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Inspection on 24/11/08 for Audley Court Remedial Treatment Centre

Also see our care home review for Audley Court Remedial Treatment Centre for more information

This inspection was carried out on 24th November 2008.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The wealth of information we received from people using this service was all complimentary. People told us they appreciate the help, advice and support they get from the stage where they are thinking about coming to stay at Audley Court, to its day to day management, and its care and support provided by a committed and loyal team. They spoke highly of all aspects of the services they received. One person commented, `Audley court gives the highest standard of care to all soldiers, sailors and airmen who come to stay here. The staff are truly dedicated to their work, and to the needs and welfare of all the people residing here. ` Staff were also full of praise about their workplace.They told us, `Audley Court provides a safe supportive and rewarding place for staff to work and develop.` `It works closely with other components of society to ensure the client journey though care is seamless.` On this occasion Audley Court more than met minimum standards we expect to see provided for a service of this type. The health needs of people living at Audley Court are met and the systems in place mean individuals get the care from other professionals they need. People in particular made comment about the excellent management of their psychological health care needs, and the service demonstrated this with their consistently good recordkeeping. The care team have a high percentage of staff who have attained the minimum expected care qualification, and nursing staff have developed themselves to keep up to date with current professional practices necessary for this specialist field of care and support. Although the service has been subject to a lot of disruption as a result of a major refurbishment programme, excellent management systems mean people living, visiting and working at Audley Court have continued to have a safe, spotlessly clean and comfortable place to stay.The service have recently been commended for its high standards in food hygiene and infection control by external professionals. Audley Court also provides people with an excellent range of facilities and equipment to compliment the full programme of therapeutic and leisure activities laid on by its trained staff team.

What has improved since the last inspection?

Changes to management systems at Audley Court have resulted in the seven statutory requirements we made at our last inspection being met. People using the service are now fully involved in planning their safety and well-being. As a result, care paperwork fully contains necessary details about the person it is written for, resulting in people being confident their needs will be met. A successful recruitment drive has meant staffing levels have improved, with minimal care and support provided by temporary staff, resulting in people receiving a consistent service from a knowledgeable competent team at all times. A lot of recordkeeping for staff has been redeveloped and records now show they get the majority of training they need, as well as management support for the team to develop themselves professionally. Audley Court is committed to continuously improving the service it provides, and now has thorough monitoring systems including a better complaints management system. These systems make sure there is information available to confirm to people that theyexplore and act upon opinions and suggestions of all people living visiting and working at the home. Although this service already provides a very good environment to make people feel safe and comfortable when they reside at Audley Court, the organisation who owns and manages the service are currently carrying out a major refurbishment of the premises. The layout of the home is being thoroughly reorganised to make all areas user friendly and additional facilities including extra counselling rooms and a fitness suite have been already been provided in order to improve and enhance anyone`s stay at the service.

What the care home could do better:

There were no statutory requirements made as a result of this inspection. It is considered that Audley Court Treatment Centre continues to raise its standards and is setting its own objectives for continual improvement with the full involvement of the people who use it. However, as a result of our inspection findings a total of five good practice recommendations have been made in order to improve standards at the service, which will further benefit people living and working there. The service needs to be clearer in telling people thinking about staying at the centre that the bedroom doors do not lock which means there is limited secure storage for personal possessions.Although a metal storage cupboard is provided in each bedroom, its purpose is for drug storage only, for those people who are responsible for their own prescribed medications. Systems to improve the way staff training is planned and organised are in need of further development, especially with regard to making sure all staff including new starters get the training they need within a reasonable timescale to keep them up to date so they have the knowledge and skills to meet all peoples needs. Additional management processes seen in need of update include the addition of our details to the service complaints information, as well as a review of the centre fire safety assessment to account for the ongoing building upgrade.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Audley Court Remedial Treatment Centre Audley Avenue Newport Shropshire TF10 7DR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Adams     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.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: Audley Court Remedial Treatment Centre Audley Avenue Newport Shropshire TF10 7DR 01952822700 01952811539 cmac@combatstress.