Arach House Care Home Service

Moor Cottage Blairninich Fodderty Strathpeffer IV14 9AD

Telephone: 01349 781822

Type of inspection: Remote scrutiny (announced (short notice))

Completed on: 1 October 2020

Service provided by: Service provider number: Highland Council SP2003001693

Service no: CS2018368787 Remote scrutiny report

About the service

Arach House is a care home service for children and young people. The service operates from a large rural property close to Dingwall in Highland Region. The provider of the service is Highland Council and the service is registered to provide care for a maximum of six young people across two separate areas. The "Crisis Unit" can provide care for no more than two children or young people at any one time with each stay not exceeding 30 consecutive days. The Emergency Unit can provide care for no more than four children or young people at any one time, each stay should be no more than 90 consecutive days.

The service registered with the Care Inspectorate in May 2019 and has not yet been inspected. The provider states the overall aim of the service is:

- Arach will provide immediate responses to engage with families and young people as appropriate in resolving crisis situations and planning for the future.

- The service has the capacity to offer residential accommodation in a temporary and short-term basis to respond to the child and young people who find themselves in crisis situation.

- Arach will not be a permanent residence for young people and a return home would be the aim for the majority. This will be achieved by a staff team, who work both in Arach as residential staff and will also work with young people and their families in their homes as outreach staff, to sustain children and young people where at all possible at home.

- Arach's provision is enhanced by the inclusion of additional services, this includes: a CAHMS Clinical Psychologist, a Forensic Psychologist, a Clinical Nurse Specialist for LAAC, Education of LAAC Development Officer, a Fostering and Adoption Social Worker, a Fostering Intensive Carer, Out of Hours Service, links to Educational Psychology, Speech & Language Therapy, Police Scotland and Action for Children's ISS service.

- These additional services will bring a well-resourced response to families in crisis with a focus on repairing relationships, an opportunity to improve the quality of decision making with regards to follow-on placements and future plans being provided with commitments from all agencies.

- Arach has an intensive foster carer, who will offer placement for young that have come through Arach service. Our intensive foster carer will also be supported by members of the care team. It is hoped that in the future we will be able to recruit many intensive foster carers.

Further to this the provider states the Aims and Objectives of the service include:

- Our primary and overall aim is to keep our young people safe from harm, to help them achieve their potential, and to provide high quality residential/outreach care for all the young people that are referred to our service.

- The service at Arach is intended to form part of an integrated range of services that will provide positive choices and opportunities to young people and their families.

- To provide a safe and stimulating environment that will encourage individual care, personal growth and future welfare by promoting positive life experiences for all young people, with due regard to age, gender, race, religion, ethnic origin, disability and sexual orientation.

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- To ensure that the rights of young people will be acknowledged and respected, educating them on their responsibilities and the expectation that the young people will also respect the adults who are working with them.

- To ensure the continuous well-being and development of young people by a trained and committed team, working in partnership with them, their families and all other services that have a significant oler in their lives.

- To ensure that the needs of young people will continue to be reviewed and evaluated regularly, that care plans will be clear, relevant and informed by the views of the young people and their families, and that assessments and plans will be maintained, reviewed and updated in line with local and national procedures.

- To create, develop, and maintain positive interaction between young people and the communities from which they originate, reside, and with whom they engage.

- To actively promote the good health, appropriate education, and positive social development with and on behalf of the young people.

- To provide a consistent team approach to the day-to-day care of young people that is firmly based on agreed professional values, ethics, and principles.

The service has a manager, assistant manager, a team of residential/outreach care staff and access to multi-disciplinary professionals from a range of services.

Following a note of concern we carried out remote scrutiny of the service over a period of approximately nine weeks from the end of July 2020, using the Care Inspectorate's Quality Framework for Care Homes for Children and Young People. Two young people were living at Arach House during this time.

Due to the COVID-19 pandemic we did not carry out a site visit as part of this scrutiny. We have not graded the service using our six-point scale.

What people told us

In order to reduce the risk of infection during the pandemic, we did not visit the service to speak with young people.

Young people did not wish to speak to us over the phone however we received one completed questionnaire from a young person and received the views of another young person and their family. Comments and views are contained in the text of this report.

How well do we support children and young people's wellbeing?

The limited feedback we received from young people was generally positive regarding their interactions with staff.

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Staff told us they worked hard to develop meaningful and secure relationships with young people. One young person told us they felt safe in Arach House and that they knew staff were on hand to help and support them. One young person told us the staff were "alright" and they enjoyed having their own privacy however at times they felt staff were always watching them. We were unable to observe staff interactions with young people however feedback from social workers and other external professionals reflected a staff group who did an excellent job supporting young people, sometimes in very difficult circumstances. They told us staff were committed and reflective carers who were open to adapting their practice to support young people and were sensitive and supportive to young people who have, at times, experienced high levels of distress. Staff told us for the majority of time they were able to engage positively with young people and we heard and read about good individualised interventions using, for example, touch, humour and empathy in order to prevent situations escalating.

