CARE HOME ADULTS 18-65
23-25 The Warren Farthing Hill Ticehurst East Sussex TN5 7QY Lead Inspector
Caroline Johnson Unannounced 31 August 2005 2.55 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 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 Stationary 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 H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service 23-25 The Warren Address Farthing Hill Ticehurst East Sussex TN5 7QY 01580 201448 Telephone number Fax number Email 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) Ltd Stephan Barton Care Home 3 Category(ies) of Learning disability (LD), 3 registration, with number of places 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That only service users with an autistic spectrum disorder may be admitted. 2. The maximum number of service users to be accommodated will be 3 (three). 3. That the service users will be aged 18 (eighteen) and under 65 (sixty-five) years on admission. Date of last inspection 9 November 2004 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 H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1 2005 to March 31 2006. The inspection lasted from 2.55pm until 6.00pm. In addition to meeting with the manager there was an opportunity to speak with two care staff. 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. The communal areas in one of the homes were seen. Bedrooms will be seen at the next inspection of the home. There was an opportunity to meet with one of the residents. As the visit was unannounced, one of the residents found the visit difficult. The next inspection will be announced and it is hoped that with planning and preparation the residents will find the experience less intrusive. What the service does well: What has improved since the last inspection? What they could do better:
At the time of inspection there were three staff vacancies, which in total means that there are 117 hours vacant each week.
23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 6 There were a number of regular relief staff covering the vacant hours and the rota indicated that staffing levels were satisfactory. However, it is essential that the vacant posts be filled as a matter of priority. A number of dates have been arranged for staff to receive core training throughout the year. This mainly includes training in moving and handling, first aid, basic food hygiene, fire safety and infection control. Once completed training is then provided on courses that are more autism specific. It is recommended that rather than waiting until the core training is provided some of the dates for the autism specific training should be brought forward. The temperature of hot water accessible to residents is currently not controlled at the point of delivery. There are written risk assessments in place. However, it is essential that these assessments be reviewed to consider safety implications. If it were to be assessed that there is a significant risk of an accident/incident occurring then the water would need to be controlled to a safe temperature at the point of delivery. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 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 standard(s) 1,5 There is a detailed statement of purpose in place. Prospective residents are provided with detailed information to assist them in their decision about accommodation. EVIDENCE: There is a detailed statement of purpose on place which as been updated to include details of the new manager. There are documents listing the facilities provided for residents, details of the aims and objectives of the home and a placement agreement. Together these documents form the service user guide for the home. The placement agreement is in a pictorial format. Records showed that the document is signed by the manager and by the residents. In respect of the last resident admitted to the home a staff member had also signed to say that she had read through the document with the resident. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 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 standard(s) 6 The care plan seen included detailed information and it had been reviewed at regular intervals. It is now time to include some goals/aspirations that the resident would like to work towards along with advice for staff to assist the resident to achieve them. EVIDENCE: One resident’s care plan was seen during this inspection. A detailed assessment of the resident’s abilities and needs had been carried out. Two reviews had been held of the care plan and the arrangements in place for the resident. Specific guidelines are in place to ensure consistency in approach and to provide security for the resident. Individual goals had not been identified and the manager advised that goals would be agreed with the resident in the near future. One of the staff team has just completed a course on risk management. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 10 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 standard(s) 11,12,14 Day activities are varied and are arranged to meet each individual’s needs and wishes. Residents are encouraged to make decisions such as the food that they eat and emphasis is placed on encouraging residents to be as independent as possible. EVIDENCE: Each of the residents has an individual timetable of the activities that they participate in. One of the residents works two days as a kitchen assistant. She also attends a day centre two days a week and also enjoys activities such as horse riding and fitness classes. Another resident attends a day centre parttime and further activities such as aromatherapy are arranged via home staff. The third resident chooses not to attend any formal day activities but she enjoys regular trips to a cattery, swimming sessions and shopping trips. One of the residents spoken with stated that she likes to plan and shop for her own meals. On the evening of the inspection she stated that she wanted to cook later in the evening, as it was too hot to eat. Another resident is supported to cook her own meals and staff cook for the third resident. There is a holiday allowance in place. One of the residents had already been away on holiday and she spoke very positively of the experience.