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Claire Angela Evans Type of registration: Number of places registered: Combat Stress care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Staffing levels in the home must meet the minimum required throughout the 24 hr day including weekends. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. The following is the minimum staffing requirement in respect of Audley Court: 08:00-14:00 14:00-17:00 17:00-20:00 20:0008:00 RMN 2 2 2 1 Care Assistants 4 4 3 2 Sliding Scale No of Patients RMN Care Assistants 27-21 2 4 20-15 1 4 This staffing notice takes into account that the senior nursing officer is supernumerary to these figures and is normally on duty from 9am 5pm 5 days a week. Date of last inspection Brief description of the care home Audley Court is situated in Newport, Shropshire. It is within walking distance of Newport High Street and its town centre facilities, including the bus station. This unique treatment centre is provided by an ex-Service organisation. It specialises in the assessment and treatment of men and women of all ranks of the three Armed Services and the Merchant Navy who are suffering from psychological difficulties attributable to Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 27 Brief description of the care home their service. The Society has two closely linked main activities: welfare and treatment. It is one of three centres of this kind in the country. The average age of people using the service is 42 years. This is reducing annually due to the recent conflicts in Eastern Europe, Afghanistan, and the Arabia Gulf. Since the last inspection the number of admissions to this service have further increased by 50 . The treatment centre is currently in the process of an extensive refurbishment and can accommodate 27 people when it is fully operational. Bedrooms of people using the service are located on the ground and first floor of the building. Some bedrooms have been equipped for an individual to share with their own personal carer if they so wish. The premises are also equipped with a lift to make areas accessible to people of all abilities.The accommodation has several communal areas for people to enjoy, including a lounge, library, a designated smoking lounge and a purpose built activities centre with training and education facilities, which is the central focus for treatment at the centre. Audley Court makes people know about the service with welcome packs which includes details of the information we expect them to provide by law. Fee information is not included in the information people are offered when they are thinking about staying at the centre. The reader may wish to obtain more up to date information from the care service about this matter. Care Homes for Adults (18-65 years) Page 5 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: three star excellent 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: We last inspected this service on the 28th November 2006. This inspection was carried out by one inspector over two days and lasted nine hours. Some time before the inspection we wrote to the home to request some up to date information to assist with this process. This meant that although Audley Court knew the inspection was imminent they were not aware of the date or time the inspection would take place. The inspection included observing activity within the home inspecting the premises an in depth look at records for people using the service and staff as well as observing talking and listening to people living there. Several of the staff on duty at the time of the inspection also shared their views about working at Audley Court. Discussions with people were carried out in private with people on their own, or Care Homes for Adults (18-65 years) Page 6 of 31 together in groups in the lounges. Everyone was happy to share their comments which are included in the main body of the report. A total of 17 people using the service and 11 staff members also returned written comments about the service to us. Discussions with the acting manager took place throughout the site visits, and feedback about the conclusions of the inspection was given at the end of the inspection and upon receipt of all our survey information. What the care home does well: What has improved since the last inspection? Changes to management systems at Audley Court have resulted in the seven statutory requirements we made at our last inspection being met. People using the service are now fully involved in planning their safety and well-being. As a result, care paperwork fully contains necessary details about the person it is written for, resulting in people being confident their needs will be met. A successful recruitment drive has meant staffing levels have improved, with minimal care and support provided by temporary staff, resulting in people receiving a consistent service from a knowledgeable competent team at all times. A lot of recordkeeping for staff has been redeveloped and records now show they get the majority of training they need, as well as management support for the team to develop themselves professionally. Audley Court is committed to continuously improving the service it provides, and now has thorough monitoring systems including a better complaints management system. These systems make sure there is information available to confirm to people that they Care Homes for Adults (18-65 years) Page 8 of 31 explore and act upon opinions and suggestions of all people living visiting and working at the home. Although this service already provides a very good environment to make people feel safe and comfortable when they reside at Audley Court, the organisation who owns and manages the service are currently carrying out a major refurbishment of the premises. The layout of the home is being thoroughly reorganised to make all areas user friendly and additional facilities including extra counselling rooms and a fitness suite have been already been provided in order to improve and enhance anyones stay at the service. What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who use the service can be confident that there is a