and Ardclach (a property available to accommodate one other young person on a permanent placement and one young person for a maximum of 12 weeks. For page 15 of 29

example, taking part in developing life skills and exploring concerns about moving on. - Outcome Star was utilised to evidence base areas for development and Action Plans were in place so that potential could be realised. - Young people were encouraged and supported to attend school or other education resource. Staff had developed close links with schools and this improved the outcomes for young people. For example, meetings held on a regular basis to discuss individual young people and ways in which outcomes could be improved. - Young people, parents and placing social workers we spoke with told us that they felt young people were provided with choice and were being supported by staff to achieve their full potential. Areas for improvement - The Care Plans for young people were written for professionals rather than young people. While young people had been involved when the Care Plan was drawn up there was little evidence of young people being supported to review the Care Plan and see the progress they had made (see Recommendation 1). - Evidencing focus work for each young person needs to improve. The current Learning and Development sessions that have taken place to formalise the process of capturing the development of young people needs to continue. Staff should continue to contribute to the 'focus work guidance' and this process should be monitored to ensure it continues to meet the individual needs of the young people. - The Care Plan format needs to continue to be monitored to ensure that the needs and interests of young people are being supported in an appropriate way. - Staff need to continue to liaise with education professionals to ensure that any issues are identified at an early stage and can be addressed at an early stage. page 16 of 29

Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 1. The service provider needs to develop systems which enable all young people to review their Care Plan. This should be carried out on a regular basis to ensure young people can see where they have made progress or identify goals which still need to be achieved. This is in accordance with the National Care Standards, Care Homes for Children and Young People: National Care Standard 4: Support Arrangements page 17 of 29

Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We examined this statement after an examination of; the Self Assessment returned to the Care Inspectorate, the previous inspection report, service user questionnaires, placing agencies feedback and any notifications and complaints we received. We found at this inspection that the service needed to make several improvements and as a result we graded this quality statement Adequate. However, we also identified the following strengths: - All young people had outstanding health needs addressed when they were accommodated at the service. - Local health resources were set up as necessary. For example, young people were registered with a local GP or with their previous GP if this was their wish or the wish of their parents. Young people were registered with a dentist and optician (when required). - Good links had been made with health care professionals and young people were supported to attend appointments. - Care Plans detailed any health and wellbeing issues and these were reviewed if there was any changes. - Young people were encouraged and supported to lead a healthy life style. For example, going for walks, going sailing or horse riding. - Young people were encouraged to eat a healthy diet. We found several examples of how this had improved the outcomes for young people during this inspection. page 18 of 29

- Following our advice, the service had benefited from visits made by the Community Dietician. - Medication and First Aid supplies were stored in a safe place. Medication administered was recorded and regular audits carried out. - Staff had carried out training in managing medication and, when appropriate and after a risk assessment was carried out, young people were encouraged to administer their own medication. - Assessment plans for young people and any therapeutic work carried out by staff was overseen by the Therapeutic Practice Manager who in turn reported to the Therapeutic Service Panel who overseen all work carried out within the house. - Risk assessments were in place for young people and these were reviewed on a regular basis when there was changes. - Young people were supported and encouraged to stop smoking. We found one very good example of how this had been effectively carried out by staff during this inspection. - Staff had carried out training in the Protection of Children and Young people and this included training in Child Sexual Exploitation (CSE). In the 2016/17 inspecting year the Care Inspectorate is scoping child sexual exploitation practice in children and young people's services. This is part of our contribution to 'Scotland's National Action Plan to Tackle Child Sexual Exploitation' and focusses on frameworks of CSE practice, staff understanding and care planning outcomes. - A Policy and Procedure in relation to CSE had been developed and staff we spoke with demonstrated a good understanding of their responsibilities to keep young people safe and protected. page 19 of 29

Areas for improvement - The service needs to ensure that when risk assessments are carried out this is done in liaison with young people and the agreement of the placing social workers. Staff need to ensure that the child's plan is followed and that there are no changes to this without consultation and agreement of the placing social worker (see Requirement 1). - The service needs to ensure that when in-house training is delivered this is carried out in accordance with best practice and in keeping with current legislation to ensure the safety and health and wellbeing needs of young people are met at all times (see Requirement 2). - When it is clear that young people no longer require prescribed medication a referral must be made to the responsible GP for an assessment of this. For example, medication records showed that some young people had not been in receipt of certain medication because of improvements to diet. The prescribed medication was no longer necessary. - Staff need to continue to promote the benefits of healthy eating and drinking with all young people. Grade 3 - Adequate Requirements Number of requirements - 2 1. To ensure the safety of young people at all times, all risk assessments need to be carried out in liaison with young people and the agreement of the placing social worker. There should be no changes to the child's plan which may present them with additional risk due to lack of consultation with young people and their placing social worker. This in accordance with: Inspection report Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011: Regulation: 4(1)(a) and the National Care page 20 of 29

