Cairnryan House Care Home Service Children and Young People Cairnryan House Cairnryan DG9 8QX Telephone: 01776 707231
Inspected by: Chris Barratt Type of inspection: Unannounced Inspection completed on: 13 December 2012 Inspection report continued
Contents
Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 9 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20
Service provided by: Dumfries & Galloway Council
Service provider number: SP2003003501
Care service number: CS2003010873
Contact details for the inspector who inspected this service: Chris Barratt Telephone Email [email protected]
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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 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 4 Good
What the service does well There is a well-established and experienced staff group who are committed to their continuing training and development. The service has a very effective key-worker system and staff are attentive to internal recording and communications systems. The service had a relaxed and friendly atmosphere where young people interacted well with each other and with staff.
What the service could do better We have made a number of recommendations for further improvements. These include the need for risk assessments and care plans to be more specific and measurable and the need for a policy and procedure on safe Internet access. The service also needs to complete its service-specific policies and procedures manual and develop more formal approaches to service evaluation.
What the service has done since the last inspection The move to new premises has achieved a marked improvement in the environment provided for young people and this had contributed to a more relaxed and settled group with a significant reduction in reported incidents.
Cairnryan House, page 3 of 22 Inspection report continued Conclusion We have seen an overall improvement in the service provided with most of the Quality Statements that we examined now achieving a very good standard. More formal approaches to evaluation combined with relevant and up-to-date policies and procedures will help the service provider to maintain this high standard.
Who did this inspection Chris Barratt
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1 About the service we inspected
Before 1 April 2011 this service was registered with the Care Commission. On 1 April 2011, the new scrutiny body, Social Care and Social Work Improvement Scotland (Care Inspectorate) took over responsibility for the regulation of care services in Scotland. This means that from 1 April 2011 this service continued its registration with the new body, the Care Inspectorate, although it moved to new premises in Cairnryan on 18th July, 2012.
Cairnryan House is a local authority residential care home service and is registered to provide care for a maximum of 4 young people aged between 12 and 18 years.
According to its Statement of Purpose, Cairnryan House provides a region-wide service for young people in need of accommodation in a local residential placement. Although the property is not the purpose-built centre the Council had hoped to provide for the area, it satisfies the National Care Standards for a care service of this type. The accommodation comprises, on the ground floor, a lounge area, a staff office with en-suite, lounge/dining area, kitchen, toilet, laundry room, boiler room and storage. The upper floor has four single occupancy bedrooms with shower en- suite and access to the fire escape. On a landing off the main staircase there is a fully fitted bathroom and the staff office.
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 - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 4 - Good
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 0845 600 9527 or visiting one of our offices.
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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 This was our first inspection visit since the service moved from Stranraer to its new accommodation at Cairnryan. Our main focus during this inspection was to look at progress with the recommendations of our previous inspection and to find out how the move to Cairnryan had gone.
Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements.
Details of what we found are in Section 3: The inspection
Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement.
Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org
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What the service has done to meet any requirements we made at our last inspection
The requirement The service provider should continue to develop and finalise an 'Admission Policy' which must ensure that no young person is admitted to the service unless managers, or in their absence, senior staff, agree the admission is consistent with the service's aims and objectives and that the service is capable of making proper provision for the health, welfare and safety of the young person and other service users. This is in order to comply with SSI 2011/210, Regulation 4 (1) [a], a requirement to ensure that proper provision is made for the health, welfare and safety of people using the service. Timescale for implementation, within one month of the date of this report.
What the service did to meet the requirement See Quality Statement 1.3
The requirement is: Met
What the service has done to meet any recommendations we made at our last inspection Good progress has been made with the recommendations we made following our last inspection. Most have now been implemented but some further progress is needed and this is addressed under relevant Quality Statements.
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 self assessment demonstrates a commitment to using the process to improve the service. More consideration could be given to ways of including young people's
Cairnryan House, page 7 of 22 Inspection report continued perspectives in the self-assessment and also to providing an update on progress on the Requirements and Recommendations of previous inspections.
Taking the views of people using the care service into account Young people that we spoke to were very positive about their experience of the service. Responses to our pre-inspection questionnaires were mostly positive.
Taking carers' views into account We didn't meet or contact any family members of service users during this inspection process. One social worker responded to our case tracking questionnaires and was very positive about the service and especially the improvements since the move to Cairnryan.