robust, structured system in place to assess their needs before any admission. This makes sure Audley Court is suited to meet the persons needs and wishes. Evidence: As part of the admission process any person thinking about staying at Audley Court is provided with a range of information about the service. Two sets of records looked at showed people had been issued with a welfare and treatment brochure with specific details about what this service can offer to individuals. It lists excellent details about eight recognised psychological assessment tools used, alongside nursing support they offer in order for a variety of therapies to be considered as part of any individuals health and support they may need. This shows people are made aware of what to expect at Audley Court if they decide to stay at the centre. The service also produce a corporate style welcome information pack for prospective residents which contains the Audley Court Service User Guide.This is the information we require them to have by Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: law.This information is provided in every bedroom at Audley Court for people to refer to during their stay and contains excellent details about the local facilities offered within the town of Newport itself, so people are fully informed to get out and about to explore the local community. Although the information has been improved to reflect the recent management changes it is considered that more details should be included about the security arrangements regarding bedrooms. The ethos of the service means there are no locking facilities for privacy or security reasons on bedroom doors and some bedrooms only offer secure lockable storage for medication. As people travel long distances to stay at the centre it is advisable they are fully aware of these arrangements prior to being admitted to the service so they can decide what personal belongings they wish to bring with them. Comments received from people who have recently stayed at Audley Court confirmed they were extremely pleased with the way their admission had been managed. One person also confirmed he had been fully briefed about the service by his welfare officer.Other comments reflected challenges about the lack of bedroom door locking facilities. This matter was discussed with the management team during the inspection. There is a very structured assessment system prior to admission. Following referral, a representative from the welfare department of the organisation visits the individual and carries out an assessment report. Audley Court management and staff then make a clinical judgement based on this assessment and any other clinical reports available. If accepted, all necessary safety assessment paperwork is completed and the person is then offered the opportunity to be admitted to Audley Court for a full assessment week. This gives the centre further opportunity to decide if they can continue to fully meet the needs of the person.The assessment week also provides individuals with an opportunity to make an informed decision about whether they wish to pursue the service further. Audley Court is a national resource. Due to geographical distance service users do not generally visit for the day pre admission although this is an option open to them. The first week assessment visit serves as the trial visit. Care Homes for Adults (18-65 years) Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive.This means people can be confident the service will meet their needs. Evidence: As part of this inspection we conducted a satisfaction survey with the people who have experienced life at Audley Court. All 15 people we asked to complete comment cards returned them. In addition, two other people living at the service at the time of the inspection provided us with their written comments. Their unanimous responses confirmed they are treated well, are fully involved in their personal care and support packages and are treated with respect at all times by a knowledgeable supportive care team. Several people wrote, Audley Court provides an excellent service. Another commented, Audley Court gives the highest standard of care to all soldiers, sailors and airmen who come to stay here. The staff are truly dedicated to their work and to the needs and welfare of all the people residing here. A group discussion with people Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: staying at the centre the week of the inspection was equally complimentary. At our last inspection two statutory requirements were made to improve the recordkeeping to account for the individualised needs and choices regarding the safety care and support people receive at Audley Court. An in depth look at the records of two individuals who were currently living at the service confirmed this process has improved, and the requirements have been fully met to a very professional standard.A good recordkeeping system is now in place to identify the physical, psychological and safety needs of people are being met. The nursing team provisionally formulates care plans in readiness for a persons admission to the centre, and from the point of the individuals admission they sign their records to show their full agreement and involvement in this process. Excellent care records confirm staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. All care plans focus on the individuals strengths and personal preferences and how they will be met through positive individualised support. All care records have goals, and agreed interventions to manage individuals needs. For example, one person requiring anxiety management had agreed that alternative therapies, relaxation therapies and counselling on a one to one basis as agreed treatments to manage this need. As part of their involvement, staff and individuals devise and agree a timetable of their treatment sessions. This means that people know exactly what they will be doing during their stay at the centre. It is positive this process also includes the use of an assessment questionnaire to explore what hopes people using the service hope to get out of their admission and