Inspection on 11/06/09 for Autism Initiatives

This inspection was carried out on 11th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Autism Initiatives 26/07/07

Autism Initiatives 13/07/06

Autism Initiatives 25/01/06

Autism Initiatives 31/05/05

Autism Initiatives 23/08/04

Autism Initiatives 24/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Autism Initiatives 90 All Hallows Road Bispham Blackpool Lancashire FY2 0AY     The quality rating for this care home is:   one star adequate 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: Christopher Bond     Date: 1 1 0 6 2 0 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Autism Initiatives 90 All Hallows Road Bispham Blackpool Lancashire FY2 0AY 01253592284 01253352302 allhallows@autisminitiatives.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Autism Initiatives care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 Date of last inspection Brief description of the care home The home is registered for six adults who have Autistic Spectrum Disorders and associated learning disabilites. It is situated in the Bispham area of Blackpool, within walking distance of Bispham Village. The home is in a residential area with shops and other community resources in the close vicinity. Regular bus services into Blackpool run from close by, and public transport to a number of locations runs from the village. The house itself is situated next to All Hallows church and the exterior is completed in the similar stone fascia as the church. The house is set back from the road and has a parking area to the front. The grounds are tidy and offer a good deal of privacy for the people who live there. There are six registered single rooms within the home. There are also two main bathrooms and a separate shower facility on the first floor. One of Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home the bedrooms is situated on the ground floor and has en-suite facilities. Information relating to the home?s Service User Guide and Statement of Purpose is included in the welcome pack, which would be given to all prospective residents. This information explains the care service that is offered, who the owner and staff are, and what the resident can expect if he or she decides to live at the home. At the time of this visit, (11/07/2009) the information given to the Commission showed that the fees for care at the home are from GBP 1,354.78 to GBP 3,321.71 per week. 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: one star adequate 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: As part of the inspection process an unannounced visit took place over a total of 6 hours on the 11th June 2009. The residents personal files and care plans were examined. Care staff records and recruitment records were also looked at. The Commission also sent out surveys to the care staff of this home to tell us about their experiences of working for Autism Initiatives at All Hallows Road. We received information about the home from the local authority social services who have placed people at this home. We also undertook an Annual Service Review in July 2008.The service also supplies the Commission with reports of incidents that happen within the service. As part of the inspection process the manager of the home was asked to complete Care Homes for Adults (18-65 years) Page 6 of 31 annual quality assurance assessment about how she felt the service was progressing and what changes had been made since our last visit to the home. The results of this have been assessed and aspects of this document have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: We found that the medication that had been prescribed for the people who used the service was being stored in a wooden cabinet. It would be good practice for a cabinet to be fitted that complies with the requirements set down in The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007 include advice to help ensure that the contents remain secure. This also includes advice on the storage of controlled drugs, as we found that storage within the home was inadequate. There had been recent concerns raised regarding care practice within this service. These had been passed to the local authority in the form of a safeguarding alert and a subsequent investigation carried out. As a consequence of this, appropriate action was Care Homes for Adults (18-65 years) Page 8 of 31 taken by Autism initiatives. We found that there were no clear and specific guidelines available for people who lived within the service who may exhibit challenging behaviour. Staff had received training in positive intervention but no individual guidelines were available for residents should physical intervention be considered. If this course of action was no longer considered then this should be clearly written within the care plan. Outside agencies should be consulted to provide precise guidelines should this intervention be required and a clear process followed to protect the interests of both the people who use the service and the support staff. A copy of the complaints procedure should be made available in communal areas of the home for people to refer to if they wish to voice their concerns. This was only available on the back of the office door when we visited the service. The environment of the home was clearly in need of maintenance. Some jobs had been started and not finished. Part of the garden area were unusable, with soil and paving slabs piled up, which was unsightly and dangeous. This work must be completed as soon as possible and outstanding tasks, such as the broken toilet and the unvarnished doors, be completed. Decoration and maintenance of the property was poor, to the detriment to the people who lived there. It is also important that the area managers visits are recorded and a report is provided regarding what his findings are, in response to Regulation 26 of the Care Standards Act. These reports must be completed at least monthly and made available for the Commission to view. The manager had not yet completed an advanced qualification in care (National Vocational Qualification level 4). This has been ongoing for some considerable time and efforts must be made to complete this. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available about this service to help ensure that only suitable residents are admitted. The people who live at this home have had their needs assessed to make sure that their needs can be addressed properly. Evidence: The caring organisation has provided information for people to read who are considering using this service. This information is in the form of a Service User Guide and a Statement of Purpose and the information has been adapted to help ensure that most people are able to understand this. These documents describe the purpose of this service and the requirements that people must have before they are considered for admittance. All of the people who used this service had assessments in place that described their current needs and what level of support that they require. It had been some time since a new resident had arrived to live at this home and the service was full when we visited. One person was admitted to the service last year. Clear assessments had been Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: completed and a gradual, planned introduction to the service was put into place to ensure that this person was comfortable with the move. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who used this service had their care and support planned properly to enable them to enjoy a full and ordinary life. Evidence: All of the people who used this service had a care plan. These included useful information for the care staff to refer to when providing care. The staff recorded what the people who used the service had been doing each day with regard to what choices they had made, what skills had been used and what had gone well. There was also other important information available, for example how the person prefers to communicate, what activities they enjoy, and their exact daily routine. The residents were helped to make decisions as part of everyday life, and choice was a major part of this. Goals were created to help the person comlete tasks and achieve things. One person who used this service was being assisted to prepare their breakfast with more independence and progress was recorded daily. This was evaluated weekly Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: by the care staff and reviewed periodically. The people who used this service were using facilities and resources both within the home and within the community: this meant that a certain amount of risk was necessary for people to enjoy life to the full. There are risks that everyone takes in daily life. Risk areas were recorded and assessed properly, and action had been taken to minimise risk. We sent out surveys to the support staff who worked for this organisation. Four were returned to us. All said that they felt that they were given good, up-to-date information regarding the needs of the people who used this service. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to experience daily routines and activity through leisure opportunities. Staff support has not been at recommended levels meaning that community support for some has been limited. Evidence: The support plans held information about peoples daily life and what activities they enjoyed. Some of the people who used this service attended a local day service specifically for those with Autistic Spectrum Disorders. Daily activities were experienced here and community links meant that activities such as pottery classes and skiing could be accessed. Recent staffing issues have meant that the people who use the service have not recived full, assessed support. The manager told us that these issues were being Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: addressed and the service would shortly be supported by a full staff team. The manager and support staff had worked extra shifts to help ensure that people were supported. There were concerns from support workers, however, that guidelines were not being followed when escorting people into the community, and that some peope were not getting full support because of staff shortages. Other people had a full daily programme of activity that was either home based or within the community. Public transport was used wherever possible and staff support was usually available to ensure continuity, mostly on a one-to -one basis. Whilst we were there people were being supported to enjoy a variety of activities that were either home or community based. These included visits to restaurants, pubs, shopping trips and visits to friends and family. Each person had their daily routine recorded in detail within the support plans so that a high level of continuity could be achieved. This meant that a similar routine could be followed by each support worker to enable the people who use the service to experience similar daily experiences whoever is supporting them. Menus for this service were seen. A nutritious menu was available on a daily basis and the people who used the service were encouraged to eat healthily. The residents were assisted to prepare meals and to help with the daily tasks around meal times. We found evidence to support this in the daily plans. A group holiday had been planned for shortly after our visit. The manager also confirmed that people also enjoyed individual holidays with full staff support. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health care issues are dealt with properly, meaning that this service cares for people well. Evidence: The people who lived within this service did not need a lot of help with their personal care. Support workers were available to offer individual advice, prompting and support but the people who used the service were generally self caring. We observed the support workers speaking respectfully to the residents and the manager told us that all personal support was done in private to ensure that people received privacy and dignity. There were records of visits to hospitals and GP surgeries. Everyone who lived at this home had a communication passport that gave information about themselves and their health needs. The support workers accompanied the people who used the service to health care appointments. Everybody had a health action plan that described their current health issues and there was evidence to show that the residents were visitors to a Well Man clinic. It was clear that health issues were taken seriously; there were Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: regular check -ups for the people who used this service at the dentist. A chiropodist visited the home regularly. Some of the people who used this service were prescribed medication by their doctor. This was stored securely, although advice should be taken regarding appropriate storage that complies with The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007, which includes advice to help ensure that the contents remain secure. We also checked the storage and records of controlled medication. This is medication that is closely monitored because of its content or strength. We found that there were storage issues around this medication, and it was not kept separately from other medication as it should be. There was, however, a register for this medication that was properly completed and monitored. Regular audit checks were carried out by the manager and any quality issues were fed back to the staff team. We looked a the medication record sheets and all were completed properly. There were policies and procedures available within the home to guide staff on how to administer medication properly and safely. One gentleman had recently experience health difficulties that affected his behaviour. He had been referred to a Psychologist, and sufficient action had been taken to help ensure that this person was being adequately cared for. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care staff were trained in ensuring that the people who used the service were protected from harm. Physical intervention instruction wasnt clear and should be explained for the protection of both the people who use the service and those who support them. The complaints procedure wasnt available for people to read and should be displayed in an appropriate place. Evidence: We looked at the procedures that are available if someone within the service, or a friend or relative, needed to voice their concerns about the service. There was information within the Service User Guide and Statement of purpose to help people to do this. We found that the complaints procedure for the home had been completed in illustration form to help people to understand the process. We did not find a copy of this displayed within the main part of the home: this was on the back of the office door. We advised on where this should be displayed so that the residents, their friends and relations, and visiting professionals could view the process and how concerns should be voiced. Four of the care staff who returned surveys to the Commission told us that they were aware of the action that they should take to ensure that people could voice concerns about the service, should there be any. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Concerns had been expressed to the Commission about some of the practices that had taken place within the home. These concerns were passed to the local authority and, as a result, a full investigation was undertaken. The organisation took these concerns seriously and several important changes have been made to help ensure that the people who use this service receive good quality care. appropriate action was also taken regarding staff involved. The care staff have undertook training in positive intervention for when incidents occur. All of the people who use this service have positive intervention support plans. This helps the care staff to make important decisions during periods of physical/verbal aggression. Training has also taken place regarding the Mental Capacity Act and how it affects the people who use this service. Training in ensuring that people are safeguarded from harm has been organised and new staff receive instruction on this subject as part of their induction. All of the carers have had some instruction on this subject as part of a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). It is important that clear and specific guidelines are available for each individual resident who may challenge the service, with regard to physical intervention. A clear decision needs to be taken as to whether or not physical intervention is appropriate and, if so, what form this should take. Guidelines should then be followed methodically and clear records kept. Advice should be requested from appropriate agencies and clear training given to all care staff regarding individual people who use the service who may challenge. There should be no ambiguity as to when this intervention is needed. This is for the protection of both the people who use the service and those that care for them. There was a clear whistle blowing policy in place, which meant that the care staff could report things that they were unsure of, or uncomfortable about, in the knowledge this would be taken seriously. Three of the support workers told us that they were familiar with this, and had received appropriate instruction regarding safeguarding people. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service live in a poorly maintained environment. The environment is not homely and the maintenance and renewal programme is ad-hoc. Evidence: Previous inspections of this service have outlined the difficulties that existed between the caring organisation and the Housing Association that owns the building. Responsibilities for the upkeep and maintenance of this house were disputed and constantly changing. Although the manager of the service and the support workers had worked hard to try to ensure that the people who used this service lived in a pleasant, well maintained environment, this clearly wasnt a priority to the caring organisation. The support staff had helped the residents of the home to personalise their bedrooms. This included the painting and decorating of the rooms. It was clear that professional tradespeople had not been employed to paint and decorate; the support staff had undertook this task themselves, and the resulting work was unprofessional and untidy. Decorating bedrooms was clearly not in their job description and health and safety advice had clearly been compromised in undertaking this work. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Several jobs within the home, and in the garden area, had been left unfinished. Some doors had been replaced and had not been varnished. One of the toilets was out of service and had not been repaired for some time. The stair carpet was threadbare and was close to becoming a safety issue. The bathroom areas were still bleak and unhomely. Some work had been undertaken at the side of the building in an effort to improve the garden area. This work had been commissioned as a charitable venture and had not been completed. The area looked like a building site and the residents could not use this area of the garden. It was hard to see where the funding would come from to complete this work. The garden area at the other side of the property was usable but only basic garden tasks had been undertaken. Once again it was left for support workers and the people who use the service to keep the area looking nice so that they would be able to enjoy the garden. There was some work being undertaken by external grounsmen the time of our visit, but it was clear that they were performing only basic tasks. It was clear that only the basic minimum of expenditure was being invested in this property. The constant disagreement between the caring organisation and the Housing Association has been to the detriment of the people who are being cared for at the home. The responsibilities of Autism Initiatives as a registered organisation are clearly not being met and they have failed to ensure that people lived in a pleasant, wellmaintained environment. It is not the responsibility of the people who use the service to maintain and decorate their own environment. It must be hard for the people who use this service to feel valued as individuals when so little investment is being made in their living environment. There were no pictures around in the communal areas of the home, and the walls looked bare and unwelcoming. The dining area consisted of a number of odd chairs and a large office like table. The manager told us that new, specialised furniture was being considered that could withstand the rigours of daily life. On the positive side, a new kitchen had been fitted and a new suite had been purchased since our last visit, two years previously. The manager was clearly frustrated by the lack of interest that the registered organisation had shown in the home. We spoke to the area manager of the service during our visit who agreed with us that the living environment was poor and investment needed to be made. The home was clean and hygeinic and there were no unpleasant odours. The domestic had been off work for some time and the support staff were undertaking cleaning duties. Care Homes for Adults (18-65 years) Page 22 of 31 Care Homes for Adults (18-65 years) Page 23 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. The support workers are properly recruited and are trained well within their role. Individual support for the care staff was infrequent meaning that individual performance could not be assessed. Evidence: We looked at the recruitment process for this organisation. Good checks were carried out before someone was employed within this service. Everyone had a a personal file that held their information and there were police checks available in all files. This helped to ensure that unsuitable staff were not employed. All four of the support workers that replied to our survey said that they had checks undertaken before they started work. All of the staff had a period of induction where information was given to them about the service and how they should work. Oner staff member that we spoke to during the inspection told us that he had recently completed a probationary period of six months. The manager was pleased with his progress and a recommendation had been made to continue his employment. This meant that there were stages of employment where checks were made as to whether or not the probationary staff member was a suitable employee and had the right values to work within the organisation. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: There had been several recent training events for the support workers in a number of different areas. Good, regular training is important because this means that skills are passed on and knowledge is improved, enabling the carers to work more confidently in their role. One of the care staff commented via a staff survey: All the training has been relevant and I have felt more confident in my role, I am more aware of service users needs. Everyone who worked within the home had a job description so that they knew what their role was within the team. Almost all of the support staff had achieved a nationally recognised qualification in care (National Vocational Qualification in Care level 2 or 3). There were enough staff on duty during our visit to help ensure that the assessed needs of the people who lived within the service were addressed properly. The two gentlemen that were at home during our visit had individual one-to -one support. The surveys that were returned to us, however, told is that there were times when staffing levels were not what they should be due to sickness of annual leave. The manager confirmed this, saying that there had been vacancies within the team that were about to be filled, and a full staff team would be in place. The support staff had worked extra shifts to help ensure that