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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 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths Based on our findings during this inspection a very good standard had now been achieved for this Quality Statement.
Young people and staff had looked together at the 'house rules' and agreed that it was time to scrap some of these since the move. We were told that this had led to much more emphasis on negotiated agreements and solutions and it was felt that this had mostly been successful.
A pattern of regular "residents' meetings" had been maintained and these had provided a forum where issues could be discussed openly with each other.
Young people have the support of an independent advocacy service and we were told they had provided regular opportunities for young people to raise matters with them.
Communication that we observed between young people and staff was open, relaxed, and respectful.
We made a recommendation following our last inspection that quality assurance questionnaires about the service should be managed externally. The service's Action Plan confirmed this would happen but this has not been fully implemented. However, we discussed the feedback process with the manager and were satisfied that a reliable process is now in place. We also confirmed that any complaints about the service are dealt with by the Young People's Residential Services Manager. We are therefore satisfied that sufficient steps have been taken to address the concerns we raised at our last inspection.
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Areas for improvement Minutes of meetings with young people suggest that, whilst there is more opportunity for young people to negotiate things with staff, there are some inconsistencies depending which staff are on duty. However, we also saw evidence that staff are discussing these openly with one another in order to arrive at a more consistent approach which takes account of young people's frustrations about different staff practice.
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Based on our findings during this inspection a very good standard had now been achieved for this Quality Statement.
Following our last inspection we made a Requirement concerning the need for an Admissions Policy. We were assured by the manager that this has been drafted by the service provider's Policies and Procedures Group but needs further amendment following the move to Cairnryan, see Areas for Improvement below. However, we confirmed through discussion with the manager and staff that the new policy was already being implemented and that this had been beneficial orf young people. There hadn't been any occasions when the service had either been required by senior officials to go over its registered numbers or to accept "inappropriate" referrals. We were told that there were now clearly understood protocols (not seen by us) concerning emergency admissions and the manager confirmed these would only be accepted if there is a suitable vacancy. On the one occasion when a young person had been admitted in an emergency, a review had been held within 24 hours to ensure suitable plans were put in place.
Cairnryan House has a very well developed key-worker system which comprises a designated "Key Team" for each young person; key-team members were very familiar with current needs and agreed strategies to meet these. Young people confirmed they appreciate this approach and that key-team members provide a very good level of support when preparing for or attending Children's Hearings and Reviews. Two staff had trained in an approach known as "Teen Star". This provided a very helpful set of "tools" for supporting and measuring change when working with young people and, as reported in our last inspection, was now being implemented by key-worker teams.
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Excellent attention was given to record keeping using the social services department's "Framework-i" software which helped to ensure very Good communication with young people's social workers. Social workers confirmed they had very good communication with staff at Cairnryan House.
Very good attention is given to identifying young people's health needs and ensuring these are properly supported. The service has excellent links with the specialist nurse for looked after children and health education specialists.
We recommended following our last inspection that the service should continue to develop its care planning paperwork in order to compile a single and more cohesive personal plan for each young person. The new paperwork which had been introduced before that recommendation had now been in place for almost a year and the manager and staff described this as a "better system". Overall this provides a very good account of areas of work being undertaken with young people by staff at Cairnryan House and the desired outcomes. But see also Areas for Improvement.
Risk assessment documentation now includes some more positive information, for example, information about young people's strengths which may be relevant to consideration of risks. This helps to provide a more balanced view of actual risk levels. See also Areas for Improvement. Areas for improvement As noted above, the new Admissions Policy needs further review and amendment following the move to Cairnryan, for example, the new premises do not have an "emergency room". A copy of the revised Admissions Policy, including the protocol for emergency admissions, should be provided to the Care Inspectorate. See Recommendation.
Following our last inspection we recommended that individual risk assessments should be further developed to ensure that they include any specific measures thought likely to reduce risk levels to a safer and more manageable level. In respect of both risk assessments and care planning, there is still scope for staff to describe in more detail, actual tasks or approaches to be undertaken by staff and/or young people in order to achieve the desired outcomes. This will also help to make such work more "measurable" which, we note, is an improvement proposed in the service's self-assessment. We note that some of this work is addressed by other means, especially Teen Star (see Strengths above). Where this is the case, we suggest that care plans and risk assessments should be cross-referenced to relevant sections of each young person's Teen Star "programme". Consideration should be given to including the young person's "action plan" in the service's "quick reference folder" in order to ensure this information is readily accessible to staff. See Recommendation.
