Edinburgh Outreach Support Service

Telephone: 0131 5263910

Type of inspection: Unannounced Inspection completed on: 13 October 2016

Service provided by: Service provider number: Autism Initiatives (UK) SP2004006462

Care service number: CS2008175789 Inspection report

About the service

The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at www.careinspectorate.com.

Edinburgh Outreach, formerly known as Lothian Occupational Services provides a support service to adults with autism in Edinburgh and the Lothians. The majority of service users are young adults in the process of transition from school and children's service to adult services.

Service users are now provided with individual packages of support in and from two resource centres, one based at a centre in Craigmillar (already in operation on a long term basis) and the other at premises at Gorgie Road which has been in operation since October 2015.

There have been a number of changes since the previous inspection. The Hermitage Project was closed at short notice this year. We heard this was due to financial sustainability. We heard that alternative support packages were being planned for service users affected. Service users who previously attended the centre at Inverleith now received support at the premises at Gorgie Road.

Support is provided on a 1:1, 2:1 or group basis to support service users to develop skills and confidence, to get involved in a range of activities and to access a variety of community facilities.

Autism Initiatives has a vision statement as follows:

Our expectation is that people with autism can learn and develop and we support this process every single day. We will create unique services for people to enable them to have ownership of their own lives and future.

What people told us

As not all service users would be comfortable communicating with the inspector, we mainly observed the support that people were getting across both centres.

We met with a service user who was involved in producing the newsletter. This was supporting them to use their research and communication skills. We heard that this service user really appreciated the service provided and felt involved in the delivery of the service. They told us how the service had encouraged them to find voluntary work experience with a view to developing their confidence and increase their skills to enter paid employment.

We met a group of service users at Gorgie Road while they were being supported and observed how staff supported them. We later joined the social group on an outing to a local pool hall. We heard of the range of ways in which service users were supported to reach their potential:

- A service user told us that they liked going on trams and that they had been supported with this. We observed staff supporting service users in an individualised way. - A service user liked to watch the activity over a drink and snack rather than join in and appeared relaxed and settled doing this. They told us they liked going for a drink and for something to eat with staff. - Another service user was given time and individual space to familiarise themselves with the environment. They then joined in a game of pool. We

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observed how his support worker was attentive to the signs when he wanted to finish playing and leave the group. - A service user was supported to travel to the pool outing later on at a pace suited to them. This helped them to participate in the group once they felt less anxious and had time to spend with a member of staff. - A service user shared their written work that they produced on the computer the inspector. We saw that they were being well supported by staff in this chosen interest and this was supporting them to use and develop their creative talents.

At Craigmillar Activity Centre we were introduced to service users. We heard from a service user how they liked going there and enjoyed playing football and darts and going out. A group of service users were involved in singing happy birthday to a service user and presenting them with a card and cake.

We saw that staff were attentive to the needs of people in attendance and that support was individualised and provided in a caring, respectful and sensitive way.

We received feedback from relatives of service users through phone contact and looking at comments made in the returned care standard questionnaires. We issued thirty-two care standard questionnaires. Feedback in the thirteen returned care standards questionnaires indicated that the majority of respondents were overall happy with the quality of care and support. However, two relatives told us that they very unhappy with the service.

Comments included:

'My relative appears to be very happy when they leave in the mornings to go the service. The staff who support them report back to us as to how their day's happenings. The staff all seem to be very fond of my relative and my relative has a strong sense of humour and enjoys their activities programme. There seems to have been quite a turnover of staff which is not helpful as my relative does not like change. The staff who support my relative are all excellent but most seem to be young graduates who leave for more permanent work in their chosen professions.'

'An excellent service provider. The only one that has met my relative's needs. The staff bend over backwards to offer help and support. They certainly go that extra mile. Wish we had known about Autism Initiatives years ago. Thank you.'

'With recent changes to services, closure of some, management have been unhelpful, and have not included service users in decisions. Carers are now limited and (although parents are never informed) there always appears to be a drive to employ more. Hours are cut because there are no carers yet parents are expected to ensure hours are used. It is a service for autistic people - routine - yet management have no idea the complications caused by their inability to manage. The service has drastically deteriorated over the last two years to an almost appalling service.' - No contact details were left to follow this up for the individual service user.

'I feel that the staff in my relative's service understand and meet their needs. My relative goes away in the morning happy and returns the same way at the end of the day. I feel that the management listen to me well and I feel comfortable communicating with them if necessary. The most important thing for a parent is to know that their relative with additional support needs is safe and that they trust their support staff. I feel that like this each day.'

