CARE HOME ADULTS 18-65
23-25 The Warren Farthing Hill Ticehurst East Sussex TN5 7QY Lead Inspector
Caroline Johnson Announced Inspection 10th January 2006 09:30 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 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 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 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. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 23-25 The Warren Address Farthing Hill Ticehurst East Sussex TN5 7QY 01580 201448 01580 201448 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) Sussex Autistic Community Trust (Care Services) Limited Stephan Robert Barton Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. That only service users with an autistic spectrum disorder may be accommodated. That service users accommodated must be aged between eighteen (18) and sixty five (65) on admission. That the maximum number of service users to be accommodated will not exceed three (3). 15 June 2005 Date of last inspection Brief Description of the Service: 23-25 The Warren is situated on a small housing estate in the village of Ticehurst. The village with its local shops is approximately half a mile away. The home consists of a pair of inter-joining houses each with its own lounge, dining room and kitchen. The home is registered to accommodate three adults with an autistic spectrum disorder. 23-25 the Warren is one of four homes in East Sussex run by the Sussex Autistic Community Trust. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, the second inspection in the year running from April 1 2005 to March 31 2006. The inspection lasted from 9.30am until 12.30pm. In addition to meeting with the manager there was an opportunity to meet with one of the residents. A number of records including, staff training, staff rota and health and safety documents were seen. In addition one of the care plans was examined in detail. Attention was focused on the individual needs of the residents accommodated and how they are met in practice. The communal areas in both houses were seen. One of the residents was finding the lead up to the inspection very stressful so the home made a decision to take the resident out for the morning of the inspection. When the inspector arrived the manager reported that another of the residents was upset. They suspected that there had been an incident between two of the residents but neither resident was saying what had happened. A staff member was escorting one of the residents to her day centre and she was going to try to find out the cause. As a result it was only possible to meet with one resident prior to her leaving to attend day care. What the service does well:
The home caters for three adults each of whom has very complex and different needs. The home is run well and they make good use of specialist support from external agencies. Staff know the residents well and are skilled at picking up on subtle changes in behaviour that can be an indicator that something is wrong or that there is something bothering a resident. There is a very good system in place for seeking the views of residents and their relatives about the care provided in the home. This involves completing satisfaction questionnaires. This process was followed during the summer and a partnership day was held whereby everyone was invited to a buffet meal and the manager reported the findings of the questionnaire process and any action taken as a result of the process. The Trust offers a very comprehensive training package that is available to all staff. The manager and a senior support worker have completed NVQ (National Vocational Qualification) level three and the manager has almost completed NVQ level four. Each of the residents has a timetable of the activities that they choose to participate in. This is reviewed at regular intervals and always at residents’ reviews. The resident spoken with stated that she was very happy in her home and with the support provided to her. She also stated that she enjoyed the activities on offer. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 7 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 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: There have been no admissions to the home for some time. The manager was clear of the procedure to be followed should they have a vacancy and need to assess prospective residents. This standard will be inspected at future inspections. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The quality of care planning and risk assessments was good and it was evident that there is clear and detailed information provided to ensure that residents’ needs are met. EVIDENCE: One of the care plans and risk assessments were examined in detail. Information provided was very detailed ensuring that staff had clear advice about how to meet the individual’s needs. Where risks are perceived there is a detailed risk assessment in place highlighting the action to be taken to minimise the risk of an accident occurring. Residents are encouraged to make decisions and choices in a variety of ways such as choosing the food they eat, the clothes they wear and the activities they would like to participate in. One of the residents has recently become engaged to be married and the manager advised that the service would provide whatever support they can to enable the resident to make informed choices/decisions about her future. The manager stated that a meeting would be arranged with the resident’s social worker for the resident to discuss her
23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 10 wishes. When speaking with the resident she spoke of saving for her wedding and she was very excited about her plans for the wedding. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Residents are offered a variety of interesting and stimulating activities. They are encouraged to be as independent as possible and to make decisions about how to occupy their time. One of the residents chooses to have a poor diet. Record keeping in relation to food offered, eaten or refused and information about portion sizes needs to improve. EVIDENCE: Residents continue to have an individual programme of activities tailored to their needs and wishes. One of the residents made a decision some time ago to opt out of day care and finding suitable activities for this resident can be difficult at times. Activities she chooses to attend include: - swimming, cinema, cafes and pubs. There are limited local amenities but residents do make use of local shops and pubs. They prefer Hastings for clothes shopping. Residents are supported if need be to maintain contact with their family and friends. The manager advised that they have a good rapport with the relatives of residents. Relatives are invited to reviews and staff support the residents in relation to sending cards for special occasions.
