Action for Children

(1)

311 Clifton Road

Aberdeen

AB24 4HN

Telephone: 01224 699656

Type of inspection: Unannounced

Inspection completed on: 20 December 2017

Service provided by:

Service provider number:

SP2003002604

Care service number:

CS2014333318

(2)

About the service

Action for Children - Clifton Road provide a care home service for a maximum of seven young people between the ages of 16 and 21. The service is provided from a large detached house, with three self-contained

'bungalows' to the rear of the property. The accommodation has recently been fully renovated with four en suite bedrooms in the large detached house, and four self-contained properties at the rear, intended to allow a greater level of independence for young people who would benefit from this. The house has a large communal living room, dining room, 'chill out' room and kitchen.

The service is close to local shops, parks and public transport links, with Aberdeen City Centre a short bus journey away.

This is the services third inspection this year. At the inspection in May 2017 there were serious concerns, resulting in grades of 2 (Weak) across the quality themes care and support, staffing and management and leadership. A second inspection was carried out over various dates in July and August and September 2017 which noted some improvement, with significant plans for improvements to the staffing situation. This (third)

inspection was carried out in December 2017.

What people told us

During the days of the inspection all of the young people were in. All but one spoke to the inspector. Young people spoke about the things they had been involved in since the inspectors last visit (only a couple of months earlier). They generally spoke of the positive progress they had made and were observed to enjoy the company of staff. None of the young people raised any of the issues they had previously spoken of (regarding too many unfamiliar staff).

Self assessment

No self assessment was requested by the Care Inspectorate for the inspection year 2017/18.

From this inspection we graded this service as:

Quality of care and support 3 - Adequate Quality of environment 4 - Good Quality of staffing 3 - Adequate Quality of management and leadership 3 - Adequate

Quality of care and support

Findings from the inspection

Relationships between staff and young people were good, with staff knowing young people well. Previous difficulties with a changing staff team had been resolved (see 'Quality of Staffing' in this report) resulting in a more consistent approach and greater stability. Young people were becoming clearer about responsibilities and expectations, resulting in a noticeably calmer environment with a significant decrease in notifiable incidents.

(3)

Young people were doing well, with the majority in education or employment, and others engaging in purposeful activity. Plans were also in place to provide a more structured day with a higher level of individual support to the young people who needed this.

All young people had safety plans, however, these did not always accurately reflect the level of risk some of the young people were placing themselves at. Despite significant input from senior members of staff to progress the development of support plans, these were not in place. A decision had been made that there would be greater benefit to the young people to have pathways plans and one of these had been developed, however, none of the rest of the young people had up-to-date support/pathways plans. This was a requirement at the inspection in May 2017, and had improved at the inspection visits from July to September, however, progress had not been sustained (see requirement 1).

Most of the young people did not have up-to-date chronologies which recorded significant events in their lives. The manager had recognised the need for staff training to support this and had planned a development session for the staff team. This will hopefully lead to an understanding of the information which should be recorded and why (see recommendation 1).

Young people were all registered with healthcare services and supported to make and attend appointments. Not all relevant healthcare information (eg, regarding allergies) had been recorded with limited or no healthcare information in some young people's records. In discussion with staff they knew young people's healthcare needs well, so this was more an issue of appropriate record keeping than the welfare of the young people (see

recommendation 1).

Some young people had waited a considerable period of time for important healthcare assessments which would assist staff in providing the best possible care and support. These were now being actively progressed by staff at the service but progressing slowly.

Young people were supported by staff to develop and improve life skills. For each young person this was

individual to their skills and the areas of support they needed. Activities and interests were also encouraged both in the community and in-house.

Requirements

Number of requirements: 1

1. The provider must ensure that all service users have a written plan which details how their support needs will be met. Support plans should be reviewed regularly to ensure the information is accurate and relevant.

This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, No 210: 5(1) - A requirement in relation to personal plans.

