Inspection on 28/11/06 for Audley Court Remedial Treatment Centre

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Audley Court Remedial Treatment... 24/11/08

Audley Court Remedial Treatment... 21/03/06

Audley Court Remedial Treatment... 03/10/05

Audley Court Remedial Treatment... 08/03/05

Audley Court Remedial Treatment... 09/11/04

Audley Court Remedial Treatment... 05/03/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME ADULTS 18-65 Audley Court Remedial Treatment Centre Audley Avenue Newport Shropshire TF10 7DR Lead Inspector Deborah Sharman Unannounced Inspection 28th November 2006 09:15 Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Audley Court Remedial Treatment Centre Address Audley Avenue Newport Shropshire TF10 7DR 01952 822700 01952 811539 cmac@combatstress.org.uk www.combatstress.org.uk Combat Stress 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) Miss Claire Angela Evans Care Home 27 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (27) of places Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 RMN Care Assistants Sliding Scale No of Patients Assistants 27-21 20-15 RMN 2 1 Care 4 4 2 4 14:00-17:00 2 4 17:00-20:00 2 3 20:00-08:00 1 2 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 Service: Audley Court is registered with the Commission for Social Care Inspection to provide personal care and accommodation for 27 people with a Mental Disorder. Audley Court is situated in Newport, Shropshire. The Society was founded in the immediate aftermath of the First World War. For over 80 years, it has been the only ex-Service organisation specialising 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 their service. The Society has two closely linked main activities: welfare and treatment. The age range of the client group is between 19 and 90 years of age. At the Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 5 time of the inspection there were 27 people in residence. The Registered Manager is Claire Evans. She is line managed by Mr Leigh Skelton, the Clinical Director and Responsible Individual. The home has been audited by the Health and Social Care Advisory Service with a view to becoming a centre of excellence for the treatment of Post Traumatic Illness. In November 2005 a purpose built activities centre with training and education facilities was completed and now is the central focus for treatment at the centre. The age of the Service Users at Audley Court is reducing annually due to the recent conflicts in Eastern Europe, Afghanistan, and the Arabia Gulf and since the last inspection referral rates to the home have increased by one third. Audley Court provides an excellent standard of service in many areas and there is a very high level of satisfaction amongst service users. Although seven requirements for improvement arose from this inspection the Organisation and Manager had identified some of these areas that require improvement. The home is registered to care for service users with Mental Disorder arising from psychological trauma. Given this, omissions in responding to identified risk of self harm are considered to significantly impact upon service user safety. Therefore at this inspection, Audley Court is judged to provide a good rather than an excellent service overall. Compliance with meeting the new requirements will be assessed at the following inspection. Fees are charged on a daily basis and range from £177.07 to £235.00. However Audley Court wishes to make it clear that residents at the home do not meet these charges as they are met by the Veterans Agency funding or charitable funding. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection meaning that all key national minimum standards were assessed to judge the performance of the home. As the inspection was unannounced nobody connected with the home received prior notification and were therefore unable to prepare. One Inspector conducted the inspection over a nine-hour period arriving at 9.15am. The newly registered Manager joined the inspection at 10.30a.m and supported the inspection process throughout the remainder of the day. A variety of methods were used to gain evidence including discussions with the Registered Manager, Facilities Manager and Senior Charge Nurse, a tour of the ground floor accommodation and newly built activity centre and assessment of documentation including assessing in detail care provided to one service user. The Inspector was able to verify documented care through discussion with this service user and with his permission, was able to see his bedroom. The Manager, service users, relatives and Professionals who visit the home provided information to CSCI prior to inspection. This information in conjunction with events known to CSCI since the last inspection was used to focus the plan for the inspection and issues requiring clarification were explored. The Inspector was also able to talk generally with two other service users and a group of service users during the tour of the premises. Outcomes for service users are clearly excellent with a very high degree of satisfaction. The nature of comments made about the service to the Inspector prior to and during the inspection is, in the Inspector’s experience, unprecedented and the Organisation, Manager and all staff within the home are to be commended What the service does well: There are a number of areas that the service does very well indeed. There is a high level of service satisfaction and service users independently commented on the professionalism and approach of staff. Service users strongly feel that their needs are known, that they are understood, responded to sensitively and that promises made are honoured and appropriate care is delivered. Service users consistently commented that all