Due to the aims of the service, admissions were not always on a planned basis. This meant that at times staff were in a position of offering support to children and young people that were unknown to them. This made it difficult to help support regulating their emotions and finding ways of coping with frustration and anxiety, although in most cases this was done well. There were times the service had struggled to meet more complex areas of need with consistency and confidence. This was reflected in incident eportsr and reflective accounts from staff where the level of emotional distress, physical aggression and increased risk presented great challenges to the service.

Staff and other professionals confirmed there were occasions that young people were admitted to the service with very little information available. It is acknowledged this is a drawback of operating an emergency service and generally speaking additional staff are deployed to ensure all young people's needs were met. In principle however, the system should normally ensure that all known needs and risks are taken into account in deciding whether the service is suitable for young people. This should include the impact an admission could make on the existing group of children and young people. (See area for improvement 1)

Some staff told us there was not always a consistent approach to who would be on duty at any one time. It was thought this was down to staff being used to support young people in the community.

It was noted that both staff and young people had worked well together during the pandemic and in particular during the lockdown period when frustrations could have escalated due to being confined to the house. During this time young people were not attending school however there was good evidence that staff worked well with young people to ensure a learning environment that supported healthy options and exercise. The service worked hard during this time to ensure young people were able to maintain family contact within Government guidelines.

Due to the short term nature of Arach House young people were encouraged to attend their named school. We found that despite the best efforts of staff and very good links with educational staff, young people often did not attend school for significant periods of time orf a variety of reasons. The service should continue to exhaust all avenues to ensure children and young people's learning is encouraged and supported throughout their stay in the service. (See area for improvement 2)

We saw that there were very strong links to external agencies. Social workers and other relevant professionals told us that young people were encouraged to take part in their own personal planning. One young person expressed a wish to have more in-put in to this process and felt they were being excluded from some aspects of their plan. The management agreed to support this young person in directing aspects of their assessment and further involvement in their plan.

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The service had a wide range of risk assessments for specific areas of concern about young people's safety and welfare. They demonstrated an understanding of young people's individual coping strategies and challenges. which supported positive outcomes for young people.

Areas for improvement

1. The provider should ensure that key background information about young people is always obtained so that it can inform the assessment and planning process both prior to and following their arrival. This is in order to ensure that care and support is consistent with the Health and Social Care Standards, which state that 'My care and support meets my needs and is right for me' (HSCS 1.19).

2. The provider should review approaches to supporting young people to take part in and get the most out of educational and learning opportunities. This is in order to ensure that care and support is consistent with the Health and Social Care Standards, which state that 'I am supported to achieve my potential in education and employment if this is right for me' (HSCS 1.27).

How good is our leadership? We found the management team at Arach House to be focused and committed to supporting a dynamic and skilled team of carers and the children and young people in their care.

We discussed the Aims and Objectives of the service with the management team, staff and other professionals. The service had been operating for just over a year and feedback suggested the service needed to review it's statement of aims and objectives and take in to account how the service had been operating since first egisterr ed. Feedback to the Care Inspectorate reflected some confusion and frustration at how the service operated rather than how it should operate. This led to particular frustrations from staff not being able to support young people to move on to a more appropriate longer term placement or back home. These frustrations were mirrored by the management team and the external manager also. It was difficult to ascertain whether the problem had been amplified by the global pandemic and therefore out with the hands of the service or if some more thought was required about how the service should operate.

The delays in young people moving on from Arach House within the timescales of the conditions of registration did not support good outcomes for young people, creating uncertainty about when or if they would move on. This was reiterated by staff and other professionals.

We reviewed incident reports and found that there were some serious incidents that should have been submitted to the Care Inspectorate. Some incident records were incomplete and did not contain relevant signatures and did not appear to have been reviewed. In some instances there was no relevant cross reference to young people's personal plans or risk assessments. This could lead to inconsistencies in care and does not support good outcomes for children and young people. (See area for improvement 1)

Young people and staff told us they were unclear of their role in quality assurance and and the evaluation of the service. Young people told us they had been asked things about their environment and the food they liked but they weren't clear about this process. Some staff told us they were unaware of their role within the quality assurance process. Some told us they thought their views would and had been taken seriously but were not clear if they had effected change. (See area for improvement 2).

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The management team worked well with other agencies and organisations to ensure effective partnership working. They worked confidently with others to enable children and young people to benefit from effective multi-agency support. This was seen as a real strength of the service which was reinforced by comments from professionals from out with the service.