Cairnryan House, page 11 of 22 Inspection report continued Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2
Recommendations 1. A copy of the service's revised Admissions Policy, including the protocol for emergency admissions, should be provided to the Care Inspectorate. National Care Standards, care homes for children and young people, Standard 2.6/7: First Meetings 2. Managers and staff should continue to develop Individual risk assessments and care plans to ensure they describe specific tasks and approaches to be undertaken by staff and/or young people in order to achieve the desired outcomes. National Care Standards, care homes for children and young people, Standard 4:1: Support arrangements
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Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good
Statement 1
We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths We haven't specifically looked at the Quality Statement during this inspection but, based on our findings in relation to Quality Statement 1.1, we accept that a very good standard has been achieved. Areas for improvement See Quality Statement 1.1
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Based on our findings during this inspection a very good standard had now been achieved for this Quality Statement.
Following our last inspection we made a recommendation concerning the need to apply for a variation in the service's Conditions of Registration following a fall in the number of rooms available. However, this had been superceded by another application due to the planned move to 4-bedded Cairnryan House.
Everyone that we spoke to was very pleased with the new house which is much more "homely" and comfortable than the previous house. A social worker described it as much more "like a family home with a warm atmosphere". This marked a significant improvement and had resulted in a calmer and more relaxed social atmosphere than we'd experienced in previous inspections.
Cairnryan House, page 13 of 22 Inspection report continued There had been a marked fall in the number of incidents arising from young people's disaffected behaviour and current risk assessments reflected this. Social workers told us about the positive progress made by young people since the move and confirmed they'd been fully involved in individual risk assessments.
The location of the staff base contributes to improved staff awareness of young people's whereabouts and helps to promote a more relaxed approach to monitoring their interaction and behaviour.
Young people had participated in discussion of health and safety issues and their views and experiences had been taken seriously by staff, e.g. in relation to safe internet access and hot-water temperatures. Areas for improvement As with other similar services, staff felt challenges about issues of internet safety for young people. Although internet access was protected by appropriate "fire-walls" staff had sometimes been concerned about how to allow young people safe access to social networking sites. Staff were unaware of any current issues concerning this but were very aware of potential risks and had discussed these openly with young people. Wherever possible, these should be addressed on a case-by-case basis using individual risk assessments and written agreements. The service has access to Dumfries and Galloway's "Acceptable Use Policy" for "Public Access ICT Facilities" (e.g. Public Libraries) which includes some helpful guidance but doesn't have it's own internet policy or written guidance for young people concerning internet safety and no specific staff training on this. Such a policy would need to consider additional safeguarding issues specific to the needs of service users. See Recommendation
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1
Recommendations 1. The service should develop a policy/procedure on safe internet access for young people using the service together with appropriate written guidance for young people. Consideration should be given to delegating a suitably trained staff member as "champion" for safe internet access. National Care Standards, Care homes for children and young people. Standard 6.15: Feeling safe and secure
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Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good
Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths We haven't specifically looked at the Quality Statement during this inspection but, based on our findings in elatior n to Quality Statement 1.1, we accept that a very good standard has been achieved. Areas for improvement See Quality Statement 1.1
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Based on our findings during this inspection a very good standard had been maintained in relation to this Quality Statement.
There is a very well-settled group of experienced staff at Cairnryan House and those that we met spoke very positively about the service since its move to Cairnryan. All staff were registered with the Scottish Social Services Council (SSSC) and the service manager had recently completed her social work degree. Permanent staff had all completed HNC in childcare and were at various stages of progress with SVQ level 3. Newer staff had registered to undertake their SVQs. The service had successfully negotiated support form the Centre for Excellence for Looked after Children in Scotland (CELCIS) to provide HNC training for new staff following the withdrawal of previous training arrangements for this part of south west Scotland.
Cairnryan House, page 15 of 22 Inspection report continued The progress now made with qualifying training is a notable achievement given the distance from Stranraer to the main centes for training.
Very good attention had been given to the induction of new staff.
All staff received regular 1:1 supervision from a senior staff member and staff confirmed to us that they elf t well-supported. The Young People's Residential Services Manager was also described as a big support to the service. As noted elsewhere in our report, following two staff undertaking Teen Star training they were cascading this training to other staff.