Standards: Care Homes for Children and Young People: National Care Standards: 4:1 and 7:1 Timescale: Immediate on receipt of this report. Inspection report 2. The service needs to ensure that when in-house training is carried out that this is delivered in accordance with best practice and in keeping with current legislation to ensure the safety and health and wellbeing needs of young people are met at all times. This is in accordance with: Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011: Regulation 4(1)(a) and the National Care Standards: Care Homes for Children and Young People: National Care Standards: 7:1 and 7:8 and 8:1 Timescale: Immediate on receipt of this report. Number of recommendations - 0 page 21 of 29

Quality Theme 2: Quality of Environment Quality theme not assessed page 22 of 29

Quality Theme 3: Quality of Staffing Grade awarded for this theme: 4 - Good Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We examined this quality statement after we took account of the Annual Return, Self Assessment and notifications made to us by the service. We found that the service was operating to a good level with regards to this quality statement. We identified the following strengths: - Staff training was carried out on a regular basis and this was done both inhouse and at an organisation level. - Staff had carried out training in Child Sexual Exploitation and Child Protection. We spoke with all members of staff to gain their understanding of this training and all demonstrated a good knowledge. Staff was clear about what actions they would take if there was child protection concerns and were also aware of professional boundaries. - Staff were registered with the Scottish Social Services Council (SSSC) and newly appointed staff were required to register with the SSSC within six weeks of appointment and be registered within six months. We carried out a check of the SSSC register to confirm this. - Staff had a good knowledge of the young people they looked after and this improved the outcomes for young people. Staff were also aware of situations, page 23 of 29

triggers which may arise when young people present with challenging behaviour. - Staff training in de escalating challenging behaviour had resulted in no record of physical restraint being used since the last inspection. - Staff encouraged and supported young people to attend school or other education resource. - Staff encouraged and supported young people to take part in activities and to try new activities. - Staff encouraged young people to eat a healthy diet. - Staff encouraged young people to assist when food was prepared. - Staff were clear about professional boundaries and how this could impact on the care of the young people. - Staff were keen to learn and to deliver a good service. Inspection report - Good links had been made with other agencies by the staff team and this improved the outcomes for young people. - Young people we spoke with (all who were accommodated) told us that they thought the staff listened to them and that they cared for them well. - Parents we spoke with told us that the staff were very approachable and they were kept informed about progress or any issues. - External agencies we spoke with told us that they thought the care being provided by staff was good and that young people were making good progress. - Staff we spoke with were motivated and keen to provide the best service they could. page 24 of 29

- The service had undergone a challenging period. However, staff were confident about moving on and confident that the service provision would improve. Areas for improvement We have identified in Quality Theme 1, Statement 3 areas for improvement and these also relate to this quality statement. Please refer to Quality Theme 1, Statement 3 for further detail. Although we noted that staff demonstrated a good understanding of the actions they would take if there was child protection concerns, management need to continue to monitor this to ensure it is embedded in practice. Grade 4 - Good 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 We examined this quality statement after we took account of the Annual Return, Self Assessment and notifications made to us by the service. We found that the service was operating to a good level with regards to this quality statement. We identified the following strengths: Inspection report - The service considered that respect for young people and each other was a fundamental aspect of the ethos of the service. - Mutual respect was promoted at every opportunity. For example, during team development days and when staff were initially recruited. page 25 of 29

- Young people's views were respected by staff. For example, cultural or religious interests. - Staff worked in an open and honest way with young people and were aware of the importance of modelling this to the young people in all their interactions. - During the course of this inspection we found that young people were treated with respect and dignity. All staff were observed to carry this out in practice. - Staff we spoke with were very clear about mutual respect for their colleagues and how this enhanced the unity of the staff team. - Staff were aware of the content of the National Care Standards (NCS) and the content of the SSSC Codes of Practice. Areas for improvement The service provider should continue to observe and monitor the practice of staff to ensure they continue to treat all young people and each other with mutual respect. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 26 of 29

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 27 of 29

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 23 Nov 2015 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 22 Aug 2014 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 20 Aug 2013 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good page 28 of 29

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 enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect 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 29 of 29