staffing levels were adequate. One of the support staff told us that: Due to staff sickness and other issues I dont think that there are enough staff on duty daily to give flexibility when escorting service users out in the community. Guidelines say that it should be two staff to one service user. There were records to show that staff meetings were regular and information was passed on regarding the people who used the service and the processes within the home. It was, however, seen that some of the support workers had not received individual one-to -one supervision for some time. This type of support is important because individual performance can be discussed and assessed, and issues can be dealt with. This support should happen frequently, at regular intervals. Support such as this is important because sometimes the support workers work alone, with no direct managerial support, and their work role and performance should be closely monitored to reflect this. Recent events within this service have shown that such support is needed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager was knowledgeable about the service provided, and managed the home well. The support for the manager from the caring organisation had improved to help ensure that the service was run properly. Evidence: We spoke to the manager of this service at some length regarding the running of the home. it was clear that she was experienced and fully capable of managing the service. Her roles and responsibilities were being fulfilled and she had a good knowledge of what was expected of her, and the service that was required to care for adults with autistic spectrum disorders and associated learning disabilities. She had achieved a recognised qualification in management (Registered Managers Award), but had not yet completed an advanced qualification in care (National Vocational Qualification level 4). This qualification is important and needs to be completed as soon as possible. The support workers that we spoke to during our visit felt that the service was being Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: managed well and that the training and support they received was good. We also spoke to the area manager of the service. He was relatively new to this post and he told us of how the support for the manager from the organisation had improved over recent months. This had been lacking. It is also important that his visits are recorded and a report is provided regarding what his findings are, in response to Regulation 26 of the Care Standards Act. These reports must be completed at least monthly and made available for the Commission to view. A concern was raised regarding the service in November 2008 and a safeguarding alert was sent to the local authority from the commission. This involved care practices at the home. The local authority and Autism Initiatives investigated these matters and a report was produced by the organisation. As a result of the investigation a senior support worker was suspended and subsequently dismissed. A number of management issues were highlighted and action plans were produced for both Autism Initiatives and the manager of the service. Many of the issues highlighted have since been adequately addressed. The manager had altered her working hours so that she was available within the home more in the evenings and weekends. There were risk assessments available within the support plans that helped the support workers to address areas of safety. Training had taken place in fire safety, moving people correctly and safely, food hygiene, and first-aid. These helped to ensure that the people who used the service lived in a safer home. There were also policies and procedures available for the manger and support workers to read, and be guided on how things should be done correctly. Certificates were available to show that the major appliances, gas installations and electrical installations had been inspected by professional contractors. We could not find records of checks done on the fire alarm and fire safety equipment. These need to be forwarded to the Commission when completed. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Controlled medication must be stored properly and securely. This is to ensure that such medication is safely stored and controlled sufficiently. 31/07/2009 2 23 13 Physical and verbal 31/07/2009 aggression by a service user is understood and dealt with appropriately, and physical intervention is used only as a last resort by trained staff. This is to ensure that it is done in accordance with Department of Health guidance, protects the rights and best interests of the service user, and is the minimum consistent with safety. 3 37 9 The manager must complete 24/07/2012 a recognised advanced award in care. (National Vocational Qualification level 4) Care Homes for Adults (18-65 years) Page 29 of 31 This is to help ensure that she has the knowledge and skills necessary to ensure people are cared for well. 4 39 26 The organisation must provide regular reports for the commission on hoe the service meets its objectives. This is to ensure that the organisation is fully aware of what is going on within the service at all times. This information should be made available for the Commission to view when necessary. 5 42 23 All major appliances must have a current certificate of safety. The fire equipment and alarm system must have a certificate to demonstrate that it is in good working order. 31/07/2009 31/07/2009 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 2 20 22 A metal medication cabinet should be fitted to ensure that all prescribed medication is kept fully secure. A copy of the complaints procedure should be available for all visitors to read so that they are aware of what action to take should they have concerns about the service. The care staff should receive regular, individual support to guide them within their role. 3 35 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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