23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 12 There are different arrangements in place in relation to menu planning. One resident does her own menu planning and cooks her meals independently. Staff plan and prepare food for another resident and records showed that she has a balanced diet. The third resident has no interest in food and encouraging a balanced diet can be difficult. Staff support her to shop twice a day so that she is encouraged to choose what she would like to eat. Records showed that some days she was eating small meals. Records for other days were not completed and it was not clear if she had been offered food, if she had chosen not to eat or if staff had forgotten to complete the records. The manager advised that the resident’s GP is aware of the problems encountered by the home in relation to promoting healthy eating for this resident. There was an opportunity to meet with one of the residents in private. She spoke very positively of the staff team and the support provided to her. She enjoys living in the home and is independent in most daily living tasks. She spoke about her plans for her future and about contact with her family. She also talked about her day activities and her desire to attend college later this year. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 The home works hard to meet the physical and emotional needs of the residents accommodated. Each of the residents are very different so different approaches are necessary. Through examination of record keeping and through discussion with the manager it is clear that the staff team know the residents well and take appropriate action if they suspect that anything is wrong. The home seeks appropriate specialist advice and support where necessary to meet the needs of the individuals accommodated. One of the residents refuses to have her weight monitored by care staff. Staff should check with the resident if she would be willing for her doctor to monitor her weight. EVIDENCE: In order to support one of the residents in relation to meeting their emotional needs a talk-time book is used. This resident sometimes find it hard to differentiate fact from fantasy and fiction so the book is used to record all information obtained in relation to this resident as factually as possible along with information about what staff said and how they dealt with particular situations. The home monitors each of resident’s behaviour closely. In relation to one of the residents who has limited verbal communication the manager advised that
23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 14 when you get to know her you are able to make a judgement about when she is under stress or upset. Subtle changes in her face can indicate that you should give her some space to calm and return later to try to ascertain what is wrong. In order to meet the emotional needs of another resident the home uses support from a psychologist. This resident requires lots of reassurance in certain situations but the reassurance has to come from the correct person and she decides whom the correct person should be. This resident also receives support from a psychiatrist. She has been unsettled recently and has absconded on a number of occasions. A multi-disciplinary meeting was held recently to discuss this resident’s needs and a further meeting has been arranged to be held in February. The home has also sought advice from a specialist in autism to identify if there is anything else they can do to support this resident. The manager advised that the police visited the home recently and were happy with the protocol in place to be followed in the event of this resident absconding again. One of the residents refuses to have her weight monitored by care staff. (See previous standard in relation to diet and record keeping). 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The complaints procedure is clear and there are good procedures in place to ensure that if abuse of any kind is suspected staff would know the procedure that should be followed. EVIDENCE: Records showed that there had been no complaints since the last inspection of the home. There is a detailed complaints procedure in place. With the exception of one member of relief staff all staff have received training on the protection of vulnerable adults. There is a new flow chart in place detailing who and when to contact if abuse is suspected. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28,30 All areas of the home seen were well decorated. Furniture provided is comfortable and homely in design. EVIDENCE: Only the lounges and dining rooms were seen during this inspection. These rooms were clean and there were no unpleasant odours present. Since the last inspection a hand basin has been fitted in one of the bedrooms. New carpets have also been fitted in the communal areas and on the stairs. On the day of inspection mixer valves were being fitted to all hot water outlets. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 The home needs to continue with their efforts to recruit to the vacant positions. There are good procedures in place to identify who has responsibility for completing tasks. Staff have attended a number of training courses and the manager is keen for this to continue in the coming year. This will obviously have a very positive impact on the home and assist staff in caring for the residents who have very complex and at times challenging needs. EVIDENCE: There was a list of tasks that are required to be completed on a regular basis listed on the wall in the office along with details of who has responsibility for ensuring that they are carried out. At the time of the last inspection a requirement was made to appoint additional care staff. Despite regular advertising and interviewing there has been only limited success in achieving this. There are now two vacancies, one for thirty-nine hours and one for twenty-nine hours each week. A team of regular relief staff cover the vacant hours. Records show that all staff (including relief staff) are provided with regular training opportunities. Courses attended in recent months include: - autism focus, POVA, first aid, food hygiene and moving and handling. The trust has a