23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 11 The manager advised that one of the residents doesn’t like holidays so it has been agreed to arrange a number of day trips so that she can still take advantage of her allowance. The third resident has not been away before with the home so a weekend trip will be arranged and if this is successful a second trip could then be arranged. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 12 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 standard(s) 20 The arrangements in place for the storage and handling of medication are satisfactory. EVIDENCE: Records seen in respect of medication administered to residents were in order. Training in medication is currently provided in-house although the manger advised that staff would be receiving more formal training via their head office. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 13 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 standard(s) 22 There is a detailed complaint procedure. Residents are encouraged to raise any concerns that they have and when they do their concerns are investigated thoroughly. EVIDENCE: As required at the last inspection of the home, the complaints procedure has been updated to reflect that the Commission can be contacted at any stage of the complaint process. There was one complaint recorded. Records showed that the complaint was dealt with appropriately and that the complainant was satisfied with the outcome. The manager advised that training in adult protection and prevention of abuse will be provided for all the staff team this year. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 14 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 standard(s) 24,28,30 All areas of the home seen were well decorated and homely in design. EVIDENCE: 23-25 the Warren consists of two, two bedded houses. The second bedroom in one of the houses is used as an office/sleep-in room. Only the lounge and dining room in one of the houses was seen during this inspection. The areas seen were clean. All other areas will be seen during the next announced inspection of the home. An intercom is used to facilitate communicate between both houses at night. During the day when there are residents at home, there is a member of staff working in each of the houses. An assessment has been carried out to determine the wishes of residents in relation to installing washbasins in their individual bedrooms. Two of the residents have indicated that they do not wish to have a washbasin installed. A washbasin is due to be installed one of the bedrooms. Since the last inspection all the staff team have received training in infection control. This has consisted of viewing a video and completing a questionnaire. Further training is to be provided via the head office. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,36 Although the home has regular relief staff that are used to cover the vacant posts it is essential that the vacant posts are filled as a matter of priority. Rather than waiting until all the core training is completed first, new staff should be given opportunities to have access to autism specific training as soon as possible. EVIDENCE: At the time of inspection two care staff had almost completed induction. One of these staff members had already signed up to an NVQ at level three and had started the course the week prior to the inspection. Another member of staff has completed NVQ training and was awaiting her certificate. There were staff vacancies for 117 hours each week. The manager advised that in the past eight months there have been at least six recruitment days but they have been unable to recruit to the positions. To cover the vacant posts there are a number of regular relief staff that work in the home. The staff rota showed that the staffing levels were satisfactory. Apart form NVQ training, relief staff have access to all other training courses that are available to permanent staff. The manager advised that his priority is to ensure that all staff have attended the core training offered by the company. At the time of inspection there were a small number of staff that still needed to attend courses in moving and handling, basic food hygiene and first aid and dates had already been set for this to happen throughout the year.
23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 16 Once these courses have been completed more specific training on autism will be arranged. Staff spoken with stated that they receive formal supervision every other month. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42 There is a good and clear communication system between the staff team and this assists in enabling them to provide a consistent approach to meeting the individual needs of the residents accommodated. Risk assessments in relation to the unregulated hot water need to be reviewed at regular intervals to safeguard against the risk of accidents/incidents occurring. If it is assessed that there are any significant risks presented then safety valves should be fitted to hot water outlets. EVIDENCE: The registered manager is currently studying for the Registered Manager’s Award. A staff member spoken with described the manager as `totally supportive’. She also stated that everyone is encouraged to participate in the regular staff meetings and that staff feel that their individual views are valued. The handover between two shirts was thorough and in addition to receiving a verbal handover the member of staff coming on shift read through the home’s diary and message book and a talk-time book in use for one resident. The home has accreditation with Investors in People.
23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 18 Hot water temperatures accessible to residents on the day of inspection were well in excess of the agreed safety limits. Hot water is not controlled at the point of delivery. Two of the residents do not require assistance with bathing the third resident requires staff support. There are written risk assessments in place to safeguard against the risks of accidents/injuries occurring. These risk assessments need to be reviewed. All of the staff team are to receive training in health and safety next year. 23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x x x 3 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 x 3 x x x Standard No 31 32 33 34 35 36 Score x 3 2 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
23-25 The Warren Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 x x x 2 x H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 20 NO 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. 2. 3. Standard 33 35 42 Regulation 18(1)(a) Requirement Care staff must be employed to fill the vacant posts. Timescale for action 15 November 2005 15 December 2005 31 October 2005 18(1)(a)(c Arrangements must be made for )(i) staff to receive more autism specific training. 13(4)(a)( Written risk assessments carried b)(c) out in relation to safety implications of hot water accessible to individual residents must be reviewed. If considered that there is a significant risk to residents then hot water must be regulated to a safe temperature at the point of delivery. 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 6 Good Practice Recommendations In respect of one resident, individual goals/aspirations should be identified in their care plan along with details of the action to be taken by staff to assist the resident to achieve them. 2.
23-25 The Warren H59-H10 s21404 23-25 The Warren v222951 150605 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection 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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