Inspection on 24/08/09 for Wessex Autistic - 13-15 Barnes Lane

This is the latest available inspection report for this service, carried out on 24th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wessex Autistic - 13-15 Barnes... 11/10/06

Wessex Autistic - 13-15 Barnes... 27/02/06

Wessex Autistic - 13-15 Barnes... 21/12/05

Wessex Autistic - 13-15 Barnes... 03/03/05

Wessex Autistic - 13-15 Barnes... 28/09/04

Wessex Autistic - 13-15 Barnes... 25/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Wessex Autistic - 13-15 Barnes Lane 13-15 Barnes Lane Beaminster Dorset DT8 3LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Heidi Banks     Date: 0 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Wessex Autistic - 13-15 Barnes Lane 13-15 Barnes Lane Beaminster Dorset DT8 3LS 0146077033 0146075003 as@twas.org.uk www.twas.org.uk Wessex Autistic Society care home 6 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 13-15 Barnes Lane provides accommodation and personal care for up to six people who have an autistic spectrum disorder. The property is owned by a Housing Association with care being provided by The Wessex Autistic Society. The Wessex Autistic Society is a regional charitable organisation which operates a number of residential and support services in the area. The home comprises three inter-linked terraced houses each accommodating two service users. It is situated on the outskirts of Beaminster. The home is staffed on a 24-hour basis with a sleep-in member of staff throughout the night. The range of fees charged by the service depend on assessment of individuals needs. From information provided to us on 1st September 2009 the fees for people who use the service ranged from 1339 to 1691 pounds per week. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of 13-15 Barnes Lane. The inspection involved a visit to the home on 24th August 2009 and a visit to the Head Office of The Wessex Autistic Society on 1st September. The aim of the inspection was to evaluate the home against the regulations and national minimum standards for care homes for adults. At the time of the inspection there were six people living in the home. The inspection was carried out by one inspector but throughout this report the term we is used to show that it is the view of the Care Quality Commission. During the inspection discussion took place with the registered manager of the service, Mrs Mandy Gibson. A sample of records was examined including staff recruitment and training records, medication administration records, health and safety records and information about people who use the service. We contacted three relatives of people who use the service by telephone following the inspection to obtain their views about Care Homes for Adults (18-65 years) Page 5 of 31 the home. Surveys were sent to the home before the inspection for distribution among people who use the service and those who have contact with them. We received a total of four completed surveys from care workers employed at the home and one completed survey from a care professional. We have received the homes completed Annual Quality Assurance Assessment which has given us some written information and numerical data about the service. A total of twenty-two standards were assessed at this inspection. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? At the last inspection we made two requirements in relation to staff training in medication and safe working practices. We found that systems are in place to provide staff with this training and the sample of records we looked at showed evidence of this training being undertaken. We have, however, made a recommendation that the home ensures that training information held at the home and the organisations Head Office is consistent and accurate. Care Homes for Adults (18-65 years) Page 7 of 31 What they could do better: As a result of this inspection we have made two requirements. Requirements relate to things the home must do in order to comply with the law. We found that there was no suitable storage facility for controlled drugs on the premises. Although, at the time of the inspection, there were no controlled drugs being prescribed for people who use the service the home must ensure appropriate storage is in place so that in the event of a person being prescribed them they can be stored safely and securely. We also found that the home did not have essential information about an agency worker employed to work in the home. The home must ensure that they have evidence that satisfactory pre-employment checks have been received for each agency worker and a summary of their experience and training to date. This is so the home can make a judgement on the individuals suitability to work in the home. We have also made some recommendations as a result of this inspection. Recommendations relate to the national minimum standards and are based on good practice. The provider should give these serious consideration in order to improve outcomes for people who use the service. We found in one instance that a joint risk strategy for one person who uses the service had not been updated in the past year. This should be done to take account of any changes in the persons health and well-being and to ensure that information remains relevant. When we looked at a sample of medication administration record charts we found evidence of some handwritten instructions about medication to be given. We have recommended that handwritten instructions are double-signed by two staff to confirm their accuracy. Although the home reports that they have not received any complaints from people who use the service, relatives we spoke with indicated that in the past they had raised some minor concerns with staff about day-to-day issues. We have made a recommendation that such concerns are documented with information about what the home has done to respond to them. This will help evidence how the service listens to people and acts on what they say. At the time of the inspection there were some gaps in information held about care workers in the home. Although the organisations Head Office holds this documentation we have made a recommendation that the home reviews their processes in line with current guidance and ensures they have enough information in the home about the staff they employ. We have made a recommendation that the home continues to look at ways in which all staff can access specialist training in autism and total communication approaches so that they have specific skills and knowledge about peoples needs and communication. As indicated in the previous section, we have also recommended that the home liaises with the organisations Head Office regarding record-keeping in relation to staff training so records are consistent and are an accurate reflection of training uptake. This is Care Homes for Adults (18-65 years) Page 8 of 31 important so that the organisations training department are fully aware of any gaps and training needs and can support the home effectively in responding to these. