Inspection on 05/03/08 for Dysons Wood House

This is the latest available inspection report for this service, carried out on 5th March 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dysons Wood House 22/11/05

Dysons Wood House 22/06/05

Dysons Wood House 01/02/05

Dysons Wood House 17/08/04

Dysons Wood House 26/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

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Fairways

Treloar College

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Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Dysons Wood House Dysons Wood Tokers Green Caversham Reading RG4 9EY Lead Inspector Stephen Webb Unannounced Inspection 5th March 2008 09:45 Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dysons Wood House Address Dysons Wood Tokers Green Caversham Reading RG4 9EY 0118 9724553 0118 9723479 dw@disabilities-trust.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dysons Wood Trust John Spiller Care Home 15 Category(ies) of Learning disability (0) registration, with number of places Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - LD The maximum number of service users who can be accommodated is: 15 7th December 2006 Date of last inspection Brief Description of the Service: Dysons Wood House is a residential home registered for 15 young adults with autistic spectrum disorders. There are two units providing accommodation on one large site with extensive grounds. The service is located in a rural area of South Oxfordshire and near to the facilities of Reading. Transport is available to access community resources and for service users to attend a day centre run by the provider, the Disabilities Trust. Due to the nature and diversity of autistic spectrum disorders, Dysons Wood House provides a service for young adults with challenging behaviours and complex needs. Fees are £1141.90 to £2793.00 per week. Additional one-to-one care is charged according to individual needs. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit from 9.45am until 7.45pm on the 5th of March 2008. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the service manager in the absence of the registered manager, who was on holiday, and briefly with some other staff members on duty during the day, and limited feedback from service users. The inspector also observed the interactions between service users and staff at various points during the inspection. The inspector examined the majority of the premises, including some of the bedrooms. What the service does well: The needs and wishes of prospective residents are established via preadmission assessment in order to ensure they can be met and are consistent with those of the existing resident group. Residents are supported to make choices in their daily lives and are supported to take risks within an improved risk assessment system. Residents’ opportunities to participate in activities and to access the local community are being improved to provide them with a more fulfilling lifestyle and better opportunities for personal growth. Residents are offered a varied diet and encouraged to be involved in shopping for and preparing meals, to enhance their well being. Appropriate medication management systems are in place to support the residents, who are unable to manage their own medication. The service provides residents with a safe, and well-maintained environment, with some adaptations and limitations to meet individual and collective needs with respect to residents’ autism. The staff recruitment systems help to protect residents. Staff receive appropriate induction and training in relevant areas to enable them to meet the needs of residents, though some training updates would be of benefit. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Staff should be provided with training on culture and diversity within an autism context, to ensure a consistent understanding. Training updates on safeguarding vulnerable adults should be provided regularly to all staff and consideration should be given to sourcing this training from an accredited trainer. Healthcare appointment records might be more accessible to tracking if separated by healthcare discipline. The manager should ensure that appropriate records of any future complaint are made within the complaints log. Records of accidents and incidents involving residents should be recorded within their case record as well as collectively. The “local” physical intervention policy needs to be updated, and should be separately indexed to improve its availability. The purchase of suitable fire extinguisher cabinets should be pursued to enable them to be distributed about the units to improve fire safety. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 7 The new quality assurance system needs to be put into practice and could be improved by seeking the views of other interested parties. A summary report of the survey outcomes should be made available to participants. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and wishes of prospective residents are established via preadmission assessment in order to ensure they can be met and are consistent with those of the existing resident group. EVIDENCE: The service gathers appropriate information about the needs of a potential resident, in order to establish that the person’s needs can be met and are consistent with those of the existing residents. Copies of care management assessments were present on the files examined. The information is used to develop the initial care plan. The service manager indicated that the trust also undertakes their own preadmission assessments, but these had been archived in the files examined. The procedure is outlined in the Statement of Purpose. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The proposed new format enables better reflection of the needs and wishes of residents’ within their care plan, and will more effectively encourage the setting of individual goals, to support residents to further develop their skills and broaden their experiences. Residents are supported to make choices in their daily lives and are supported to take risks within an improved risk assessment system. EVIDENCE: A sample of three case record files was examined as part of this inspection. One file was particularly selected as it reflected the proposed new careplanning format for the service which is intended to provide detailed working files for staff containing the necessary information in order to meet the individual’s day-to-day needs. The new format provided an improved level of information for staff in an ordered and accessible form, with a clear index. Included was a copy of the CTPLD care management assessment from which a detailed individual “Lifestyle support plan” had been prepared, which included Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 11 relevant information on the likes, dislikes and preferences of the resident. There was also a “Reach progress plan” which identified specific individual goals for the resident, details of the action taken and a record of progress, together with necessary information to enable staff to support residents in these developmental aspects. Specific guidance was also provided around supporting particular activities, routines or times of day, where necessary. There was also a weekly activities planner and details of the support provided to the resident with respect to their personal allowance. The format also included an individual communication profile that provided details of the resident’s methods of communication and how staff should respond in particular situations. The format also incorporates a risk assessment overview and copies of specific risk assessments, which provide improved information on managing identified issues, and an individual autism profile detailing the impact of autism on the resident’s daily life. There was evidence of appropriate periodic review of the care plan through copies of review minutes from the previous two years, as well as minutes of any individual meetings regarding the management of individual situations. Overall the new format was a significant improvement over the previous one and the service manager indicated that all of the care plans would be revised into this format. The new care plan format includes evidence of consultation with the resident on various aspects of their care, activities, finances etc. and this was supported through observations on the day of inspection, when residents were seen to be involved in making decisions and choices about their daily lives. Staff used choice boards to support some individuals to make choices around such things as meals, drinks and activities and the service manager indicated that there were plans to further develop their use, by providing more individually relevant colour pictures/photos, rather than relying on generic signs and symbols which may not work for all. It was acknowledged that establishing individuals’ choices was not always clear in the context of autism. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ opportunities to participate in activities and to access the local community are being improved to provide them with a more fulfilling lifestyle and better opportunities for personal growth. Residents individual rights are also being better recognised and supported through greater consistency of staff approach, and they are being encouraged to take more part in the daily routines of the home. Residents are offered a varied diet and encouraged to be involved in shopping for and preparing meals, to enhance their well being. EVIDENCE: Some concern had recently been raised by a complainant, regarding the level of activities participation by some residents. This issue was also identified in the pre-inspection information (AQAA) completed by the manager. The service manager acknowledged that one of the identified goals of the service was to increase the level of participation in activities and the level of access to the community. One way in which this was being addressed was by improvements Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 13 to the individual activities plans and developing a wider range of opportunities for individuals. The new care plan format examined provided a detailed activities plan with a mixture of in-house and external opportunities. The recent improvements in recruitment of permanent staff will also be beneficial in enabling improved access to the community, and this is also being facilitated by improved behaviour management guidelines provided by the in house psychology team to enable some individuals to access community activities to a greater degree. The trust has an in-house day service provided off-site which residents can access for a range of activities. Staff were observed asking residents about activities and going out, at various points during the inspection, and used individualised approaches in some cases to support particular residents. A number of themed evenings had been held around different nations, which had included activities such as flag and costume making, sampling cultural dishes and music, and these were evidenced within photo albums available in the service. Recent activities had included swimming, walks, shopping for food and toiletries, bowling and pub lunches. Individuals had also attended art therapy, music, cookery and pottery courses at college. Sessions with a drummer had also taken place. One resident has previously had a supported work placement in a charity shop but this was not happening currently. Limited reference was made to the service addressing any individual cultural needs, though the staff team itself, is culturally diverse. The service manager acknowledged the potential benefits of training on culture and diversity for the staff team. The service supports contact with resident’s families, wherever possible, some of whom visit regularly. The manager indicated in the AQAA that there is an intention to encourage residents to correspond with their family. Residents