The service's cook and home-maker had undertaken child care training (HNC) and there were plans for them to undertake SVQ too. This is highly commended and has helped to provide a service where staff roles are very well integrated with an excellent child-centred focus.
Following our last inspection we made a recommendation concerning child protection training and the need for this to address the specific oler of residential child-care staff. The manager confirmed that all staff had now completed 2-day "Tier 2" inter- agency training on "Working Together to Protect Children & Young People". All staff were said to have their own copy of the handbook. We are satisfied that this training satisfies the concerns that we had previously raised. Areas for improvement Please see our comments on internet safety training under Quality Statement 2.2.
As the majority of staff complete their basic professioanl qualifications this will enable future staff development to focus on developing specialist knowledge and skills.
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
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Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good
Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths We haven't specifically looked at the Quality Statement during this inspection but, based on our findings in elatior n to Quality Statement 1.1, we accept that a very good standard has been achieved. Areas for improvement See Quality Statement 1.1
Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0
Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths Based on our findings during this inspection the service has maintained a good standard in relation to this Quality Statement.
We made two recommendations under this statement following our last inspection. One concerned the need for care plans to be included in audits by the service's line- manager and also for more attention to be given to young people's comments. Although, on this occasion, we didn't look at the audit tool used by the line manager, we were assured that he visits the house weekly, is well-known to young people there and "very hands-on". He also plays an active part in "incident panels" which review all incident reports from the service. It is a very good indicator of how settled the service has been that planned incident panel meetings have sometimes been cancelled due to the lack of incidents.
Cairnryan House, page 17 of 22 Inspection report continued The service had recently introduced service evaluation forms for social workers and also "exit interviews" for young people however, up until now, feedback, although described by the manager as generally very positive, had been mostly informal and not recorded. Such feedback included social workers, the local Pupil Support Officer and Reviewing Officer Areas for improvement As noted elsewhere in this report, the service manager had recently completed her social work degree. Training for this had removed her for long periods from the day to day management of the service. Now that she has achieved this qualification she hopes to concentrate much more on developing the service.
Our other recommendation following our last inspection concerned the need for a comprehensive Policies and Procedures manual for the service. Work on this was ongoing and there was a growing set of policies and procedures suitable to the service. Work on this should continue. See Recommendation.
We were told that the Social Services Department has it's own service evaluation system but that no feedback had been received concerning this.
Consideration needs to be given to developing a more formal approach to service evaluation including the involvement of service users, their families, staff and other stakeholders. See Recommendation.
Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 2
Recommendations 1. Work on developing and maintaining an up to date set of policies and procedures relevant to a service of this type should be maintained and kept under review. National Care Standards, care homes for children and young people. Standard 7.1: Management and staffing 2. There should be a more formal approach to regular service evaluation including all stake-holders and leading to a service development plan. National Care Standards, care homes for children and young people. Standard 7.6/9: Management and staffing
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4 Other information
Complaints No complaints have been upheld, or partially upheld, since the last inspection.
Enforcements We have taken no enforcement action against this care service since the last inspection.
Additional Information
Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1).
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5 Summary of grades
Quality of Care and Support - 5 - Very Good
Statement 1 5 - Very Good
Statement 3 5 - Very Good
Quality of Environment - 5 - Very Good
Statement 1 5 - Very Good
Statement 2 5 - Very Good
Quality of Staffing - 5 - eryV Good
Statement 1 5 - Very Good
Statement 3 5 - Very Good
Quality of Management and Leadership - 4 - Good
Statement 1 5 - Very Good
Statement 4 4 - Good
6 Inspection and grading history
Date Type Gradings
21 Nov 2011 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good
29 Jun 2011 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good
19 Nov 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed
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11 May 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed
18 Dec 2009 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate
7 May 2009 Announced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good
15 Dec 2008 Care and support 4 - Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed
16 Jun 2008 Care and support 4 - Good Environment 3 - Adequate Staffing 4 - Good Management and Leadership 4 - Good
All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission.
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To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527.
This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: www.careinspectorate.com or by telephoning 0845 600 9527.
Translations and alternative formats This inspection report is available in other languages and formats on request.
Telephone: 0845 600 9527 Email: [email protected] Web: www.careinspectorate.com
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