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to ensure that they have information about peoples needs before they move in. Relevant people are involved in the admission process. Evidence: Since the last inspection of the service in 2007 one person has been admitted to the home. The person concerned was already known to the Wessex Autistic Society as they lived in another home run by the organisation. We looked at their records which indicated that their next-of-kin had been involved in the decision to move. We confirmed this with a relative by telephone who reported that, in their view, the move had been a positive one for their family member. We saw that the manager of the individuals previous placement had done an assessment of their needs before the move so that the new placement had information about them. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sound written information in place about individuals needs and preferences which enables care workers to deliver person-centred care. Risks have been given consideration to ensure that peoples safety is maintained and that, as far as possible, they are enabled to lead an ordinary life. Evidence: We looked at the care plans for two people who use the service. We found there was some very comprehensive information on file about peoples needs and how they should be supported. This included relevant information relating to their specific diagnosis and how autism might impact on their lives. There was substantial detail on file about individuals routines and how these should be respected. Information we saw took into account peoples needs and choices, including for example, how they like to be woken up in the morning and what they can do independently. In particular there was some good detail on how staff should offer individuals choice. The plans were written in a person-centred style and easy to understand. All four care workers who completed surveys told us that they were always given up-to-date information Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: about the people they support. A health care professional responding to the survey told us that individual plans were something the home did well. During the inspection we observed an example of a person who uses the service being offered a choice about where they wanted to eat their meal. The choice was presented in a way that was meaningful to them and we saw that when they had made their choice this was respected by the member of staff on duty. A relative told us that they felt the service listens to what their family member likes and they felt they were treated as an individual. The manager has told us in the homes Annual Quality Assurance Assessment that they feel they could do better at encouraging service users to have a more active role in the management of their home. Discussion with the manager indicated that they have already started to implement measures to enable people to have their say, for example, people having key-worker days each fortnight where they are able to decide what they would like to do on a one-to-one basis with staff. We looked at a sample of risk assessments for two people who use the service. These were in relation to activities both in and outside of the home, for example, going swimming, visiting the barber shop, support in the community and safety issues around the home. We found that these risk assessments had been updated in the past year and had been written in a person-centred style which gave good information on individuals needs, potential risks and actions to be taken by staff to minimise harm. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people to have access to a range of activities that reflect their needs and preferences. People are supported to have contact with their families and their rights are acknowledged and respected in their daily lives. Evidence: The home has told us in their Annual Quality Assurance Assessment that they provide a 24 hour support package to meet the complex individual needs of the service users. The manager told us that in the past people who live at the home had attended a day service run by the Wessex Autistic Society but changes had been implemented to make day-time service provision more individualised and community-based. Relatives of people who use the service told us they were very pleased with the new approach and felt it offered their family member person-centred support with activities. We looked at the records for two people. Both had a structured daily programme on Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: file indicating activities being made available to them. These included swimming, walks in the local area, horse-riding and shopping. Daily logs in the home confirmed this. Discussion with the manager also indicated that individuals are given opportunities to attend college courses or do work experience in their local community, one relative expressing their satisfaction that their family member was engaged in doing something meaningful with their time. We found that each service user is also allocated a key worker day which enables them to make choices about where they would like to go. Discussion between staff indicated that staff are allocated to service users on a one-to-one basis to enable this person-centred approach and the staff we spoke with told us that there were generally enough staff to ensure activities happened as scheduled. It was evident from discussion and observation of life in the home that each person is treated as an individual and the home is striving to be responsive to their specific needs for occupation and activity with some people leading busy and active lives and others preferring a slower pace. Comments we received from the relatives of people who use the service included; They go out far more now; X leads a normal life; X has a good life there...has a good programme. The home has told us in their Annual Quality Assurance Assessment that in the past twelve months they have provided more community-based activities for people but they are also aware that there is room for further development of this. This was echoed by a care worker who told us that service users access to external activities could be expanded through improved funding. A care professional who completed a survey told us that in their view the service usually supports people to live the life they choose. Discussion with the manager during the inspection indicated her keen sensitivity to the circumstances of service users families. It was evident that the home wants to promote peoples rights to visit their families and are looking at the support that is needed to make this a reality for all residents. It was clear from the records of people who use the service that families make regular visits to the home and service users are also able to visit their families on a regular