treatment programme.This is revisited as part of the service discharge process. Before the inspection, information Audley Court sent us stated, Our service places a strong emphasis on client choice autonomy structured goal setting risk assessment and empowerment. The above findings confirm this statement to be accurate. Care Homes for Adults (18-65 years) Page 14 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 excellent 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 have opportunities for personal development through the availability of a wide range of planned activities and therapies, both in house and as part of the community.This means people can expect to be informed of social, educational ,cultural and recreational activities planned and available to meet their needs. Evidence: Activity staff are provided in addition to care staff. They plan and deliver an extensive and varied social, recreational and occupational programme which involves activities such as community outings, sporting activities, arts and crafts, healthy living groups and cookery sessions in the training kitchen. A wide range of these types of activities were seen advertised on the activity notice board adjacent to the reception area. Details of other activities they are welcome to join in with as part of the local Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: community are also advertised.These included details of local churches and places of worship. People told us that if they do not wish to take part in organised activity they usually take the time to rest between their therapy sessions or visit local towns and places of interest independently as they wish. Three trips out to nearby local attractions were seen organised for the week of the inspection. During the inspection visits, people were engaged in a range of different activities. Some were out for the day and some were using the library and many were involved in therapy sessions. People also said they regularly use the facilities in the computer suite. In addition to the above leisure activities the service clinical programme provides stimulating activities to meet individuals needs. Specially qualified staff run group sessions to deal with issues such as emotions, sleep, and self esteem.They offer a whole range of complementary therapies including Indian head massage reflexology and aromatherapy. The service also employs an external teacher to hold tai chi sessions. In better weather conditions staff told us the people using the service enjoy using extensive grounds, gardening facilities and outdoor games and equipment of Audley Court. People told us visitors were welcome, and this happened mainly at weekends if loved ones lived some distance away.However, a pay phone is available as are email facilities to help service users to stay in touch with family and friends although individuals told us that they tend to use their personal mobile phones for this purpose. The dining room provides a restaurant style setting for meals with ample space, quality soft furnishings and table dressings. People using the service expressed a high level of satisfaction about the quality and choice of meals provided. They are always welcomed to make suggestions about the menu as part of their admission. People spoken to said the staff always checked their dietary needs as part of their admission and always asked about food allergies. The management team were also proud to share with us good news about a recent 5 star award they had received from Telford and Wrekin Council Environmental Health Services for their excellent catering standards. 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 excellent 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 services of Audley Court receive the care and support they need in a way that promotes their good health. Drug management systems ensure people are involved in the control of their medication to make sure they receive it as it has been prescribed for them. Evidence: Comments received by people using the service were unanimous to confirm they receive effective personal and healthcare support during their stay at Audley Court. Feedback from people who have stayed at Audley Court more than 10 times in recent years told us that the service has gone from strength to strength. We received many comments such as, The staff are efficient and professional. They are approachable and helpful. You are always treated and respected as an individual. Ample time is given to so we can be involved in making decisions about what we do each day. The purpose of Audley Court is to provide treatment for psychological trauma by offering a range therapeutic interventions suited to the assessed needs preference and ability of the individual. An in depth look at the recordkeeping for two people using the service Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: confirmed staff are highly aware of their role to offer support. As a team the staff respect the preferences of people using the service, and demonstrate expert knowledge about individual personal needs, to offer any available and appropriate professional psychological support. Records seen showed people were offered a full programme of support including one to one counselling, cognitive behavioural therapy, creative therapy and relaxation techniques. Paperwork also confirmed the staff team responsibility to be alert to any persons changes in mood, behaviour and general wellbeing and how they should respond and take action. A key worker system has been developed during the past 12 months to improve this support process so a more coordinated and structured approach to treatment planning and delivery is now in place. People told us this meant the care they received from admission to discharge was more individualised. The service also arranges for health professionals to visit residents when necessary, and have an established rapport with a local GP and the community nursing team. The service has also been successful in appointing its own clinical psychologist, who will be providing advice and support 30 hours a week, from early 2009. Audley