staff are always smiling and that nothing is too much trouble. All service users said that Audley Court is a sanctuary that they wish they could attend more frequently and Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 7 benefit from the treatment and care provided. They are also very satisfied with the facilities provided, the cleanliness of the facilities, the range and quality of food and the activities on offer. Service users spoke positively about pre admission processes stating that they are supported, reassured and provided with sufficient information to make a decision about whether or not to accept the offer of a place. Inspection showed pre admission processes to be excellent. Inspection also showed staff to be recruited safely for the protection of service users who also stated that they feel safe at Audley Court. Samples of service user comments are as follows: • ‘I don’t know what I would do if we didn’t have this place and professional help. ……They have my utmost respect here at Audley Court. Its our only safe haven’. ‘Home from home’… Staff are… ‘100 brilliant’. ‘An outstanding care centre in every way. I would be very hard pressed to think of any way in which it could improve. It has made a major difference to my quality of life’ ‘There is never anything to complain about’ ‘Combat Stress at Audley Court is the safest, most caring and dedicated place I know, the food is excellent, the grounds are excellent, the accommodation is excellent. Do not change a thing because Audley Court is excellent’ Excellent levels of cleanliness in private and social areas, cleaning staff very conscienscious’ Every member of staff has been professional to the highest level and the care given to every aspect of my stay has been very touching to me, thank you. I have always found that at Audley Court you are given more than ample scope to choose, and are usually very unrestricted, thanks to their approach to clients’ There is a well structured complaints procedure which clients are acquainted with and complaints forms are available in client packs in rooms.’ ‘I have always found their approach to me as a client impeccable’ and treatment has helped me to move forward thanks to the diligence and professionalism of my own lead nurse. ‘All in all they provide an outstanding service from the top downward within the environs of Audley Court’. • • • • • • • • • Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 8 • • • • • • • ‘All staff are fantastic people who want to do everything they can to help’ ‘Even if you don’t wish to do anything that day the staff will always make sure that your feeling ok’ ‘What I’ve seen who would make any complaints? This is every persons dream’ ‘There’s more cleaning staff that do a good job than in a 5 star hotel’ ‘It doesn’t matter who the member of staff is, they all know who you are and ask if you need anything’ ‘At any time the staff will listen to you and will take action on your request. They will check you are comfortable through day and night’ ‘If there were more places like this with the same staff as we have here the world would be a happier place’ What has improved since the last inspection? CSCI did not issue requirements for improvement at the last inspection. However since the last inspection, following a period of staffing shortages as a result of sickness absence the Organisation has approved funding for the employment of an additional qualified nurse and she was expected to take up post within a few days. In addition a Specialise Nurse post has been created where the post holder provides support to families of service users and supports service users with particularly complex needs. A Quality Manager has also been appointed corporately with a view to improving the Organisation’s Quality Assurance systems. Significantly too, an activity centre has been purpose built and since the last inspection is now operational. This houses a computer suite, a kitchen and in the large room there is plenty of space for arts and crafts, group work and a screen to show popular sporting events. This has released pressure on space in the main building. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 9 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 10 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 11 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 Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4. Quality in this outcome area is excellent. Service users can be confident that there is a robust, structured system in place to assess potential service users needs before admission. When it is judged that the home cannot meet applicants’ needs, they are not admitted to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a very structured assessment system prior to admission. Following referral, a representative from the organisation’s welfare department visits the service user, carries out an assessment and produces a report. The Manager and staff in conjunction with medical reports that will have been obtained then make a clinical judgement. The service user if accepted is then offered the opportunity to be admitted to Audley Court for a full assessment week. This gives the home a further opportunity to decide if they can meet the service users needs. The assessment week also provides the service user with an opportunity to make an informed decision about whether s/he wishes 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 week’s assessment visit serves as the ‘trial visit’. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 13 From inspection of documentation pertaining to the service user whose care was looked at in detail, there is good evidence that the home adheres to its admission processes and that the home is confident pre admission, that they can meet the needs of service users admitted to the home. The Inspector saw written evidence that the home turns down service users for admission where they believe they cannot meet assessed need. Service users whose application for admission is turned down receive a full explanation of why in writing. Emergency admissions are not made to the home, as service users in crisis would not benefit from treatment programmes that the home offers. The Inspector discussed admission experiences with a service user who said the experience was very positive and reassuring and that plenty of information had been provided. He confirmed that he had had total choice about whether to accept the offer of a place. Risk assessments are carried out pre admission Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 14 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate on the whole. Staff are unfamiliar with a new care planning system and this has adversely affected quality. Response to an identified risk has been insufficient. This overtly compromised the safety of one service user and compromises others where similarities exist. Whilst this is poor there was no other evidence of care being compromised and service users remain delighted with the quality of care provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are struggling with newly introduced computerised care planning systems and require more training. As a result the care plan of the service user whose care was audited consisted of a number of care / treatment objectives. Guidance as to how these objectives would be met was omitted. However other documentation shows steps had been taken to meet these needs and care records showed appropriate care and treatment was being provided. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 15 Old style care plans contain better detail about how needs would be met, are kept under review and are amended when required. Care plans are not put in place to meet need during the first assessment week stay as this week is used to assess what care is needed and a care plan is agreed at the end of this first week. This could arguably be justified for the service user whose care was audited. However another service user on his first admission to the home had some specific needs over and above those requiring treatment where a care plan is needed to guide staff intervention during this assessment period e.g. epilepsy and a known specific behaviour trigger. Furthermore the Manager expressed concern that there may be times when service users are admitted and discharged without there being a care plan because of lack of clarity over who is responsible for putting this together. Whilst this was not evidenced at inspection, the Manager was aware of the need for a general improvement in care planning systems stating she ‘is on the case’. Risk assessments are carried out either pre admission or on the day of admission. The Manager stated an intention to review how risk assessments are carried out generally, the aim being to include service users more in the process which determines either risk posed to them or by them. This would be good practice. Control measures were not in place for a service user who had a long and relatively recent history of suicide attempts. The service had assessed this service user to be at medium risk but no action was taken to safeguard him. From discussion it appears that the level of risk was obscured by the knowledge that previous suicide attempts are common to the service user group and that his care notes showed nothing to indicate concern in his behaviour. The situation was compounded by the fact that an agency nurse had booked the service user in upon admission. Intrusive checks are not made during the night and subsequently the service user was found to be drowsy having taken an overdose requiring emergency attention. At inspection the Manager committed to addressing this by reviewing and improving current systems in place. This issue is addressed under Standard 9 rather than Standard 20 because responses to assessed risk of self harm may require a range of control measures including but not exclusive to medication. Care is subject to ongoing review. It was positive to see evidence of service users directly influencing care provided to them. For example a service user had made a written request for a head massage and documentation evidenced that this was acted upon without delay and that the service user had benefited from this. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 16 As stated in the summary at the beginning of this report, service users overwhelmingly believe the home to be meeting their care needs well. Standard 10 (confidentiality) was not assessed at this inspection. However dissatisfaction with this was raised in one anonymous complaint, which is discussed further under Standard 22. CSCI is not aware of any other concern about the management of confidential information and this was discussed with the service user whose care was subject to scrutiny. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 17 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is excellent. Service users have opportunities for personal development through the availability of a wide range of planned therapies, in house and community based group or individual activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activity staff are provided in addition to care staffing ratios. A wide range of activities are available daily and service users can opt in or out by signing up to activities which are made known to service users on the notice board and in a daily morning meeting. Activities are not generally based around the assessed needs of individuals given the short-term nature of the accommodation. However with sufficient notice effort is put into arranging specifically requested activities. Constraints imposed by the short term nature of stays accounts for a minority (six out of twenty four) of feedback to CSCI that indicates that the service user can ‘usually’ or ‘sometimes’ make decisions about what do each day. However this feedback was tempered by comments, Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 18 which indicate an appreciation of some of the influencing constraints. Service users who do not wish to take part in organised activity can rest or visit local towns and places of interest independently as they wish. During the inspection, service users were engaged in a range of different activities. Some were out for the day and some were watching television. Some were involved in therapy sessions, two service users were observed using the computers in the computer suite and an older service user was enjoying a one to one art session where he was producing paintings to a high standard. Care records showed the service user case tracked had enjoyed participating since admission in an organised trip to Trentham Gardens. The home has a mini bus to facilitate travel. A pay phone is available as are email facilities to help service users to stay in touch with family and friends although service users told the Inspector that they all tend to use their personal mobile phones for this purpose. Double rooms are available and a service user told the Inspector that his wife has accompanied him previously, although service users themselves meet the cost of this. Service users are not offered keys to their rooms on the basis of their psychological vulnerability. Shortly prior to inspection two thefts were reported. The Inspector spoke to two service users about this and neither saw the none-provision of locks as a problem. They understood the rational behind there not being door locks and spoke of a culture of trust and a common bond within the service user group negating the need for door locks. The dining room provides a congenial setting for meals with ample space, quality soft furnishings and table dressings. There is a high level of satisfaction amongst service users about the quality and choice of meals provided. There is an extensive choice on the menu daily and the menu on the day of inspection was adhered to. Service users stated that snacks and drinks are available ’24 / 7’ Service users don’t help prepare main meals from the main kitchen and they appreciate the hotel type arrangement, as the focus of the stay is to relax. However a rehabilitation kitchen is available for service users use in the new activity centre where they have cooked cakes and meals for each other. The service does not arrange holidays as the home is providing service users with short breaks. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is excellent. Most service users are self-caring and abilities and independence is respected whilst facilities are available for those who may need physical assistance. Service users are fulsome in their praise for how the home supports their emotional health needs and there is evidence that the home acts upon any changes in physical health to ensure service users are safeguarded by medical advice and assistance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users largely are self-caring. The service user case tracked requires no support with personal care but was very satisfied with bathing facilities available. Specialist equipment is available for service users who require support with personal care and moving and handling. A passenger lift is usually available but is out of action currently. The expenditure for repair has been approved. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 20 Service users requiring the passenger lift had had their stays cancelled, as their needs could not have been met. Staff have moving and handling training and moving and handling assessments are carried out. The impact of emotional health on moving and handling is considered as a variable. The purpose of Audley Court is to provide treatment for psychological trauma and a range of treatments are available. Difficulties with sleep arising from psychological trauma are recognised and planned for within interventions. This was evidenced within the care plan and care records of the service user case tracked. As Audley Court provides service users with fixed length short stays it does not take responsibility for routine health screening such as optical and dental screening. However there was good evidence that medical advice and intervention is sought from a range of medical professionals in response to an identified change in a service users health. Service users health is assessed on admission through nursing and psychiatric assessment. The home has access to a psychiatrist who serves the home half per day per week. There is evidence of close liaison pre admission and upon discharge with service users GP and Psychiatrist from their home area. Service users GPs are consulted about proposed therapies and these do not go ahead prior to medical authorisation. All service users who responded to CSCI pre inspection and during inspection acknowledged the positive health benefits from their care needs being met at Audley Court. One service user who was reluctantly nearing the end of his stay told the inspector that he felt ‘fortified’. Audley Court has a history of good medication management and there have been no notifications of any errors in medication administration. Service users predominantly self-administer at Audley Court and for this reason medication practice was not assessed in detail. However as discussed under Standard 9, Risk Management, the Registered Manager must review systems to ensure a more robust response to the assessment of self-medication when risk of selfharm is assessed. The home does not have responsibility for ordering medication as service users, being short stay bring prescribed medication with them. Explicit written none negotiable guidance has been provided to families detailing how medications must be brought to the home upon admission to comply with best practice. Medication storage facilities were viewed and are appropriate both in the communal storage area and within service users rooms, each of who are provided with their own lockable medication facility. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is generally good as it is clear that most complaints are taken seriously and are responded to. Service users feel safe at Audley Court and are protected by policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have indicated to CSCI that they know how to complain should they need to. This information is provided to service users in a pack that is retained in their bedrooms. The home has received seven complaints since the last inspection. Four complaints were in relation to chairs not being comfortable. This has been addressed as the Manager learned the day before inspection that £4000.00 has been allocated for their replacement. A further complaint was in relation to the loss of the garden aviary as a result of the development of the land to build the new activity centre. These complaints were recorded. The Manager must review however her ‘chaotic filing’ as the complaints records are not maintained as well as they could be. For example each complaint is on a loose-leaf piece of paper in a drawer risking being mislaid. One complaint record was not with the others but on the file of the client to whom it related. The dates of receipt of most were not recorded and the date of resolution was not recorded making it not possible to verify whether timescales for complaint resolution have been met. An anonymous complaint had not been logged with the others as a definite indelible record and was located as an email on the Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 22 computer. The tone of the anonymous complaint rendered the assumption that it was malicious and therefore although it received a partial response, a proactive response would be expected from a service judged to be excellent. Aspects of the complaint were tangible and could have been investigated. The home continues not to manage service users monies. Lockable facilities are available in service users rooms as service users manage their own personal spending money. A service user told the Inspector that he had appreciated depositing some cash in the homes safe and was very happy with the access he had to it and how it had been accounted for. Shortly prior to inspection service users had reported two possible thefts of money. The Manager made all staff and service users aware of the risk and reported the matter to the Police, Social Services and Crime Prevention who have provided advice. There has not been any staff disciplinary action. The home has a no restraints policy given the military history of all its service users. The emphasis is on eliminating the need for challenging behaviour through a positive staff approach. All service users providing feedback to CSCI have verified this positive staff approach. The home also has a zero tolerance of behaviour that contradicts its contract with service users. Service users are required where necessary to sign an alcohol contract and where this has been broken service users have been required to leave. Staff stated that this is something that has become more robustly managed recently. There is a rolling programme of adult protection training to staff. Records indicate that this training has been provided three times in the previous 12 months but records show a significant number of staff still requires this training. Service users told the Inspector that they feel safe some describing Audley Court as a ‘sanctuary’, ‘a haven’ and ‘a dream’. One resident said he feels safer at Audley Court than at home. An improved response to the management of the assessment of selfadministration of medication will further limit any risk to service users experiencing psychological trauma. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is excellent. The environment is spotlessly clean and safely maintained. Service users describe the premises as both ‘home from home’ and ‘like a five star hotel’. The environment meets service users needs exceptionally well and is considered to exceed the national minimum standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector toured the ground floor communal areas noticing that there are smoking and none smoking areas available. The décor e.g. pictures, flags etc is sympathetic to the homes purpose and the common interests and military backgrounds of the service users. Furniture, fittings and décor are immaculate and are provided to a high specification. Communal bathrooms and toilets, whilst a little clinical, are Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 24 spotlessly clean and furnished with grab rails to ensure safety and independence for less mobile service users. A service user said there are plenty of bathroom facilities and said he is pleased that the bathroom is opposite his room. Bedrooms whilst not en suite are furnished with wash basins. The service user told the Inspector he was also happy with his bedroom, has everything he needs and was untroubled by the lack of locks on the door. At the time of inspection there were no female service users. It was therefore not possible for the Inspector to establish how female service users who are in the