are encouraged, where possible, to take part in the daily living tasks and household routines, though the level of participation is variable. The residents receive their personal mail unopened, but are supported to read and understand the content where necessary. Staff were observed to interact with the residents in the course of daily contact, during the inspection. Residents were offered choices at the lunchtime meal during the inspection, and staff used choice boards with symbols and pictures to facilitate this where individuals are unable to express their preferences verbally. Some residents had also made or assisted with the lunch provided, which included several options from which to choose. It was positive to see the inclusion of healthy aspects such as the provision of an attractively varied salad, which was also actively offered. Various sauces etc. were also offered individually. The mealtime was managed well by staff who were present in sufficient numbers to provide any necessary support. One of the in house psychology team was also present over lunch, undertaking an observation. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has improved the degree to which it provides consistent support with due regard to residents’ preferences in order to meet their needs. Healthcare needs are being met and monitored by the new recording systems, and the psychology team and a speech and language therapist, now support the day-to-day work with residents more effectively. Appropriate medication management systems are in place to support the residents, who are unable to manage their own medication. EVIDENCE: Arising out of a recent complaint, a number of concerns were raised about the consistency with which staff responded to individuals, particularly where they might present behaviours which staff find challenging. A new care plan working format has been devised which has so far been trialled for two residents. As noted earlier, this has provided more concise accessible information for staff in meeting the needs of these individuals. The proposed new care plan format and increased involvement of the in-house psychology team in providing individual behaviour management plans has led to better identification of Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 15 residents individual support needs and wishes and improvements in the consistency of approach and support offered by staff. The behaviour support plans are helpful to staff in identifying a consistent approach to specific behaviours. Good records of the occasions where these strategies are used, need to be maintained to enable review of their effectiveness over time. The improved communication profiles also provide better information to staff on the methods of communication used by individuals and how particular expressions etc. might be interpreted. The service has support from a speech and language therapist two days per week. Where necessary individual missing persons procedures are present to reflect the agreed plan for that resident. Staff are all trained in SCIP (Strategies for Crisis Intervention and Prevention), techniques to support them in managing difficult behaviours. Training is provided in house by accredited SCIP trainers. There is evidence from meeting minutes of improved planning and discussion between the psychology team and support staff to devise appropriate strategies to manage inappropriate behaviours. On the day of inspection there was a scheduled meeting to discuss the challenges presented by some of the behaviours demonstrated by one resident. The meeting, involving the support staff and members of the psychology team was to develop a management plan for the behaviours of concern. A core group of staff was also being identified to work with one individual to reduce his anxiety levels, which could be exacerbated by too many changes of staff working with him. Certificates of achievement for residents’ individual attainment of specific goals, within some files, are another indicator of a move towards a more positive, planned and developmental approach. Observation and brief conversations with some of the staff on duty indicated that they had a good awareness of the individual needs and communication methods of residents, and were familiar with the care plans. The service manager felt that the reduced levels of incidents and of absconding by some individuals, more recently were also positive evidence of improvements in residents’ fulfilment and growth. Previous concerns about the levels of isolation of one resident have been addressed through the development of a system to record his time alone to ensure that this is monitored. Management guidance regarding some previous inappropriate care practice has been reiterated, and appropriate disciplinary steps have been taken in some instances. In general it is felt that the service has improved its awareness of the need to document incidents, daily practice and the outcomes of planned interventions in order to provide evidence of practice and enable properly planned and consistent approaches. The discrete medication and healthcare file within the new care plan system details the healthcare needs of the resident and provides a collective format for recording the outcomes of various medical appointments. This could make it harder for keyworkers to track particular issues or for management Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 16 monitoring, and it is suggested that appointment records might be better separated by discipline to facilitate easier access to the information therein. The service manager reported that they had sought to develop a system of “well man” yearly medicals but this had not been supported by local GP’s, so the home will take the lead in arranging annual medical checks for each individual. Relationships with local GP’s and other external healthcare professionals were otherwise said to be positive. Medication management systems were last subject to inspection by a pharmacist in May 2005. It may be prudent to seek a further inspection to ensure that practice fully meets any changes in guidance or regulations. The home operates a dual signatory system for medication administration, with both the staff who administers and the witness initialling separate copies of the Medication Administration Record (MAR), sheet. The quantities of medication received are recorded on the MAR sheets and any returns are listed, providing an appropriate audit trail for medication. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Though the complaints records did not yet fully reflect this, it is evident that the service is now more proactive in response to complaints and has acted appropriately upon the findings of recent investigations. The service has also improved its response to safeguarding issues and has improved the way it safeguards residents from abuse, through changes in practice and improved guidance and has taken disciplinary action where appropriate. EVIDENCE: The service has an appropriate complaints procedure, which is also available in a symbol format. Nevertheless some residents would still be likely to need significant advocacy support in order to make a complaint. The service manager said that the procedure is being revised from the current Makaton format to include a version with appropriate pictures in order to improve its accessibility to residents. The complaints procedure is reportedly also sent to parents within the newsletter. Examination of the complaints log indicated that the last entry was dated December 2006, though there was a letter of complaint dated January 2007 on file, which had not been entered. The service manager stated that the matter had been investigated and had been addressed with the staff concerned. This complaint, the action taken and the outcome should be appropriately recorded in the complaints log to ensure it is a complete record. A range of concerns raised by an ex staff member, have recently been investigated independently and internally, having been raised with social Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 18 services. It is suggested that the outcome of these investigations should also be summarised within the complaints log, though most of the information will need to be held separately as part of the confidential background complaints record. A cross-reference to these confidential records should also be noted within the complaints log entry. Any future complaints should be logged within the complaints log in appropriate detail as soon as they have been received, and cross-referenced to any necessary confidential materials. Appropriate management action has been taken to address the findings of the investigation, including disciplinary action where relevant. The Trust has demonstrated a responsive approach to the findings and practice has since been improved in a number of areas as a result. Two recent safeguarding issues have been investigated, one in late 2007 and one in January 2008. The trust failed to make a prompt referral for consideration of inclusion on the POVA list in the first instance, but once this was pointed out, have now done so and have since made a prompt referral in the second case. The policy on physical interventions is incorporated within the “Behavioural Support Policy”, and as such is not readily evident from the index within the policy and procedures file. It is suggested that this local policy be separately indexed to ensure it is readily available for reference. It should also be revised as it refers to a previous behaviour management methodology. The Trust also has a generic policy on physical intervention. Staff now receive training on techniques of managing challenging behaviour from accredited SCIP (Strategies for Crisis Intervention and Prevention) trainers, and have also received training on safeguarding issues, though for some this was as long ago as 2003. It is good practice to provide regular refresher training on safeguarding to all staff. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides residents with a safe, and well-maintained environment, with adaptations made as determined by the needs of individuals, in order to provide a pleasant home. EVIDENCE: Residents live in a combination of a converted older building and a more recent purpose built separate building. Standards of décor were satisfactory throughout, though within the old building there was some evidence of damage and the need for ongoing repairs as might be expected. The trust employs handymen to carry out ongoing maintenance. All glazing throughout the service is of a specialist durable transparent plastic for safety reasons. The level of provision of ornaments such as pictures, varied from area to area depending on the level of furnishings with which individuals within that group can cope. The same is true of bedrooms, which vary from very well furnished and individualised to rather bare, depending on the needs of their occupant. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 20 Where a resident cannot tolerate curtains or blinds at their bedroom window, their privacy and dignity had been addressed by the application of translucent film to the windows. New carpets have been provided in a number of areas since the last inspection and there has also been some redecoration and new furniture provided in communal areas. Previous concerns about the inappropriate locking of one resident’s facilities at times to prevent flooding, have been addressed with staff and the locks have been removed to avoid any recurrence. The heat sensitive strips on the edges of the fire doors had all been replaced following consultation with the fire officer after the last inspection. The main kitchen area is in need of refurbishment and this was said to be imminent, including the provision of new cupboards and worktops. It is proposed to employ a cook to provide main meals, once the kitchen is refurbished, which will free up additional support worker time for direct work with residents. The manager/senior staff office was in the process of being moved nearer to the residential areas as part of improving management overview of day-to-day practice. Although there is still no direct access to the new management office without going outside to access the only door, observation during the inspection suggested that residents were already aware of the location of the new office. The service manager indicated that a substantial budget had been set aside for further improvements to the physical environment during 2008/9. Standards of hygiene were satisfactory and the service has appropriate laundry facilities which residents are supported/encouraged to use wherever possible. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recent improvements in care practice and consistency of approach have helped to improve the ability of the staff to deliver more consistent care to residents, despite the reliance on a significant proportion of agency staff. The staff recruitment systems help to protect residents. Staff receive appropriate induction and training in relevant areas to enable them to meet the needs of residents, though some training updates would be of benefit. EVIDENCE: A variety of concerns arose recently out of a complaint to social services, regarding some aspects of care practice, a lack of management monitoring of day-to-day practice and a lack of consistent approaches to the management of some difficult and challenging behaviours. Since the findings of the investigations into these matters, various steps have been taken to improve care practice and management overview, and disciplinary action has been taken where necessary. Improvements have been made to behaviour management guidelines with the support of the in-house psychology team, and senior staff reportedly now Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 22 spend more time in the residential areas. The management office is also being relocated closer to the residential areas. Observation and discussion with staff during the inspection indicated a good awareness of the individual needs of residents, and of how to communicate with them. The improvements in guidelines were also noted. Progress continues to be made on NVQ attainment, with the service manager, manger and two senior staff having NVQ level 4, (three of whom also have their Registered Manager’s Award), and two further staff undertaking level 4. Eight staff have NVQ level 3, with a further one in process and three registered to start level 3. Two further staff have level 2 with one other registered to start. Other staff will start NVQ on completion of their probationary period and foundation training. Observations during the inspection indicated that there were sufficient support staff on duty to meet the needs of residents on the day, though the level of reliance on agency staff remains high. This has had an impact at times, on the level of community access for some residents who may present challenging behaviour in the community, as there are not always sufficient permanent staff, available to enable them to go out safely. The two recent rotas examined in detail indicated that of the staff on duty the majority were almost always agency. To minimise the effect of this the service manager said that no agency staff start work in the service without first attending an induction session about the service and the needs of the residents. They also use a regular group of known agency staff wherever possible to minimise the number of different individual staff the residents have to encounter. The situation was also reported to be improving with a new permanent senior and a new support worker about to start work, two more support workers awaiting CRB clearance, and two further appointments made the day before the inspection. Examination of two recent recruitment files indicated that an appropriately rigorous recruitment and selection process was in place. Required records were retained on file. The service receives a memo confirming CRB clearance from the head office personnel section. In one instance a staff member had commenced work on receipt of “POVA first” clearance ahead of receipt of their CRB, but they were engaged in induction and shadowed existing staff when meeting residents. One resident has been asked whether he would like to be involved in the staff interview process but declined to take part. The service uses the Common Induction Standards together with a servicespecific induction. Staff are given a copy of the General Social Care Council guidance booklet. One staff member who was still engaged in her induction was positive about the team spirit and felt that guidelines for managing behaviour were now in place. She felt she was getting a positive induction, and being given the time to get to know the residents and shadow more experienced colleagues before having to take the lead herself. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 23 Staff are invited to complete an exit survey, when leaving to clarify their reasons for leaving the organisation. Staff receive a core-training package based on the Skills For Care outline, from a mixture of in-house and external trainers. To date the training on safeguarding vulnerable adults has been provided inhouse via the quality assurance section, and for some it was last provided as long ago as 2003. It is suggested that external training from an accredited trainer would be more appropriate. It is also recommended that this training should be updated regularly for all staff. As part of their core training, support workers also receive training on Makaton, Autism awareness, medication, first aid, non-verbal communication and behaviour management techniques. It is recommended that training on cultural awareness is also provided as this is not currently part of the training provided. Support workers all receive food hygiene training as they are currently responsible for preparing all meals, though with the planned employment of a cook, this responsibility may diminish in future. A training overview spreadsheet was in the process of being devised to enable management to have a clear overview of the current position, and a copy of this was supplied to the inspector. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recent improvements in the operation of the home have benefited residents in terms of the consistency of their care and support. As yet, the views of residents and others have not been systematically sought in planning and reviewing the operation of the service, but a new quality assurance system has been devised to achieve this. The health, safety and welfare of residents is promoted satisfactorily though there remains room for further improvement. EVIDENCE: The manager has attained the NVQ level 4 and Registered Manager’s Award and is supported by an experienced and qualified senior staff team in managing the service. Following concerns arising from a recent complaint, the managers and senior staff are now taking a more proactive role in the day-to-day operation of the Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 25 service. Their office has been moved closer to the residential areas and they have increased their presence within the home, both during the day and outof-hours. The manager now visits the residential units each morning, to observe day-to-day practice first hand and is available to residents or staff to raise any concerns. The service manager indicated that he and the assistant manager have also increased their presence within the residential units. Senior Management have responded to the issues arising from the recent complaint and the service manager indicated a number of improvements in monitoring, behaviour management guidance etc. as already discussed. The service manager said that the regularity of staff supervision had been improved, and is now subject to ongoing senior management monitoring via regular management team meetings. The service manager indicated that the Trust had recently developed a quality assurance survey system for residents and relatives, which is to be facilitated by the speech and language therapist for some service users, but this system was not yet operational. Consideration should be given to surveying the views of other interested parties such as care managers and external healthcare professionals, as well as the service staff, as each has their own valuable perspective on the service. The results of the quality assurance survey should be summarised and made available to the participants. The Trust undertakes regular monthly monitoring visits to the service as required, and reports were available for inspection on site for most of these visits as required. The service was subject to a National Autistic Society accreditation inspection in October 2007, receiving a positive report, which commended their “sound autism practice” and “multi-disciplinary approach”. The service is also subject to accreditation visits from the local authority, most recently in February 2008, when their accreditation was renewed. For the most part the service protects the health safety and welfare of residents effectively. Copies of residents’ accident and incident records are filed collectively by month, to enable management to monitor overall patterns. However, they are not also being copied to the relevant resident’s case record, as they should be. This individual record would also enable keyworkers to track accident and incident levels for a particular resident to identify individual issues. These records should also be copied to the relevant individual case record. At the time of inspection all of the fire extinguishers for the residential units were being held in the kitchen to prevent inappropriate use. (The fire authority had been consulted regarding this). The service manager agreed the limitations of this practice and was already exploring the purchase of tamperproof extinguisher cabinets to contain the extinguishers in appropriate locations about the buildings. It is recommended that that this option be pursued to provide the best possible fire safety in the service. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA13 YA19 YA22 Good Practice Recommendations The manager should consider the benefits of the provision of training on culture and diversity to staff. The manager should consider the benefits of separating healthcare appointment records by discipline in order to enable more effective monitoring and tracking. The manager should ensure that all concerns and complaints are recorded appropriately within the complaints log on receipt and cross referenced to any confidential records held elsewhere. The manager should consider revising the physical intervention policy and having it as a separate indexed item within the policy/procedure document The manager should consider providing regular training updates on safeguarding issues to ensure that staff awareness of current practice is maintained. Consideration should be given to obtaining this training from an external accredited trainer. DS0000013079.V359306.R01.S.doc Version 5.2 Page 28 4 5 YA23 YA23 Dysons Wood House 6 YA39 7 8 YA42 YA42 The Trust should consider broadening the quality assurance survey to include surveys to care managers, external healthcare professionals and its own staff, in order to obtain feedback from a wider range of sources. The results of the quality assurance survey should also be summarised and made available to participants. The manager should establish a system for recording incidents and accidents to residents within their case record as well as collectively. The purchase of suitable fire extinguisher cabinets should be pursued, to ensure the best possible fire safety for residents and staff, by enabling them to be distributed about the units rather than being held in one central place. Dysons Wood House DS0000013079.V359306.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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