Court also liaises with care specialists local to the permanent address of a person for ongoing advice and support to help the individual, and their family when they return home. Audley Court also fully respects the rights of people in the area of medication. They recognise and work with the decisions made by a person regarding any specific requests about how their medication is managed. As part of their admission, people are fully involved in a safety assessment, which will determine whether an individual will be responsible for their own medication during their stay at Audley Court. On the week of the inspection, four of the people living there were in agreement for the care team to have this responsibility on their behalf. Review of the service medication management systems showed these were being managed safely and professionally. Knowledgeable nursing staff showed us the robust systems which are in place to account for the safe receipt, storage and disposal of medications. These are checked weekly as part of the nursing team audit and confirm that the service medication policy is put into practice. The service has a designated secure drug storage area, and all rooms allocated to people living at Audley Court have appropriate metal locking storage for their medications. However, some bedrooms do not offer alternate safekeeping facilities for valuables, and this means people use their medicine cabinet for this purpose. This matter was discussed at the time of the inspection. 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. People know how to complain and are protected through the homes complaints and safeguarding adults procedures.Staff are fully aware of their role in protecting residents from abuse.This means people using the service can be confident they will be protected from abuse and have their rights protected. Evidence: Audley Court actively welcomes comments in order to improve the service they provide. 100 of written comments received from both the people using the service and staff team were unanimous that they knew what to do if they had to express a concern or make a complaint. One person commented, We are all well looked after and have no complaints. Another person wrote, On admission you are given a client folder. In this folder is a complaint form plus a guide how to make a complaint. Review of the folder showed the company complaints is clearly written and easy to understand, however it lacked the details to inform people how they could contact us, the commission if they wished to share any information with us. It is positive staff receive training how to manage any concerns people might raise when they start working for the service.100 of staff who responded to our survey confirmed they knew what action to take if anyone was not happy with the service at Audley Court. Review of the complaints management system confirms the service keeps a full record of complaints, which includes details of the investigation and any Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: actions taken. Evidence seen also demonstrates they make system changes as they learn from complaints. Examination of Audley Courts complaint log showed that they had received three complaints in the past 12 months and all have been acted upon and investigated appropriately. We are not aware that Audley Court has been involved in any safeguarding adult referrals or safeguarding adult investigations. 100 of comments we received from the staff team confirmed they are fully aware of their role in protecting people living at the home from abuse. Recordkeeping carried out as part of a persons admission to the home clearly identifies protection of the resident is paramount, and accounts for their safety in a variety of ways, including the safe use of equipment in the home such as recliner chairs, minibus seat belt safety, and electrical equipment safety. However as recorded earlier in the report, systems do not fully cover valuables management. This matter was further explored and although people are aware of the availability of the safekeeping facilities in the office, their paperwork does not account for it. It is positive the Assistant Manager of the service has recently undertaken managers training in safeguarding adults in September 2008, and is in the process of improving recordkeeping to account for staff training for this matter. When we reviewed staff training records it was not clear when people had received this aspect of training. A system which identifies staff receive this training when they start work for the service and as part of their ongoing development will reflect good practice for this sensitive issue. The above matters were discussed with management at the time of the inspection, and immediate action was taken to ensure permanent improvements to this part of the service would be carried out. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: People who made comments to us about the home were in agreement that the home always smelled fresh and had a welcoming clean and tidy appearance. These comments were confirmed upon an extensive the tour of the premises. Furniture, fittings and decor are immaculate and are provided to a high specification. Communal bathrooms and toilets are spotlessly clean and furnished with grab rails to ensure safety and independence for less mobile service users. Spot checks of hot water temperatures in these areas were all satisfactory. The home domestic assistants are to be commended for their efforts as the home has been subject to extensive refurbishment for some time, which has made their cleaning duties more challenging. There has been continued progress with the upgrade of the Audley Court. Before the inspection we were provided with a wealth of details to inform us of the improvements Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: that had been carried out. The laundry has been relocated and fully refurbished with new equipment. Personal protective equipment seen on hand in this area makes sure staff can handle soiled laundry effectively. Three new counselling rooms, a new kitchenette and an upgraded