Some staff and external professionals commented that they often had to wait a significant time to get a response from a member of the management team, especially if this involved a written response. Young people also held this view. We noted that the management team have responsibility for attending a high number of meetings both internal and external when planning future referrals as well as management of another service. We would encourage the management team to review their workload in order to focus on the future development of the service, particularly as it comes out of the COVID19 period.

Areas for improvement

1. The provider should ensure that there is a systematic process for analysis of incidents over time so that any learning can be identified. This is in order to ensure that care and support is consistent with the Health and Social Care Standards, which state that 'I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes' (HSCS 4.19) and 'My care and support meets my needs and is right for me' (HSCS 1.19).

2. The provider should ensure that there is a systematic process of evaluation in place. This process should include all staff, children and young people, parents, carers, external professionals and others involved in the service. This is in order to ensure that care and support is consistent with the Health and Social Care Standards, which state that 'I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes' (HSCS 4.19) and 'My care and support meets my needs and is right for me' (HSCS 1.19).

How good is our staff team? We found staff to be well qualified, trained and eager to use their skills and knowledge to improve outcomes for young people in their care. Most staff spoke of a strong team ethos and were confident they would be supported by their colleagues if required. They enjoyed working with young people but often felt similar frustrations to others in what they saw as slow progress with young people moving on.

Staff told us at times they did not feel empowered and, especially at weekends, felt isolated. The management team told us they were always on hand if required and regularly received out of hours calls from the service. It would be helpful if a system was in place to support this, that all staff were aware of and could refer to if necessary.

We reviewed staff training and it was clear most staff had completed core training when the service commenced operating in May 2019. Since March 2020 there had been no training on offer, other than online due to lockdown. When opportunities arise the service should ensure all staff get opportunities to take part in essential training such as first aid, child protection, food hygiene, de-escalation and restraint and medication.

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Feedback we received from staff about child protection and the procedures that were in place were mixed and not consistent with the child protection policy. The policy was for the Highland Council employees. The service would benefit from developing a stand alone child protection policy for Arach House that, whilst making reference to the local authority policy, was more relevant to the service. This should contain clear guidance to the procedures staff should undertake in the event of a child protection concern.

The service had found it difficult to maintain regular team meetings during the lockdown period. Staff commented on this and some told us they found changes to personal plans were missed or it often took time for planning issues to filter through due to poor communication. Often at team meetings the agenda was very long and time was not used effectively. Staff told us they usually received 1:1 on a regular basis (approximately every 6 weeks) however some found this not to be an effective use of time and it did not address their needs. We discussed this with the management team and looked at ways team meetings and 1:1 could be more dynamic and provide a more positive learning experience for everyone. The management team took this onboard and will review aspects of both processes.

How good is our setting? The Care Inspectorate had not visited the service since it was registered in May 2019. Staff and young people found most areas of the service to be homely, nurturing and comfortable. Other areas, for example the stairway and entrance area, had been identified as areas that required further decoration. The service were working on this and told us they had involved young people in the process.

Staff told us that repairs to the interior of the building often took time to complete. The management team told us this was due to difficulties with workmen gaining access to the service and in particular young people's rooms during the period of lockdown. Young people had access to a kitchen but were only able to access the laundry with a member of staff. The service should explore options to enable children and young people to develop the skills they need by allowing independent access to laundry areas.

How well is our care and support planned? We reviewed young peoples personal plans, risk assessments and other relevant documentation. Personal plans were reviewed regularly and young people were included in this process. This was confirmed by staff, the management team and other professionals, such as social workers (see previous comments regarding young people's view of their input).

In discussion with external professionals and staff it was clear that staff operated in a person centred way with health and social care professionals working collaboratively. The process supported young people to develop the knowledge, skills and confidence they need to effectively manage and make informed decisions about their own health and welfare.

We read that staff were trained in trauma informed care however found it interesting that no staff referred to this approach when we discussed planning and care for young people. It was clear from documentation and from discussions with staff and external professionals that staff worked well within the framework, building supportive relationships, collaborating and empowering young people.

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We found that personal plans were underpinned by an assessment of need and risk for each young person. There were links to "Getting It Right For Every Child" and the wellbeing indicators (SHANARRI) however they were not "SMART" - Specific, Measurable, Attainable/Achievable, Relevant/Realistic and Timely. For this to be achieved plans need to be straightforward with well defined, achievable goals with clear information about progress and future targets identified. Young people's development and achievements should be identified, evaluated and amended in accordance with their changing needs, circumstances and desired outcomes. The lay-out of personal plans should contain easy, at a glance information about young people's current needs with any risks identified and contingencies in place. (See area for improvement 1)

Areas for improvement

Complaints

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

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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

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

Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas.

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