CARE HOME ADULTS 18-65
Autism Initiatives - Lilford Court 1-2 Lilford Court Havisham Close Birchwood Warrington, WA3 7JZ Lead Inspector
David Jones Announced 30 August and 6 September 2005 11:00
th th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Autism Initiatives - Lilford Court Address 1-2 Lilford Court Havisham Close Birchwood Warrington WA3 7JZ 01925 817103 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Autism Initiatives Mrs Lindsey Briggs Care Home 8 Category(ies) of LD Learning Disability (8) registration, with number MD Mental Disorder (8) of places Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The home is registered for a maximum of 8 service users to include: * Up to 8 service usrs in the category LD (learning disability under the age of 65 years. * Up to 8 service users in the category MD (mental disorder, excluding learning disability or dementia, under the age of 65 years). * Up to 8 service users may be in both categories LD (learning disability under the age of 65 years) and MD (mental disorder, excluding learning disability and dementia) 2 3 That Mrs Lindsey Briggs achieves the Registered Managers Award by the end of July 2005. The registered person, must at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 26th April 2005 Brief Description of the Service: 1-2 Lilford Court is located at the head of a cul-de-sac in a residential part of Warrington town. The home is established to provide care for younger adults with Autistic Spectrum Disorder. Accommodation is provided in two adjoining, four bedded houses, which share the same staff team. Each house is set within spacious gardens and provides separate entrance, entrance hall, a lounge, kitchen, dining room, multi sensory room, four bedrooms, office space and bathing and showering facilities. The premises are not adapted to accommodate the needs of people who have a physical disability. Access to local amenities and public transport is good and the service is provided with two minibuses, which are used on a daily basis. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place on 30th August and 6th September 2005. Five residents, three members of staff and the registered manager were spoken with during the inspection. Inspection comment cards were received from three relatives and a visiting relative was spoken with on the second day of the visit. Staff were observed interacting with and supporting residents. The gardens and some parts of the building were looked at, as were some records along with the case notes of three residents. What the service does well:
Lilford Court is well managed and run in the best interests of residents. Prospective residents individual aspirations and needs are assessed. Residents and relatives are involved with the development of detailed support plans designed to meet the precise needs of the individual. The daily routines and the way in which the home is conducted promote responsibility, individual choice, and freedom of movement within a risk management framework. Residents are consulted and participate in the all aspects of life in the home and each resident is provided with a written contract or statement of terms and conditions. The atmosphere in the home is friendly and relaxed. There is a dedicated team of staff who carry out their duties in good humour. They support and treat residents with respect and promote independence and positive interaction. . Visiting relatives congratulate Lilford Court on providing excellent standards of support and care. Communication is also said to be excellent. Contact is made with each resident’s health and social care professionals when required. Residents live in a well maintained, clean and comfortable home. Their bedrooms have been decorated and personalised to reflect their characters and needs. Appropriate arrangements are in place to assure the health and safety of residents and staff. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Care must be taken to make sure that support plans that involve positive intervention and restraint are drafted in accordance with established good practice. These must be confirmed and, where possible, agreed with the resident’s advocates including health and social care advisors without delay. The registered persons’ representative must carry out visits to the home in accordance with the requirements of the regulations and provide the registered manager and the Commission for Social care Inspection with a report on the conduct of the home, at least once in every month. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 and 5. New residents are admitted only on the basis of a full assessment undertaken by competent persons and involving the prospective resident, family members and health and social care professionals. Prospective residents visit the home and they and their representatives are assured that their needs, likes, dislikes and wishes are known and will be catered for. Each resident has an individual statement of terms and conditions. EVIDENCE: Reading of case records and discussion with the manager and a visiting relative confirmed that residents move into the home after appropriate assessment and admission processes. These involve the resident; their family members and their health and social care advisors. Support plans are drafted from initial care management assessments provided by placing agencies and are further developed by monitoring, review and evaluation. A planning meeting known as a “WIN (What I Need) meeting” is arranged before the resident moves in. This involves the resident, family members and health and social care advisors. This provides an opportunity to discuss the assessment, explore any further needs, and confirm how these are to be met. All residents are provided with terms and conditions documents.
Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 10.The home’s assessment and care planning systems make sure that residents and their representatives are placed at the centre of decision-making and the development of detailed and risk assessed support plans. This enables the resident aided by his/her representatives to better understand how their assessed and changing needs are to be met. Support plans that involve restraint must be written in accordance with a model accredited by the the British Institute for Learning Disabilities, and shared and agreed with the resident’s representatives, without delay. This will make sure that all such plans are evaluated and reflect good practice. Residents are assured that information about them is handled appropriately and confidentially. EVIDENCE: A visiting relative said that the home’s assessment and support planning arrangements were excellent and could not be faulted. Communication was also said to be excellent. Support plans reflect each individual’s aspirations and personal goals and confirm how all identified need are to be met.
Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 11 Support plans are drawn up with the involvement of the resident and their representatives. Strategies relating to behaviour management are linked to the S.C.I.P model (strategies for crisis intervention and prevention). The SCIP model for crisis intervention is approved by BILD (The British Institute for Learning Disabilities). It is clear that the vast majority of the positive intervention plans seen had been discussed and agreed at review meetings with the respective resident and their representatives. However, it was noted that a number of positive intervention plans implemented on the 15th August 2005 had not been shared with or agreed by the resident’s representatives. The manager advised that the plans would be shared with the resident’s representatives at the next review meeting. One of the plans seen was inappropriate in that it suggested practices that are not supported by the SCIP model or the British Institute for Learning Disabilities. The manager advised that the particular positive intervention plan had been inappropriately worded and withdrew it and replaced it with an appropriately worded positive intervention plan. See requirement 1. A confidentiality policy is in place at the home and support staff sign a confidentiality statement. Entries in case records are written in an appropriate and respectful style. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17. Residents’ rights are and responsibilities are recognised and supported. A varied and nutritious diet is available. Choice is offered and healthy eating is promoted. EVIDENCE: The daily routines and the way in which the home is conducted promotes responsibility, individual choice, and freedom of movement within a risk management framework. Staff were seen to interact with residents in an appropriate and supportive manner. Timely prompts were offered to remind residents of their responsibilities to the home and each other and to provide structured support, where required. Staff seek to involve residents in all domestic routines and residents are responsible for their bedrooms. Residents are offered a healthy, varied and nutritious diet. Staff are aware of individuals’ likes, dislikes and personal preferences and were seen to involve residents in meal preparation. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20. Residents receive personal support according to their individual needs. Health care needs are monitored and contact is maintained with health and social care professionals on an ongoing basis. Appropriate polices and procedures for the administration and safe storage of medication are in place. EVIDENCE: Discussion with a visiting relative and staff and observation of their interactions with residents indicated that residents’ personal preferences as to how they wish to receive personal care are known and complied with. A parent of two people who lived at Lilford Court advised that the staff team had done an excellent job in learning to understand the personal needs of his children. He stressed that recognition of their individual needs and characters and focused support planning had proved essential to the success of their respective placements at the home. Staff were seen to provide sensitive and flexible personal support according to agreed support plans that are designed to maximise the individual’s privacy, dignity, independence and control over their lives. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 14 Reading of records and discussion with staff indicated that residents’ health care needs are monitored and contact is maintained with health and social care professionals on an ongoing basis. Information provided by the manager indicated that all staff involved in the administration of medication had received appropriate training from a pharmaceutical company. A medications check confirmed that medicines were stored, administered and recorded appropriately. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23.Satisfactory polices and procedures are in place for the protection of residents and ensuring complaints are listened to and acted upon. EVIDENCE: The home’s complaints procedure provides appropriate guidance and information as to how to make a complaint. No formal complaints had been received since the last inspection. Robust procedures for responding to suspicion or evidence of abuse or neglect were in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. The manager said all staff had received guidance on the implementation of adult protection procedures. Further training needs identified via the home’s staff appraisal systems would be addressed in due course. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30. The premises are suitable for its purpose and provide residents with comfortable, clean and well equipped accommodation. EVIDENCE: Lilford Court provides a homely and comfortable environment. The home is spacious, bright, cheerful, airy and clean throughout. The premises are in keeping with the local community and have a style and ambience that reflects the home’s purpose. Each of the two houses reflects the personalities needs and preferences of the respective groups of people who live in each side of the home. The gardens are well maintained and are put to good use. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36. Staff were employed in appropriate numbers and skill mix sufficient for the well being of residents. EVIDENCE: Information provided by the manager including staff rosters indicated that staffing levels had been increased since the date of the last inspection to meet the needs of a new resident. Staffing levels vary to meet the changing needs of residents. There is a minimum of six support staff on duty when all residents are at home and up to nine support staff when residents are involved in activities in the community. The home had benefited from a recent recruitment drive. Four full time support workers had been appointed. Staff rosters confirmed that numbers of agency staff used had reduced by 50 since the last inspection. The increase in staffing levels had created a further 1.2 fulltime posts and the deputy manager had resigned to take up training for another professional career. Vacant support worker posts had been advertised and recruitment interviews were being held in the week following the inspection. The deputy manager’s post is to be advertised internally.
Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 18 Effective induction procedures are in place for permanent and agency staff. Discussion with staff and the manager confirms that Autism Initiatives operate a comprehensive staff-training programme, which incorporates “Skills For Care” staff training standards. However, only one member of staff had an NVQ in care to level 2. See recommendation 1. The manager is an NVQ assessor and arrangements had been made with St Helens College to develop the home’s NVQ training programme. Three members of staff are working towards NVQ level 2, one is working towards NVQ level 3 and a further five are due to start the programme in the near future. Staff were observed to carry out their duties with skill, attention to detail and with respect for residents. They confirmed that communication in the home is good and they have regular recorded supervision meetings with senior staff or the manager at least once a month. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 41 and 42. Lilford Court is well managed and run in the best interest of residents. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose. Effective quality assurance processes are in place and the health and safety of residents is promoted. EVIDENCE: The registered manager is a experienced, committed and caring professional, who has a Diploma in Health and Social Welfare, a Degree in Psychology and has completed the Registered Managers Award. Staff said that the manager is supportive and provides clear guidance and leadership. Discussion with relatives and written information provided before the inspection indicated that the home is well managed and high standards of support are provided for residents. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 20 There had been no incidence since the previous inspection that required notification of the CSCI. However the manger advised that she was clear as to the regulatory requirements regarding notification. Discussion with staff and reading of the home’s records systems confirmed that staff are supervised appropriately and incidents involving residents are analysed and reflected upon in the interests of developing good practice in the home. Effective quality assurance processes are in place and a report on quality issues is produced annually. There is no evidence that representatives of Autism Initiatives had visited the home in accordance with the requirements of regulation 26 in July or August 2005. See requirement 2. Information provided confirmed that appropriate maintenance checks; fire protection procedures and other health and safety precautions are carried out on a regular basis. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 x 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x 3 3 Standard No 31 32 33 34 35 36 Score x 2 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Autism Initiatives - Lilford Court Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 2 3 x F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 22 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 6 Regulation Requirement Timescale for action Immediate and ongoing 2. 41 12, 13, 14 The registered persons must and 15. make sure that support plans that involve positive intervention and restraint are drafted in accordance with established good practice. These must be confirmed and, where possible, agreed with the residents advocates including health and social care advisors without delay. 26 The registered persons must 30.09.05. carry out visits to the home in accordance with the requirements of the regulations and provide the registered manager and the Commission for Social care Inspection with a report on the conduct of the home, at least once in every month. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 32 Good Practice Recommendations The registered persons should ensure that at least 50 of the staff team attain a qualification in care at NVQ level 2 or above. Autism Initiatives - Lilford Court F51 F01 S27020 Lilford Court V231908 300805 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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