Inspections of registered children’s residential houses by the Care Inspectorate - Appendix 2
Renfrewshire Council · 2 November 2023
Back to Education and Children's Services Policy Board — 2 November 2023 and its agenda
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BeecBeech Ah Avvenue Childrenue Childrens Hens Homeome Care Home Service 1-3 Beech Avenue Hunterhill Paisley PA2 6XN Telephone: 01418 897 375 Type of inspection: Unannounced Completed on: 25 May 2023 Service provided by: Service provider number: Renfrewshire Council SP2003003388 Service no: CS2003001245
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About the service Beech Avenue is a care home for children, registered to care for a maximum of six young people, up to and including age 20 years. The service is managed by Renfrewshire Council and provides care and accommodation on a short or long term basis for young people from the Renfrewshire area. The property is a large house, with a substantial outdoor area, located in a residential area of Paisley. Each young person has their own bedroom and there is a large kitchen with dining space, along with shared living room areas. At the time of inspection, there were six young people living at Beech Avenue. About the inspection This was an unannounced inspection which took place on 17 May 2023 from 11:00 to 19:00 and 18 May 2023 from 08:45 to 18:00. The inspection was carried out by two inspectors from the Care Inspectorate. To prepare for the inspection we reviewed information from the service. This included registration information, information submitted by the service, and intelligence. To inform the inspection, we: - spent time with five young people living at Beech Avenue - spoke with 11 members of staff including managers - observed practice and daily life - reviewed documents - spoke with two external professionals and two parents - accessed feedback questionnaires. Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 2 of 11
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Key messages - Staff had developed warm and nurturing relationships with young people. - The service should ensure young people feel consistently safe. - Beech Avenue was committed towards least restrictive practice. - The service should increase the opportunities for independent advocacy. - Young people enjoyed family time. - The provider should review their quality assurance and admissions processes. - Young people were meaningfully involved in support planning. - The service should ensure staff have opportunities to complete required training. From this inspection we evaluated this service as: In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent How well do we support children and young people's rights and wellbeing? 3 - Adequate Further details on the particular areas inspected are provided at the end of this report. Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 3 of 11
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How well do we support children and young 3 - Adequate people's rights and wellbeing? We evaluated this key question as adequate, as there were some strengths but these just outweigh weaknesses. Staff spoke to, and about the young people respectfully. Young people benefitted from warm and nurturing relationships with staff, who skilfully responded through their knowledge, understanding and commitment to the young people. The strengths of these relationships encouraged young people to approach staff with concerns. Young people felt listened to and respected most of the time, however we had serious concerns that not all young people were consistently emotionally and physically safe and protected from harm. Young people had reported a reduction in feeling safe and, although safety planning had been established, this had significantly impacted on all the young people at Beech Avenue (see Requirement 1). There were positive examples of staff advocating on behalf of young people, however greater use of independent advocacy may have benefitted particular young people to ensure their concerns, views and rights were consistently being responded to sensitively (see Area for Improvement 1). Beech Avenue had effective collaboration with numerous external agencies. Partnership working was in place to support safeguarding of young people, however a number of young people continued to experience high risk situations, compromising their safety at times. This was despite the commitment and best efforts of the staff team at Beech Avenue. Individual safeguarding assessments had been undertaken, however there was less confirmation that the young people's representatives were collectively satisfied that the dynamics and relationships in the house were safe (see Requirement 1). There was strong dedication and focus within the service towards least restrictive practice and positive use of de-escalation strategies. This was supported by a stable staff team with relationships based on compassion, an understanding of trauma, alongside an environment that was warm and welcoming. Some young people were more engaged than others in their care and support, but all were encouraged to participate meaningfully through the use of various formal and informal methods to gain their views. Young people's mental health was given priority to support them make the most out of life. They also benefitted from specialist referrals being put in place promptly, with an example of a proactive and well planned multi agency approach to a complex health matter. Where safe, connections to family were nurtured, ensuring that young people's identities were maintained. Not all young people were involved in their local community, some having less structure to their day, however the service was supporting young people to enjoy new experiences where possible; for example, holidays. The majority of young people were participating in education, with one young person being actively supported to return to school after a significant period of absence. Education was flexible based on the needs of the young people, with staff supporting young people to maximise their attendance. Outwith school, the service could increase opportunities for young people to develop their independent life skills to support and build on individual strengths. Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 4 of 11