library were also seen,and a new fitness room was also in the progress of being fitted out. The recently installed disabled shower and toilet we saw is a popular facility which is regularly used. Two people using the service also commented that the new ventilation system installed in the designated smoking area was also a godsend. The service continues to have specialist accommodation for a person to bring their own carer to stay with them, although demand for this has dropped during the past year. New lampshades and bedside lamps have also been provided in all bedrooms for people using the service. People we spoke told us they were happy with their bedrooms although they suggested master key systems might be beneficial to improve privacy and security. They did comment Do Not Disturb signs were available, and this aspect of the accommodation had not deterred them from returning. No females were staying at Audley Court during the time of the inspection. The newly built activity centre continues to be fully operational with its a computer suite, training kitchen, and a large communal space for groups, arts and craft, Externally, the extensive gardens are very well maintained. The service told us that they were winners of Newport in Bloom garden competition for the tenth year in a row. Garden furniture and garden games are available, and leisure equipment such as golf equipment and bicycles are kept in good order for people to use. As recorded earlier the home has been inspected by the environmental health officer who confirmed the home was exceeding food hygiene regulations. the environmental health officer commented Audley Court had very high standards of food safety legislation. Systems to improve infection control have been maintained since our last inspection. As a result the service scored 99 in a recent infection control audit of their hygiene practices for this matter. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents.People living at the home are supported and protected by the homes recruitment policy and practices.This means people can have confidence in the people who care for them. Evidence: Favourable comments received from people living at the Audley Court confirmed that they receive the care and support they require. One person commented, They are the only people that many of us can speak to and it is a great help knowing that they are here should I need to come back in the future. Examination of past, present and future rotas between the months of October to December 2008 confirmed the home is adequately staffed and takes into account the dependency needs and numbers of people living at the home.Rotas have also been planned and organised in line with the home refurbishment programme. Information recorded on the team rotas confirm a good skill mix to be on duty at all times, and clearly identify when the management team is on duty. The rotas also identify when team members are allocated for training and development time, and activities with people using the service. Information provided for us by the management confirmed the home has been satisfactorily staffed in recent months. The home has recently had a successful recruitment drive which has Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: resulted in the use of agency staff to be minimal. Only one shift was covered by temporary staff in the month leading up our inspection. Audley Court management also employs administration, housekeeping, catering and laundry staff to ensure smooth running of all aspects of the home. Examination of the files for two recent new starters showed that suitable recruitment procedures are in place. Each file was well-organised and contained references, criminal record bureau disclosures and confirmation of identity and qualifications. Before our inspection the home told us they had a staff training programme which met National Minimum Standards. However, examination of the records of two new starters showed this was not the case. Audley Court have not been recording staff induction training in line with national guidance like they did at our last inspection. Records seen contained a brief checklist of topics which lacked necessary detail to confirm people had received a structured introduction to working at the home. Discussion with employees and the management team on the inspection day also confirmed staff had been working at Audley Court for more than 12 weeks prior to receiving their formal induction training. However, staff comments sent to us indicated that they are clear regarding their role and what is expected of them. Staff were unanimous they had excellent training opportunities. They told us, The training at Audley Court has helped me develop my nursing skills in accordance with National Institute for Clinical Excellence guidelines. It provides a safe supportive and rewarding place for staff to work and develop. 80 of the carers have the minimum expected care qualification, and nursing staff have undertaken specialist training for conditions such as post traumatic stress disorder and a variety of specialist behavioural therapies necessary for the treatment of people living at the service. Plans are also being made for two staff members to visit a leading specialist unit in Australia that supports individuals with similar needs to those who use Audley Court. Although the service use a notice board as a training monitor along with computerised records to track staff training and development, our findings confirmed some training needs had not been managed effectively.The service could do with a better system to monitor mandatory training to ensure it gets planned and carried out within the expected timescales necessary to comply with health and safety legislation.Training information seen for six staff members in their files and on data printouts identified this has been a challenge. Records to evidence staff get the supervision they need to develop themselves show this aspect of staff training to be in hand.Staff comments also confirmed this. One person wrote, I am happy that I am clinically and professionally supported by my colleagues and Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: managers. Two members of the management team also confirmed they were booked on a 3 day workshop for this matter during the week of the inspection. 