Timescale: Within 14 days of receipt of this report. Recommendations

Number of recommendations: 1

1. Documentation which would inform the care and support young people need should be in place, and updated as required. This includes relevant healthcare information, accurate risk assessment and chronologies.

(4)

National Care Standards Care Homes for Children and Young People - Standard 4: Support arrangements

Grade:3 - adequate

Quality of environment

The service is provided from a large detached property with three self-contained properties to the rear of the building. The building is close to local shops and amenities and a short bus journey to the city centre of Aberdeen.

The main building and properties to the rear had been extensively refurbished to a high standard. All of the bedrooms were spacious and had en suite facilities. The 'bungalows' to the rear of the property were self-contained with a bedroom, kitchen, bathroom and living area. The properties to the rear of the building offered young people greater independence with continued access to staff support, but at a reduced level. They provided young people with the opportunity to develop the skills required to manage and maintain their own

accommodation, prior to getting a flat in the wider community.

At the time of the inspection one of the bedrooms was extensively damaged. Despite ongoing repairs the room was in a very poor condition. Senior staff within the organisation had been in discussion about effective ways to improve the room and limit further damage, but nothing longer term than continual repair had been agreed or actioned (see recommendation 1).

Communal areas included a large dining room, living room and kitchen, and a 'chill out' room with TV and gaming equipment. They were all pleasantly decorated to provide a warm, homely environment. Young people were observed to spend time relaxing in the communal areas, chatting to staff and cooking meals.

Environmental checks were in place and consistently carried out. Staff had been delegated individual roles and completed relevant training such as asbestos awareness, legionella and cooksafe.

Requirements

Recommendations

1. The organisation should continue to consider how best to ensure that all young people live in an environment which ensures their safety and wellbeing.

National Care Standard Care Homes for Children and Young People - Standard 5: Your environment Grade:4 - good

(5)

Quality of staffing

There had been considerable improvement in the staffing situation.

The staff team had been a consistent group for some months, with the previous high use of agency staff now resolved. The staff team were all employed, or about to be employed, by Action for Children and as such committed to the service and providing consistent care to the young people who lived there.

Staff teams had been developed which combined the skills and experience of individual staff. Team leaders had been appointed to provide further support to each team. Keyworkers had been identified for all of the young people and because of the more stable team, should provide more consistent support than previously. A staffing board had been introduced to allow the young people to know who would be there throughout the day.

Team meetings had been established, were structured and included practice development. Though there

had been a limited number at the time of inspection, team meetings demonstrated positive topics of discussion and challenge.

Plans were in place for future practice development sessions and for ongoing training.

No new staff had started since the previous inspection, however, comprehensive induction plans were in place for new staff who would start in the coming months. This included service and corporate induction, shadowing experienced staff, and working alongside senior staff. Corporate and service specific induction books were also in place to support the new employee. This will be examined further at the next inspection when the new staff will have used these.

All of the staff were registered with the Scottish Social Services Council (SSSC). All staff had access to training, including online training. Most of the staff had completed the core training expected by the organisation, though there were gaps particularly with proact SCIP (Strategies for Crisis Intervention and Prevention) and safeguarding. A training analysis had identified training required by staff in the forthcoming year, which included 'training for trainers' in proact SCIP and medication administration (see recommendation 1).

Requirements

Recommendations

1. The organisation should ensure that all staff have received core training. This should include the protection of vulnerable people and Strategies for Crisis Intervention and Prevention (proact SCIP).

National Care Standard Care Homes for Children and Young People - Standard 7: Management and Staffing

(6)

Quality of management and leadership

The service had benefitted from the recruitment of an experienced manager.

In a short time the service had progressed significantly, with a more consistent team, and approach, which had benefitted the young people and led to a more stable service.

Staff supervision and team meetings had been established and were being effectively used to develop a shared understanding and consistent approach. The manager had identified knowledge gaps which had been addressed through professional development sessions. Staff stated that they were well supported and felt that the service was progressing very positively.