minority may perceive the lack of locks in a largely male dominated environment. This is something which the provider may wish to build into its quality assurance system. A newly built activity centre is now operational and has a computer suite, kitchen for service users to use and a large communal space for groups, arts and craft, with in addition a large screen for ‘public’ popular sports occasions. Service users with the exception of one in pre inspection feedback stated a high level of satisfaction with the cleanliness of the premises. Cleaning staff have been commended to CSCI. Given one service users concern, attention was focussed during inspection on cleanliness and the Inspector was satisfied with the standards being maintained. The laundry facilities were observed to be spotless and well equipped. The extensive gardens have an interesting design and are very well maintained. Garden furniture and garden games are available. The home has received one complaint about the loss of the garden aviary s a result of building the new activity centre, which received a written response. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good because staff who are safely recruited to safeguard service users are provided in sufficient numbers in spite of recent levels of high sickness. Most staff hold appropriate national qualifications to prepare them to meet service user need. Service users speak very highly of all staff and are exceptionally satisfied with how their needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels have been met throughout a period of high sickness absence. Agency staff have been used to maintain staffing numbers but inevitably this in the Manager’s opinion has undermined quality and is born out through lapses in the admission of a service user who was able to attempt self harm. The high number of admissions and discharges places strain on the staff levels but the Organisation has recognised this and has agreed to fund an additional qualified nurse which will increase qualified staffing levels to 4 at times. This nurse has been recruited and is waiting to start. . Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 26 A Nurse specialist post has also been created since the last inspection. Her remit is to support families and provide support to service users with complex or challenging needs. No service users have expressed any concerns about staffing levels stating ‘there is always someone around to speak to’ Safe recruitment practice protects service users. All pre employment checks were available prior to a new staff member starting in employment. There was however no evidence on file that the starter had been issued with a job description to outline job role and responsibilities or evidence that a copy of the General Social Care Council Code of Conduct had been provided. Existing staff have been provided with this document. There is a robust system in place for recording staff training. Records are computerised and there is an audit trail available. Training is not authorised to be loaded onto the computerised profile until the staff member has produced a certificate as evidence. This may account for some of the apparent omissions in training provided to staff. Records for many staff do not evidence that a minimum of 5 days paid training have been provided per year. For example a night carer employed for many years, according to records has not undertaken any training in 2006 and only two mandatory training courses in 2005, which are due for refresher. The same was found to be true for a second night carer and day carer employed for a number of years. Some staff, not all have received training in Adult Protection with several courses having been run throughout 2006. The computerised training profile for the staff member whose recruitment was assessed shows her to have done induction training. Supervision records were not available to the Inspector as the supervisor had gone home at the time of request but discussion evidenced good supervision arrangements including the provision of group and individual supervision. A supervision programme for all staff is in place to ensure the regular provision of supervision. A high percentage (86 ) of staff hold qualifications to the required national level. The minimum target is currently 50 so the national minimum standard has been exceeded. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is excellent. Robust and well-managed systems are in place to support the overall management of the home. Where there are shortfalls this is identified and responded to by the Organisation. Outcomes are clearly very good for service users who continually express a very high degree of satisfaction with the service provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This was the first inspection following the appointment of the current Manager who has also been registered with the Commission for Social Care Inspection since the last inspection. Whilst it is acknowledged that the new Manager is settling into her new role, she has been employed at Audley Court in other Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 28 roles for many years and demonstrated a very good understanding of the Organisation, the home and the service users whose needs are very specific. She also supported the inspection in a positive and open manner. From general feedback service users clearly believe the home to be well managed. A service user spoken to confirmed this to the Inspector and another said it had improved over the past 5 years. All staff according to records, with the exception of two employed in the last six months has done fire training and moving and handling training. Some Adult Protection training has been provided this year although