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 excellent 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 receive a safe,consistent and good quality service.This means they can be confident that their needs will be fully met. Evidence: The Registered Manager for the service Claire Evans, has been on planned extended leave, and during this time an appropriately qualified and experienced member of the management team has been acting in this role. Information seen before and during the inspection visit confirmed the home has been managed effectively during this time. The service also has a facilities manager as well as an assistant manager to support this person in his role. The management team are to be commended for their efforts as it has been a particularly challenging time to manage the service.Admissions have increased by 50 during the past year, and many parts of the have been upgraded as part of the ongoing refurbishment programme. Prior to our inspection,the acting manager submitted an excellent annual quality assurance assessment (AQAA) to tell us about Audley Court. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. The AQAA contained Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: comprehensive information with a wide range of supporting evidence, some of which was seen during the inspection. The AQAA demonstrated a high level of understanding about the importance of equality and diversity and a range of evidence showing how they have listened to people who use the service and the staff team. Through this information the service have demonstrated self-awareness and identified the areas in which it still needs to improve. Discussions with the management team during the inspection gave evidence of how the improvements were to be achieved - including the issues we have recommended be prioritised in this report. There is an ongoing programme of monitoring and auditing all aspects of the service at Audley Court .Management have set up three monthly forums to focus on how the service can be improved.One person told us, Audley Court continually audits all aspects of care and staff performance. It strives to improve. In August 2008 a staff satisfaction survey had very positive outcomes and the service have already made improvements as a result of it. Staff also told us any suggestions they make to improve the service are welcomed at their regular team meetings. People who use the service are fully involved in evaluating their care and support. Suggestions they made to improve their treatment groups were listened to and acted upon, and as a result some sessions now last longer and others are held for smaller groups of people. In addition to monthly quality monitoring visits, the service also gets a detailed three monthly audit by the quality services director.The last one was carried out in September 2008. Safe working systems in the home have continued to ensure good management of monies and valuables kept in safekeeping for people using the service. Review of the records of three people confirmed this system to be robust and that company policies were being followed. Many service and maintenance records for essential equipment used in the home were seen to be up to date and complied with necessary health and safety legislation. The home has effective recordkeeping systems for accidents, which meets all health and safety and data protection legislation. Any accident reported has evidence of its follow up and review by management. During the inspection the fire alarm was triggered by workmen involved in the home upgrade. This was managed appropriately and effectively.Fire safety records seen in fire log book were excellent. The sevice also have a printout system to monitor times of any fire alarm testing or emergency. However, examination of the fire risk assessment for the service showed it needs further expansion to include interim measures being taken to account for the effect the prolonged refurbishment may have on the fire alarm system. 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 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 1 It is recommended the information people receive about the service before their admission tells them that the bedroom doors at Audley Court do not have locks.This will make people fully aware of this arrangement as they make the decision whether the service will meet their needs. In order to fully comply with medication stroage legislation and maintain security of medicines stored on the bedrooms of people using the service it is recommended the metal locking facility provided is used solely for medication storage. This will offer assurance to people using the service that there is less risk of medication being mislaid or stored inappropriately by reducing access to this facility. It is advised the service expands their complaints procedure to include CSCI contact details.This will mean people using the service will be provided with all of the information they need if they wish to consider reporting a complaint or concern. That all new starters have evidence to confirm they have received structured induction training within six weeks of their appointment in line with Skills For Care common Induction standards. This will assure people using the service that they are being cared and supported by a fully trained staff team. 2 20 3 22 4 35 Care Homes for Adults (18-65 years) Page 29 of 31 5 42 It is advised the home fire safety risk assessment is reviewed regularly in line with environmental changes as they occur during the home refurbishment programme, so that it accounts for any impact this may have on the fire detection system and any changes to evacuation procedures.This will ensure people using the service can be cnfident all aspects of their health and safety are being attended to. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. 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