Clear roles and expectations had been identified for individual team members, including the newly appointed team leaders. These were in the early stages so it was too early to assess their effectiveness, however, the intention was that there would be clear areas of responsibility which would ensure all tasks were completed to a good standard and timeously. Issues with documentation identified elsewhere in this report would indicate these are not yet fully effective.

The organisation had comprehensive systems of auditing, including internal auditing from senior staff within the organisation (but not part of this service). An internal audit had been completed prior to the inspection which had highlighted areas of improvement (there had not yet been time for the manager to produce an action plan).

Regular monitoring reports were provided to the local authority, in addition to a range of key performance indicators returned to the organisation. At the time of the inspection the key quality assurance system (easpire) was not effectively used as staff had not had the training required to understand the information which had to be recorded and submitted. Training for staff had been planned and therefore this should allow the

organisational systems of quality assurance to be fully and effectively used in the near future. This will be examined at the next inspection.

As identified in the text above many of the areas for improvement, particularly in relation to quality assurance, had been identified but were not yet in place, or established. No recommendations have been made as the service have a clear plan. Progress will be examined at the next inspection.

Requirements

Recommendations

(7)

Previous requirements

Requirement 1

The organisation must ensure that at all times, suitably qualified and competent persons are working in the service in such numbers as are appropriate for the health and welfare of service users.

This is in order to comply with SSI 2011/210 15 - A requirement in relation to staffing. Timescale: Immediate

This requirement was made on 22 September 2017. Action taken on previous requirement

This requirement had been met. See report ('Quality of Staffing') Met - within timescales

Previous recommendations

Recommendation 1

Support plans, risk assessments and outcome star action plans should be current, of a consistently high quality and should detail the strategies of support for each young person. They should identify the involvement of young people.

National Care Standard 4 - Support Arrangements This recommendation was made on 6 July 2017. Action taken on previous recommendation

A requirement and recommendation which relates to support planning and documentation has been made within this report.

Recommendation 2

Where window restrictors are fitted to ensure the safety of young people these should be in place and work effectively. Any necessary repairs should be reported and completed promptly.

What the service has done to meet any requirements we made at

or since the last inspection

What the service has done to meet any recommendations we

made at or since the last inspection

(8)

National Care Standard 5 - Your Environment This recommendation was made on 6 July 2017. Action taken on previous recommendation

A recommendation has been made in relation to the environment within this report. Recommendation 3

Systems should be in place to ensure that agreed safety checks are carried out as required and recorded. These include water testing and use of the Cooksafe guidance to ensure food safety standards are met.

National Care Standard 5 - Your Environment This recommendation was made on 6 July 2017. Action taken on previous recommendation

Systems and training were in place to ensure the required safety checks were in place. Recommendation 4

Regular staff meetings and supervision should be held to ensure staff have the opportunity to discuss their work practice and for professional development.

National Care Standard 7 - Management and Staffing This recommendation was made on 6 July 2017. Action taken on previous recommendation

Staff meetings and staff supervision were in place (see Report). Recommendation 5

Effective quality assurance processes should be established which identify and affect positive change. National Care Standard 7 - Management and Leadership

This recommendation was made on 6 July 2017. Action taken on previous recommendation

Quality assurance systems were being developed/established (see Report).

Complaints

There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com.

(9)

Enforcement

No enforcement action has been taken against this care service since the last inspection.

Inspection and grading history

Date Type Gradings

22 Sep 2017 Unannounced Care and support Not assessed Environment Not assessed Staffing Not assessed Management and leadership Not assessed

23 May 2017 Unannounced Care and support 2 - Weak Environment 4 - Good Staffing 2 - Weak Management and leadership 2 - Weak

26 Jul 2016 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and leadership 4 - Good

16 Jan 2016 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 4 - Good Management and leadership 3 - Adequate

(10)

To find out more

This inspection report is published by the Care Inspectorate. You can download this report and others from our website.

Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can 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. You can also read more about our work online at www.careinspectorate.com

Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect

Other languages and formats

This report is available in other languages and formats on request.