'The service user is non-verbal but is supported to communicate using signs and symbols. They clearly enjoy being at the centre and spending time with staff and other service users.'

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'There have been some changes of staff recently but the manager has organised a review to discuss things in more depth. They are really good at communicating changes with me and told me they are recruiting very soon as some staff have moved on.'

'Despite reassurances prior to the commencement of the service there has been a high turnover of staff which has impacted on the quality of the service provided. During the past year there has been a change of senior team members and the level of communication between us and the service noticeably dropped. At the outset the team were very responsive to our needs and very proactive communicators. Recently the lack of staff has resulted in the service provider being unable to provide the required level of support. A meeting has been organised to review the situation and plan better for the future. Hopefully that will improve but there has definitely been a eductionr in customer focus and communication.'

We received very positive feedback about the quality of support, management and staffing from two health professionals who visited the Craigmillar Activity Centre to support people and were also involved in training staff.

Self assessment

We were satisfied with the detail within the self assessment. This told us about the things the service thought they were doing well and ways in which they would like to improve on.

From this inspection we graded this service as:

Quality of care and support 4 - Good Quality of staffing not assessed Quality of management and leadership 4 - Good

What the service does well

Service users support plans were developed around their individual needs. 'About me' documents provide detailed information about each person's needs, choices and interests. Risk assessment documentation is used to identify any potential risks and guidance put in place for staff to follow to minimise risks.

The organisation had quality assurance systems to check that plans were being kept up to date and regular reviewed. The organisation supports staff in their training and development. Adult support and protection and whistleblowing are included in the comprehensive induction programme. A probationary period meant that staff competencies were regularly assessed before a permanent contract was authorised.

There were robust recruitment procedures in place to vet staff before they were employed. The majority of staff had received regular supervision which helped them to reflect on practice and discuss any training and development needs.

At the Craigmillar resource we found that there were robust induction plans for staff. There was a well established management team there who had developed strong support and supervision systems for staff. A sensory room had been installed at the Craigmillar base since the previous inspection and was a wonderful

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Staff received a range of training including autism and positive intervention techniques. A range of communication formats were in use to support service users to express themselves. Service users had opportunities to participate in a range of activities, with some being supported to attend college; participate in voluntary work and access leisure facilities. This supported people to develop their skills and confidence. For example one service user was working towards travelling independently and they had made really good progress towards achieving this goal.

What the service could do better

Staff turnover and continuity in staffing were issues of concern raised during this inspection. The management team were communicating with service users and relatives affected by staff changes. Both parts of the service were experiencing staff shortages at the time of the inspection though recruitment was taking place and a relief pool of staff was being used where there were shortfalls (See requirement 1)

We heard that communication with relatives and service users could be have been much better in certain cases. The team leader at Gorgie Road was organising review meetings and had taken charge of rota management until the new senior had been inducted into post.

The Human Resources department was reviewing staff retention and turnover and using information from exit interviews to identify possible improvements.

The Gorgie Road resource would benefit from environmental improvements such as the development of a quiet sensory area. (See recommendation 1)

Requirements Number of requirements: 1

1. The provider is required to ensure that there are at all times sufficient numbers of staff with the appropriate skills, experience and knowledge of each service user's support needs. This is to ensure that all service users experience a consistently high quality of well planned support tailored to their individual needs and circumstances.

This is to comply with the Social Work Improvements Scotland (Requirements for Care Services) 2011 Regulation 15 (a) Staffing - a equirr ement that the care provider ensures that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users

Timescale: Within eight weeks upon receipt of this report.

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Recommendations Number of recommendations: 1

1. We recommend that the service develop an environmental improvement plan and considers the development of a quiet sensory area at Gorgie Road.

National Care Standards 5 Support Services - Your Environment.

Complaints

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

Inspection and grading history

Date Type Gradings 20 Nov 2013 Announced (short notice) Care and support 5 - Very good Environment Not assessed Staffing 5 - Very good Management and leadership 5 - Very good

21 Nov 2012 Unannounced Care and support 5 - Very good Environment Not assessed Staffing 5 - Very good Management and leadership 4 - Good

24 Nov 2010 Announced Care and support 5 - Very good Environment Not assessed Staffing Not assessed Management and leadership Not assessed

20 Jan 2010 Announced Care and support 5 - Very good Environment Not assessed Staffing 5 - Very good Management and leadership 5 - Very good

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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.

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

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