CARE HOME ADULTS 18-65
Autism Initiatives - Redpoll Lane 29 Redpoll Lane Birchwood Warrington Cheshire WA3 6NP Lead Inspector
David Jones Announced Inspection 14th September 2005 10:00 Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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 Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Autism Initiatives - Redpoll Lane Address 29 Redpoll Lane Birchwood Warrington Cheshire WA3 6NP 01925 837004 9999 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) Autism Initiatives Care Home 2 Category(ies) of Learning disability (2), Mental disorder, registration, with number excluding learning disability or dementia (2) of places Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The 2 Service Users may be both LD and MD Date of last inspection 18th May 2005 Brief Description of the Service: Number 29 Redpoll Lane is located on a side road on a housing estate in a residential part of Warrington new town. The home is established to provide care specifically for younger adults with Autistic Spectrum Disorders. The home is a three bed roomed house with a lounge, dining room and kitchen on the ground floor and private gardens to the rear. Aids and adaptation have been provided to meet the needs of one resident. However, the premises do not provide level access and are not designed to meet the needs of people who have a physical disability. Access to local shops and public transport is good and residents have their own car that is used on a daily basis. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced visit took place over 8 hours on 14th September 2005. Three staff members, two temporary managers and the two residents were spoken with. Discussion with the two residents was limited however, due to communication difficulties. Resident’s records and case notes were examined and some parts of the home and gardens were seen. What the service does well: What has improved since the last inspection?
There has been a significant improvement in the quality of life of both residents with one, in particular, taking advantage of numerous opportunities for community based activities. Progress has been made to address requirements from the last inspection. Support plans; assessments and risk assessments are regularly reviewed and are updated as required. Appropriate Adult Protection polices and procedures are in place and staff have received guidance on how to respond to suspicion of abuse. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 6 Some staff vacancies have been filled and shift patterns have improved to make sure that staff are not expected to work continuous shifts without appropriate breaks and rest periods. Effective staff support and supervision systems are in place and the home’s induction procedures have improved. All staff, including agency staff benefit from one-one scheduled supervision provided by senior staff. Staff morale is improving with staff looking forward to positive developments in the home’s assessment, care planning processes and staffing arrangements. What they could do better: 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 - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, and 4. New residents are admitted only on the basis of a full assessment undertaken by competent persons. These involve 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. EVIDENCE: This service is designed to meet the precise needs of two individuals. Autism Initiatives operate effective assessment and admissions procedures that make sure the resident and his representatives are placed at the centre of decision making. These procedures 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 on an ongoing basis. 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. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 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 helped by his/her representatives to better understand how their assessed and changing needs are to be met. Residents make decisions about their lives with assistance when needed and information about them is handled appropriately and confidentially. EVIDENCE: Information provided by management and staff and Reading of case records indicated that assessments, risk assessments and support plans relating to both residents have recently been reviewed and further developed as appropriate. Support plans reflect each individual’s aspirations and personal goals and confirm how all identified needs are to be met. Some of the new support plans are not signed by the author, dated or provided with a review date. This information is needed to confirm that an appropriately experienced and trained person has drafted the support plan and to aid analysis and review. See recommendation 1. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 10 Staff respect residents rights to make decisions and that right is limited only through the assessment process, involving residents and their representatives. Some of the new assessments and support plans had not been shared with the respective residents’ health and social care advisors. It is recommended that all new assessments, risk assessments and support plans are shared with the respective individual’s health and social care advisors without delay. See recommendation 2. 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 manner. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 11 and 12. Staff help and support residents to maintain and develop social and independent living skills and take part in valued and fulfilling activities. EVIDENCE: Staff help residents explore and take advantage of recreational and occupational opportunities in the local community. Each individual has a flexible activities programme covering the seven-day week. These are designed to meet individual needs and personal preferences. Visits to community facilities include the pub; shops, parks, swimming baths and other places of interest take place frequently. Tensions between the two residents identified on previous inspections have been eased by a significant increase in activities and opportunities taken up by one of the residents. He has been able to get out of the house more. This has resulted his tendency to pinch the other person to significantly reduce in frequency. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 12 Plans for residents to go into the community, where unfamiliar people and places may present them with challenges, are detailed in the individual’s support plan. Management and staff confirmed that these plans provide appropriate guidance for staff, but they have not been confirmed with each person’s representatives. See recommendation 2. Staff demonstrated skill in their interactions with residents, offering timely prompts to help them relax and join in ordinary domestic activities. Staff provide learning opportunities and promote independence, individual choice and freedom of movement within the home. Residents are relaxed within the home’s environment and one spoke positively of the staff indicating satisfaction with his care and support. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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 the following standard(s): 18, 19 and 20. The high usage of agency staff has a destableising effect on one of the residents who requires contiuity in the people who provide him with support and care. Health care needs are monitored and contact is maintained with health and social care professionals on an ongoing basis. The home’s medicines storage facilities remaine inadequate and require further improvement to ensure the safe storage of medication. EVIDENCE: Staff provide sensitive, and flexible personal support to each of the residents and demonstrate skill and understanding in their approach. However, discussion with management and staff and reading of a number of incident reports indicated that the high numbers of agency staff have a destabilising effect on one of the residents. If this individual is uncertain of who is going to be on duty or there are unexpected appearances of unfamiliar staff his anxiety levels are liable to rise and he is likely to present with challenging and potentially injurious behaviour. The home’s contracted staff and those agency staff who are familiar with the needs of this resident are generally able to respond in a manner which defuses this behaviour at an early stage an so prevent potentially injurious behaviour. However, there have been a number of incidents, which have resulted in the resident protesting about changes in staff by throwing furniture and banging himself on the wall. It is essential to this
Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 14 individual’s well being that a staff team, which he is familiar, provides continuity of care and support. See requirement 1. 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. A medications check showed that medicines are administered and recorded appropriately. All staff responsible for the administration of medication have received training from the pharmacy with the exception of two. The temporary manager indicated that training has been arranged for all existing staff and new recruits to take place on the 1st October 2005. The temporary manager also advised that new proprietary medicines cabinets are on order. In the meantime, two small medicines cabinets have been fixed to a solid wall, but are too small to provide appropriate storage. See requirement 2. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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 the following standard(s): 22 and 23. Satisfactory polices and procedures are in place for the protection of residents and ensuring complaints are acted upon and residents are listened to. EVIDENCE: No formal complaints have been received since the last inspection. The home’s complaints procedure provides appropriate guidance and information as to how to make a complaint. Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. These include the Autism Initiatives adult protection polices and procedures and those provided by the relevant local authorities. The temporary 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 - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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 the following standard(s): 24, 26, 27 and 30. Residents live in a homely, clean and comfortable environment that has been equipped to meet their personal requirements. EVIDENCE: The home is spacious, bright, cheerful, airy and clean throughout. The premises are in keeping with the local community and the style and atmosphere reflects the home’s purpose. The accommodation has two reception rooms and an enclosed rear garden. The premises are well maintained and appropriately decorated throughout. Resident’s bedrooms are decorated and furnished to reflect individual needs and personal preferences. A separate toilet is on the ground floor and a bathroom with toilet, shower and bath on the first floor. Handrails and a toilet frame are provided for one of the residents to maximise his independence. New toilet frames have been provided to replace those that were rusting. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Staff are provided in sufficient numbers and some progress has been made to address staff training needs and reduce the numbers of agency staff used. High numbers of agency staff remain and the resulting lack of continuity of care and support adversely affects one resident. Recruitment procedures require further development to make sure that new staff are appropriately supervised and residents are adequately protected. EVIDENCE: Staffing rotas, discussion with the temporary managers and staff confirmed that appropriate numbers of staff are employed for welfare of residents. Information provided indicated that the staffing team is made up of a full time Team Leader post (Registered Manager), one Senior Support Worker post and five full time Support Worker posts. Due to staff movement and difficulties recruiting replacement staff, the home it is currently running with two temporary managers, one full-time and three part-time permanent support workers. In addition there is one agency member of staff who is contracted to Autism Initiatives to work 20 hours per week in the home. The remaining 130 Support Worker hours per week are worked by a number of agency staff. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 18 A full-time support worker had been recruited since the last inspection and the number of shifts worked by agency staff had reduced accordingly. Shift patterns have also improved. Autism Initiatives are endeavouring to recruit staff from Warrington Area and have held a number of promotions to encourage interest in job vacancies. In the interim and in keeping with good practice, the temporary manager has tried to use agency staff who are familiar with the home and residents’ needs. However, reading of incident reports and further discussion with management and staff confirmed that the high usage of agency staff continues to have a negative effect on one of the residents with an increase in challenging behaviour. See requirement 1. Staff records and information from the temporary manager showed that none of the support workers had an NVQ in care at level 2 or above. However, two members of staff had registered to complete the qualification since the last inspection. See recommendation 3. Some progress has been made to address staff training needs from the previous inspection. The temporary manager said that the most recent staff member had started a structured induction programme and was currently working through a workbook. All agency staff with the exception of one had completed the home’s induction training and other staff had received guidance on adult protection procedures, and training in crisis intervention. Arrangements have also been made for other training including medication, first aid, basic food hygiene and fire training for those needing it. See requirement 3. One new support worker had been recruited since the last inspection. The temporary manager stated that this individual had started employment before receipt of an enhanced CRB (Criminal Records Disclosure) on the basis that a POVA First check (Protection of Vulnerable Adults Register) had been received. Reading of the rota confirmed that appropriate arrangements had not been made for the supervision of this staff member in the interim of an appropriate CRB being received. See requirement 4. Staff said they have regular recorded supervision meetings with the temporary manager at least once a month. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38. Residents benefit from the management approach of the home, which creates an open, positive and inclusive atmosphere. EVIDENCE: In the absence of the designated home manager, two temporary managers are employed in the home with one taking lead responsibility for day-to-day management under the direct supervision of the locality manager. Staff said that both temporary managers are accessible, supportive and provide direction and leadership. Morale is said to be improving with staff looking forward to positive developments in the home’s assessment, care planning processes and staffing arrangements. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 20 It is clear that the new management of the home had brought many benefits to residents with much improved outcomes for quality of life in general. However, both management and staff remain concerned as to the high numbers of agency staff employed in the home and the negative impact this is having on one of the residents. Their concerns are justified and further action must be taken to make sure that a satisfactory number of permanent staff are employed and an effective staff team is created. See requirement 1. Progress continues to be made to address staff training needs and scheduled staff supervision has been introduced. Care must be taken to make sure that new staff employed before receipt of a CRB are appropriately supervised by a designated and appropriately experienced staff member. See requirement 4. Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 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 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 3 X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 2 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Autism Initiatives - Redpoll Lane Score 2 2 2 X Standard No 37 38 39 40 41 42 43 Score X 3 X X X X X DS0000027045.V249520.R01.S.doc Version 5.0 Page 22 Yes 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 YA18YA33Y Regulation 18 Requirement The registered person must ensure that the employment of staff on a temporary basis at the home does not prevent service users from receiving such continuity of care as is reasonable to meet their needs. (Previous timescales 060804, 31/03/05 and 30.06.05 not met.) The registered persons must provide appropriate storage for medication, affixed to a solid wall with the appropriate fittings, and in addition must ensure that all staff involved in the handling and administration of medication are suitably trained. (Previous timescale 31/03/05) not met. Timescale for action 31/10/05 2 YA20 13 & 17 31/10/05 3 YA33 18 The registered person must review staff training needs and
DS0000027045.V249520.R01.S.doc 31/10/05 Autism Initiatives - Redpoll Lane Version 5.0 Page 23 4 YA34 19 subsequently take appropriate action to ensure that all staff are appropriately trained and skilled Particular attention must be given to the training of staff in Fire Prevention procedures, food hygiene and First Aid. (Previous timescales 31/03/05 and 31.07.05 not met.) The registered person must 14/09/05 ensure that staff employed pending receipt of CRB are only employed in the home if they are supervised and accompanied by a staff member who is appropriately qualified and experienced. 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 YA6 Good Practice Recommendations The registered persons should make sure that assessments, risk assessments and support plans are signed and dated and where appropriate provided with a review date. The registered persons should make sure that all support plans, risk assessments and assessments are shared with the respective residents representatives including health and social care professionals without delay. The registered persons should ensure that all staff achieve an NVQ in care to level 2 or above. 2 YA7 3 YA32 Autism Initiatives - Redpoll Lane DS0000027045.V249520.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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