according to profiles a significant number remain in need of this. Eighteen staff are qualified in first aid. All maintenance certificates sampled are up to date demonstrating that the home is well maintained and that safety is prioritised. Four staff are qualified to risk assess and a range of risk assessments including COSHH assessments for the premises are in place with good control measures to limit risk identified. Good, well maintained accident records are also available, each one of which is seen by manager. Some Regulation 26 records and recent team meeting records were scrutinised. In the Manager’s words the filing system is ‘chaotic’, so minutes prior to October 06 could not be located and therefore evidence of previous meetings and minutes could not be satisfactorily provided. The Manager has however recognised the need to improve her administration system. Team meeting minutes that were available show that teams are provided with guidance, support and direction. Quality assurance systems are robust for the ongoing management of health and safety issues but the system is fragmented. There is no evidence on the premises of service user satisfaction being routinely sought, collated and acted upon. The Provider has since assured that this information is available at Head Office for analysis. This could have helped the Manager to account for general satisfaction vis-à-vis confidentiality management following receipt of an anonymous complaint. There is no evidence of quality assurance systems being in place for the management of care practice and systems but this is, the Inspector was told, to be addressed by the newly appointed corporate quality manager. There is no record of the new manager receiving formal supervision. She said that she receives sufficient support from other managers, from the previous manager who mentors her, from the Director who does monthly regulation 26 visits and clinical support from a commissioned external consultant. Management supervision however was not evidenced and is required both to meet the National Minimum Standard but also to ensure and evidence support provided to this newly appointed Registered Manager who does not currently Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 29 hold a management qualification. In discussion however the Manager stated that she feels well supported but did express the need for more administrative support. Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 4 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 3 34 4 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 X 2 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 2 X X 4 X Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 31 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 Standard YA6 Regulation 15 Requirement Care plans must improve: The registered Manager must ensure that a written plan is prepared stating how the service users’ assessed needs in respect of health and welfare are to be met. Care plans must be put in place prior to assessment week admission where staff may need guidance about known assessed needs e.g. behaviour, epilepsy, moving and handling etc. Requirement arising from inspection November 2006. 30/11/07 The registered Manager must review how risk of self-harm is assessed. Where risk is identified control measures must also be identified, must be agreed with the service user and must be implemented and regularly reviewed. Risk of self-harm must be reviewed retrospectively for each individual service user on a Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 32 Timescale for action 31/01/07 2 YA9 13(4) prioritised basis as per the requirement above prior to subsequent and new admissions. (A 12-month timescale has been given to ensure that this is completed for all service users receiving a service on a cyclical basis. This must however be carried out prior to each service users admission over the next 12 month period) 3 YA22 22(2) Requirement arising from inspection November 2006. The Registered Manager must ensure that any complaint made under the complaints procedure is fully investigated. The registered Manager must review the method of recording complaints to ensure that the following are documented: • • • All complaints or issues raised (including anonymous complaints), Details of any investigation, action taken and outcome. Timescales for the resolution of complaints 31/12/06 4 YA35 18 Requirement arising from inspection, November 2006. The registered manager must ensure that persons employed to work at the care home receive training appropriate to the work they are to perform and that plans are in place to address omissions in training provided to individual staff. (The date provided for compliance refers to the production of a training plan to meet training gaps) 31/01/07 Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 33 5 YA37 18 Requirement arising from inspection November 2006. The Manager must be provided with recorded formal supervision (six minimum in twelve months), which addresses all aspects of her role including management. Requirement arising from inspection November 2006. The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. The system referred to shall provide for consultation with service users and their representatives. Requirement arising from inspection November 2006 30/11/07 6 YA39 24 30/06/07 7 YA41 17 Records required by regulation for the protection of service users and for the efficient running of the business must be maintained, must be up to date and available. Requirement arising from inspection November 2006. 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Audley Court Remedial Treatment Centre DS0000022236.V316077.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!