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Mealtimes at Beech Avenue were nurturing, where young people and staff could enjoy spending time together, benefitting from a well balanced diet. Managers were visible, approachable and familiar with the individual young people at Beech Avenue, seeking ways to promote improved outcomes for young people, and ensuring complaints were thoroughly considered. We were, however, particularly concerned regarding the admissions, matching and monitoring of young people's experiences by the provider, which had placed some young people at risk of potentially poor outcomes. As a result, we have made a Requirement for this area (Requirement 1). The service had a number of quality assurance systems in place at various managerial levels, and there had been progress in developing their incident recording documents, including improved oversight by management. These systems could be strengthened by greater analysis and learning to more effectively support care planning, risk assessments and overall individual outcomes for young people (see Area for Improvement 2). The service had worked hard to maintain a consistent staff team, enabling young people to develop trusting and long term relationships. There was also flexibility in terms of staff deployment. Specific guidance regarding formal staffing analysis will be shared with the service to support matching staff skills with young people's needs. Staff were safely recruited, and there were good examples of therapeutic work and support with young people. Team meetings supported effective communication, with supervision, on the whole, providing opportunities for learning and reflection. However, improvements were necessary regarding the recording of training undertaken by staff. This is to ensure staff complete mandatory training, alongside training specifically relevant to meet the complex needs of the young people at Beech Avenue (see Area for Improvement 3). Care planning and risk assessments were thorough, well presented and easily understood for young people. Young people's views were meaningfully included within the documents and at the time of inspection, discussion regarding further improving the care planning process took place. Requirements 1. By 1 December 2023, the provider must ensure that young people are living in the right environment, where their needs are being effectively met, including taking account of young people’s views. To do this, the provider must, as a minimum: - ensure that the needs of the young people are closely and thoroughly matched to one another and to the skills and availability of staff - review and document the suitability of the placements of the young people at Beech Avenue in collaboration with other relevant agencies and services - undertake detailed impact risk assessments in a timely manner to support the matching, admissions and care planning processes. Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 5 of 11
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This is to comply with Regulation 4(1)(a) and (d) (welfare of users) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210). This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: My care and support meets my needs and is right for me (HSCS 1.19) and I am listened to and taken seriously if I have a concern about the protection and safety of myself or others, with appropriate assessments and referrals made (HSCS 3.22) and I am in the right place to experience the care and support I need and want (HSCS 1.20). Areas for improvement 1. To ensure children and young people's rights, views and choices are supported, the provider should encourage greater use of independent advocacy service for the young people. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I am supported to use independent advocacy if I want or need this (HSCS 2.4). 2. To support continuous improvement and meet young people's changing needs, the provider should improve their quality assurance processes, including greater analysis of incidents. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes (HSCS 4.19). 3. To ensure young people are supported and cared for by staff with the appropriate skills and training for their role, the service should establish clear oversight of training to ensure mandatory and relevant key training is being undertaken. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow their professional and organisational codes (HSCS 3.14). Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 6 of 11