basis. This was confirmed by all the relatives we spoke with who told us they have regular contact with their family member. One relative told us they were always made to feel very welcome when they visited. Two of the relatives we had contact with told us that, although they were Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: generally very satisfied with the care given to their family member by the home, communication could be improved in various ways. One relative told us that they would like to be updated on things that go on in the home, for example changes in staff. Another relative told us that better communication around their family members health needs would be beneficial. All the relatives we spoke with told us that the manager and staff were approachable and would answer questions if asked but that they would appreciate a more proactive approach. We suggest that the home looks to see if there are ways in which families can be engaged more effectively. Observation of life in the home indicated that people have access to their bedrooms as they wish and are given choices about where they want to spend their time. From the care plan for one person it was clear that routine was very important to them and discussion with them indicated that this was respected. Daily logs also gave further evidence of this. The homes staff induction programme was seen to contain a section on rights and responsibilities. A relative we spoke with told us that from their experience of visiting the home the food provided was varied and of a good standard. We saw that records of meals provided are maintained in the home. The records we sampled showed a few omissions but generally were in sufficient detail. We saw that people were given a choice of where they wanted to eat, either in the communal dining area or in their own bedrooms. Dietary preferences were given consideration in peoples care plans. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are given the support needed to promote their health and well-being. There are sound systems in place in relation to medication administration to ensure people are given the medication they are prescribed. Evidence: We found that detailed plans were in place for each individual with regards to their needs and preferences with personal care. These gave good information to care workers on how to meet peoples needs on a daily basis and fulfil their personal care routines. A health care professional told us that they felt the service respected peoples privacy and dignity. Relatives we spoke with also confirmed that they were satisfied with the personal care afforded to their family member although one relative felt that at times more attention could be paid to ensuring they always looked smart and that this was followed through consistently by all staff. Another relative told us they felt the support given to their relative met their needs and had led to an improvement in their health and well-being; X has improved a great deal. The records we looked at during the inspection showed evidence that people have access to professional support with various aspects of their health care. This included Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: access to the primary health care team, dentist, community nurses, psychology and psychiatry. One relative we spoke with told us that the staff team at the home had responded particularly well when their family member had experienced ill health. Another told us that the home had been flexible in planning support around their relatives needs. Appointments with various professionals had been documented in peoples records providing sufficient information about the outcome of each visit. It was clear from our discussion with the manager of the home and inspection of records that the home is responsive to changes in peoples behaviour and there was good information on record about this. For one person we found that a joint risk assessment had been carried out in March 2005 between health professionals and the home in relation to their behaviour. We have made a recommendation that this is updated to ensure it continues to contain valid information. Medication taken by individuals who use the service had been listed in their care plans with information about how these should be administered. For one person who has epilepsy we saw that there was a specific epilepsy care plan on file which gave clear instructions to care workers on administration of PRN (as required) medication and when emergency services should be contacted. We saw that records of seizures had been maintained. We looked at a sample of three care workers records all of which showed evidence that they had received training in epilepsy and the administration of medication. We looked at the medication storage and records for two people who live in the home. Medication was seen to be stored in lockable metal cabinets fixed to the wall of the home. The home did not have storage suitable for controlled drugs. Although people at the home were not being prescribed controlled drugs at the time of the inspection we have made a requirement that suitable storage is put in place so that in the event of individuals being prescribed such medication it can be stored safely. We found that medication administration record (MAR) charts were in place for people and these had been fully completed to indicate that medication was being given as prescribed. We noted that instructions on the MAR charts were often handwritten by care workers. We have made a recommendation that handwritten instructions are signed by two members of staff to confirm their accuracy. Records showed that regular medication audits take place in the home to check that medication is being given as prescribed and procedures are followed. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to respond to complaints and safeguarding issues. Care workers are aware of these procedures. People who use the service know that they will be listened to if they raise concerns. Evidence: The home has told us in their Annual Quality Assurance Assessment that they have not received any complaints about the service in the last twelve months. This was confirmed with the manager at the time of the inspection. All the relatives we spoke with reported that they felt able to raise concerns with the manager if they needed to and they felt she would listen to them. Some of the relatives we had contact with indicated that they had at times raised issues, not as a formal complaint but as queries or niggles. We recommend that the manager documents these issues and the response given by the home so that there is a clear record of concerns raised and their outcome. The home has a complaints procedure and all care workers responding to our survey indicated that they knew what action to take if a service user or relative raised concerns. The home has told us that there have been no safeguarding referrals or investigations in the home in the last twelve months. The home has its own organisational policy on adult protection and the disclosure of abuse. We have forwarded to the home a copy of the Bournemouth, Poole and Dorset safeguarding adults policy and advised the manager to ensure that a copy of this is available in the service. The manager told us Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: about some current concerns in relation to one service user and the action she is taking to liaise with the funding authority to promote their welfare. The homes Annual Quality Assurance Assessment states that all staff attend training in the protection of vulnerable adults. This was confirmed by the sample of staff training records we looked at. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment is suitable to meet the needs of the people who live there and promotes their right to an ordinary life in the community. Evidence: The home comprises three terraced houses along an ordinary street on the outskirts of the village of Beaminster. Two residents live in each of the three properties. There are internal doors between each property so that people can move between the houses if necessary. The home is situated within walking distance of the shops and amenities of the village but also has easy access to rural areas. On-road parking is available outside the properties. The manager has told us in the Annual Quality Assurance Assessment that the home is owned by a Housing Association who are responsible for carrying out maintenance tasks. The home has told us that in the last twelve months there has been redecoration in all communal areas, partial refurbishment of the garden and completion of the new office area so that it is adjacent to the home. They have told us that improvements to the home will continue over the next year with planned work to take place in the garden and kitchens. This is positive as when we inspected one of the kitchens in the home we found that cupboards were chipped and a drawer handle needed to be replaced. The home has recently had new ovens installed. We observed Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: that some of the exterior paintwork of the home would benefit from repainting and suggest that this is incorporated into the homes maintenance plan. The relatives we had contact with expressed satisfaction with the home environment indicating that in their view it was homely, comfortable and met their family members needs. They noted that there had been improvements to maintenance in the home. The aim of the home is to provide a homely environment for the people who live there and therefore infection control procedures are proportionate to the nature of the service. The home has told us in their Annual Quality Assurance Assessment that they have a policy for preventing infection and managing infection control. The manager told us that in-house training on food hygiene and infection control is available to staff. We noted that the homes induction programme also covers these areas. We are not aware of any outbreaks of infection in the home. We have been told by the home that a rota is in place to ensure domestic tasks are done to ensure that the home remains clean and hygienic. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally operates safe recruitment procedures for its staff to ensure they are suitable to work with vulnerable adults although more robust procedures are needed in relation to the employment of agency staff to ensure people are protected. Care workers are supported to access an induction programme and nationallyrecognised qualifications in their employment. Increased access to specialist training will further strengthen the homes capacity to meet the specific needs of people who use the service. Evidence: We looked at the records for three care workers employed to work in the home who had been appointed since the last inspection of the service. Although these contained most of the information required by the regulations we identified that on two peoples files there was only evidence of one written reference. The manager told us that the organisations Head Office was responsible for co-ordinating recruitment and original copies of documentation could be found there. We made arrangements to visit the organistions Head Office the following week so that we could be confident that full and satisfactory pre-employment checks had been obtained for each care worker. We found that sufficient information had been obtained and kept on file. For one person we saw that the organisation had identified a gap themselves and taken action to rectify this. It was not clear from the records we examined that a system is in place by Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: which references are verified with the referee who supplies them but we were told that this had recently been implemented and is now part of the organisations procedures. We have directed the organisations Human Resources office to guidance on our website about recruitment information that needs to be kept in the care home so that they can review their procedures accordingly. While we were at the home we observed that an agency worker was doing a shift there. The manager told us that agency workers are used infrequently in the service but there have been occasions when it has been necessary to ensure that staffing levels are adequate. We asked the manager whether they had received information about the agency worker before she came to work in the home from the supplying agency. The manager showed us a folder where information about some agency workers had been stored. The folder did not include information about this particular agency worker. We have made a requirement that the home ensures they always obtain sufficient information about all agency workers who come to work in the home before they start work. This is important so that the home can be fully confident that appropriate pre-employment checks have been carried out on each worker by the agency and they have information about their training and experience as a care worker. Records of training for permanent care workers were seen both at the home and at the organisations Head Office. A dedicated training officer is employed by the Wessex Autistic Society who works across the organisation. We found that an induction programme is in place for all new care workers. Three out of four care workers responding to our survey told us that their induction had covered everything they needed to know very well when they started. One said this was mostly the case. We saw that a spreadsheet is maintained at Head Office by which training uptake is monitored and updates arranged as necessary. There were some instances when training records held at Head Office differed from those held in the home. We have made a recommendation that the home ensures this information is consistent. We saw that four care workers employed by the service had