23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 18 very comprehensive training package and the manager advised that the intention is that all staff will eventually have access to all courses available. A number of courses have been booked for the coming months and in particular the focus is on courses that are autism specific. The manager and the senior staff member have both completed NVQ level three. A third member of staff has started studying for level three and the manager reported that another carer on completion of their induction training will also start NVQ training. Records showed that all staff receive supervision on a regular basis. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42,43 The manager should have a minimum of two days a week for the carrying out of management tasks. The home has demonstrated that they listen to the views of the residents and their relatives and where they can, they make changes to improve the service they provide. EVIDENCE: The manager advised that he has almost completed NVQ level four. Rotas show that the manager generally has one management shift each week. On all other occasions he is working on shift with the residents. In the week following the inspection the manager had two management days but they were to be taken up interviewing and attending a manager’s meeting. Although it is a small service the complexity of the needs of the individuals accommodated adds to the management tasks. As part of the inspection process, comment cards were sent to the residents and to their relatives. Three comment cards were received from relatives. Respondents chose to use the tick system and no general comments were made. The overall response was very positive. However, one relative
23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 20 highlighted that they `were not informed of announced inspections’ and another stated that they are `not always’ kept informed of important matters affecting their relative. Each of the residents completed a comment card. One was wholly positive. Another was also very positive but through the process it became apparent that the resident did not know who they could contact if they were unhappy about their care. Staff commented on this form that they talked to the resident about who they could contact. The third comment card was only partially completed. The resident ticked that their privacy was respected but all other questions were either a no response or sometimes. At the time of inspection the resident was unsettled and the manager was not surprised with the responses given. Since the last inspection a satisfaction questionnaire was distributed to residents and to their relatives to seek their views. As a result of the process one resident stated that they would like a new mattress (and this has since been provided). The results of all the findings were collated and the manager presented the findings at a partnership day. The partnership day involved residents, their relatives and staff, meeting for a buffet meal one afternoon in the summer. The manager stated that it was a very good day for all concerned. The home has accreditation to the National Autistic Society. The manager advised that the accreditation would be reviewed at the end of February. All notifyable incidents are reported to the Commission without delay. There are a range of measures in place to ensure the health, safety and welfare of the residents and staff. The manager advised that portable appliance testing was carried out in December 2005. The central heating system is service regularly. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
23-25 The Warren Score 3 2 X X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 3 3 DS0000021404.V268476.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? 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. 1. Standard YA17 Regulation 17(2) Sch 4 para. 13 Requirement Timescale for action 31/01/06 2. YA33 18(1)(a) 3. YA37 8(1) Record keeping in relation to on of the resident’s diet must be more detailed showing food chosen by the resident, offered by staff, eaten or refused and information about portion sizes. Care staff must be employed 31/03/06 to fill the vacant posts. [This was a requirement of the last inspection - timescale given 15/11/05]. The manager must have a 28/02/06 minimum of two management days each week designated to the carrying out of management tasks. 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. Refer to Standard YA19 Good Practice Recommendations In relation to one resident the home should encourage her to have her weight monitored either by care staff or by her
DS0000021404.V268476.R01.S.doc Version 5.0 Page 23 23-25 The Warren GP. 23-25 The Warren DS0000021404.V268476.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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