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Areas for improvement Previous area for improvement 1 The service is to review the approach to the recording of medication to ensure daily clarity, and ensure it is clear to all staff how much medication should be issued. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I use a service and organisation that are well led and managed (HSCS 4.23). This area for improvement was made on 14 October 2021. Action taken since then Medication was considered at this inspection – overall this was positive with additional suggestions made to the service, including strengthening the auditing process. Previous area for improvement 2 Develop a policy and procedure for staff relating to the management of young people under the influence of substances whilst at Beech Avenue, incorporating procedures for searches and disposal of drugs on the premises. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I use a service and organisation that are well led and managed (HSCS 4.23) I am protected from harm, neglect, abuse, bullying and exploitation by people who have a clear understanding of their responsibilities (HSCS 3.20). This area for improvement was made on 14 October 2021. Action taken since then We note that this has not been developed since the last inspection but continues to be incorporated into the Development Plan with no specific date. Previous area for improvement 3 Quality assurance and monitoring systems are to be developed to evaluate children and young people’s outcomes and experiences to ensure they receive the best possible care and support. What the service has done to meet any areas for improvement we made at or since the last inspection Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 7 of 11
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This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes (HSCS 4.19). This area for improvement was made on 14 October 2021. Action taken since then Systems have clearly been established to support this, however this inspection has made a further area for improvement including analysis of incidents. Previous area for improvement 4 Review the service development plan to ensure this has specific outcomes, how these will be achieved and how progress will be measured. This should take into account the views of young people, families and stakeholders. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I use a service and organisation that are well led and managed (HSCS 4.23) I am actively encouraged to be involved in improving the service I use, in the spirit of genuine partnership (HSCS 4.7). This area for improvement was made on 14 October 2021. Action taken since then Beech Avenue has an updated development plan which includes the new Quality Indicator 7.1 which is specific to young people in Beech Avenue. It was also encouraging to see the development days/action plans for house managers and for seniors. Previous area for improvement 5 It is essential that the service has a robust and rigorous assessment and matching process for admissions to ensure the best interests of all children and young people, taking into account the CI guidance - Matching Looked After Children and Young People: Admissions Guidance for Residential Services. This should include staff from the service taking an active role in this process. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I use a service and organisation that are well led and managed (HSCS 4.23) I am in the right place to experience the care and support I need and want (HSCS 1.19). This area for improvement was made on 14 October 2021. Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 8 of 11
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Action taken since then This inspection continued to identify concerns regarding the matching and admissions process and has made a Requirement. Previous area for improvement 6 The service should ensure that there is a process to determine the number, experience, qualifications and skill mix of staff for each shift. This will take into account the specific needs of individual young people. This process will also benefit from the manager having a system in place that identifies individual training needs and achievements. Consideration should be given to the document: Guidance for providers on the assessment of staffing levels. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: My care and support meets my needs and is right for me (HSCS 1.19) My care and support is provided in a planned way, including if there is an emergency or unexpected event (HSCS 4.14). This area for improvement was made on 14 October 2021. Action taken since then It continues to be unclear how this process was being effectively undertaken and further guidance will be shared. Previous area for improvement 7 Care plans to be reviewed to ensure they comply with SMART principles. The service should take effective steps to engage young people in their care plan, and record actions to be taken to achieve positive outcomes, how they will be measured, how achievable they are and within what timeframe. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: I am fully involved in assessing my emotional, psychological, social and physical needs at an early stage, regularly and when my needs change (HSCS 1.12) My personal plan (sometimes referred to as a care plan) is right for me because it sets out how my needs will be met, as well as my wishes and choices (HSCS 1.15) I am fully involved in developing and reviewing my personal plan, which is always available to me (HSCS 2.17). This area for improvement was made on 14 October 2021. Action taken since then We found care planning documents to be effective, and they encompassed the young people’s views. Discussion regarding further improvement took place at the inspection. Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 9 of 11
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Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Detailed evaluations How well do we support children and young people's rights and wellbeing? 3 - Adequate 7.1 Children and young people are safe, feel loved and get the most out of life 3 - Adequate 7.2 Leaders and staff have the capacity and resources to meet and champion children and young people's needs and rights 3 - Adequate Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 10 of 11
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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 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. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. Inspection rInspection reporteport Inspection report for Beech Avenue Childrens Home page 11 of 11