completed a foundation course in autistic spectrum disorders. The training officer told us that this course was currently under review but it was hoped that more care workers would be able to undertake this training in the future. We have made this a recommendation as a course of this nature will help equip staff with the specialist knowledge and skills they need to understand and meet the needs of people who use the service. We identified from records kept in the home that two people, including the manager, had undertaken training in Picture Exchange Communication System (PECS) in 2004 / Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: 2005. There was little evidence of other staff undertaking training in total communication approaches. The homes Annual Quality Assurance Assessment tells us that all the people using the service have some communication difficulties. We also saw evidence on one persons care plan of PECS and total communication approaches being recommended. We discussed this with the training officer who agreed that this is an area that could be looked into to ensure staff have the skills to be able to understand and use total communication in their daily work and interactions. We have made a recommendation to this effect. The homes Annual Quality Assurance Assessment tells us that thirteen care workers are employed to work in the home. The assessment also states that nine out of the thirteen have a National Vocational Qualification at Level 2 or above with a further three people currently working towards this qualification. They have told us that they plan for all staff to have completed National Vocational Qualifications in the next twelve months. Again we noted that training records held at the agencys Head Office differed from those in the home. All four care workers responding to our survey told us that they were being given relevant training that kept them up to date and helped them understand peoples needs. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run effectively and in the best interests of the people who live there. Procedures are in place to manage health and safety issues in the home and ensure peoples welfare is promoted. Evidence: There is a clear management structure within the Wessex Autistic Society with clear lines of accountability. The manager of the service, Mrs Mandy Gibson, is registered with the Commission and has been deemed fit to run the home. Discussion with Mrs Gibson indicated that she has many years experience of working within the organisation and with people with autism. Mrs Gibson achieved her Registered Managers Award in May 2008. She is supported in her role by human resources, training and finance functions based at the organisations Head Office. We found that a service development plan for 2009-2010 was in place. This was service user focused and clearly identified areas in which the home could be developed to meet peoples needs more effectively. We saw that systems are in place whereby the home consults with people who use the service and their relatives. We looked at a Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: sample of surveys that had been distributed by the home to families as part of their quality assurance process. These aimed to assess families satisfaction with their relatives well-being, involvement in their community, staffing and home environment. Responses to these surveys showed that people were either very satisfied or satisfied with the care delivered to their family member and comments demonstrated that they have confidence in the Wessex Autistic Society to meet peoples needs; We believe the Society provides a happy, varied and secure life for our son; I am confident that the service is well-organised. We looked at records in the home that demonstrated that systems are in place to ensure health and safety checks are undertaken on a regular basis. These included daily checks on refrigerator and freezer temperatures and weekly checks on water temperatures, all of which were fully completed. We contacted Dorset Fire and Rescue Service following the inspection to confirm when they had last visited the home. They told us that they had carried out an inspection in May 2007 when it had been identified that smoke detection was needed in the kitchens of the home to activate automatic doors. The manager has told us that this has now been addressed. The manager told us that fire safety awareness is incorporated into peoples induction training with updates being provided internally as part of staff meetings. This was confirmed by the organisations training officer who told us that staff can also access formal fire training which is organised centrally. During our tour of 15 Barnes Lane we noted that chemical substances had been securely stored in the home to promote the safety of people who live there. We looked at the training records for three people employed by the service. All showed evidence that they had undertaken first aid training. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 You must ensure that you have a suitable facility in place for the storage of controlled drugs. You must do this to ensure that in the event of a service user being prescribed a controlled drug you are able to store it safely and securely. 13/11/2009 2 34 19 You must ensure that you have sufficient information to evidence that appropriate pre-employment checks have been carried out on agency workers including information about their training and experience. You must do this to determine that people you allow to work in the home are safe to do so. 16/10/2009 Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 You should ensure that joint risk strategies are reviewed at least once a year with relevant professionals to ensure that they continue to be an accurate reflection of peoples needs. You should ensure that handwritten instructions on peoples medication administration record (MAR) charts are doublesigned to ensure the information is accurate. You should keep a record of any day-to-day concerns that are expressed by people who have contact with the service and the action you are taking to address these. You should review your systems so that sufficient information about care workers pre-employment checks is maintained in the home in line with current guidance. You should ensure that care workers have suitable training in total communication approaches that meets the needs of the people they support. You should continue to ensure that all care workers are able to access specialist training in autistic spectrum disorders so that they are well-equipped to understand and meet peoples specific needs. You should ensure that training records in the home correspond with those held at Head Office so that there are clear and consistent records about peoples training uptake and needs. 2 20 3 23 4 34 5 35 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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