Inspection on 07/06/05 for Carlton Autistic Care Centre

This inspection was carried out on 7th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Carlton Autistic Care Centre 26/09/07

Carlton Autistic Care Centre 19/09/06

Carlton Autistic Care Centre 05/10/05

Carlton Autistic Care Centre 22/03/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Carlton Autistic Care Centre Greenway Milnsbridge Huddersfield HD3 4RZ Lead Inspector Alison McCabe Tony Brindle Unannounced 7 June 2005 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. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Carlton Autistic Care Centre Address Greenway Milnsbridge Huddersfield HD3 4RZ 01484 649899 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) Carlton Nursing Homes Ltd John Sumpton Care Home 16 Category(ies) of Learning Disability - 16 places registration, with number of places Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 22 March 2005 Brief Description of the Service: Carlton Autistic Services is a care home providing personal care and accommodation for up to sixteen younger adults with a learning disability and autistic spectrum disorder. Carlton Autistic Services is a purpose built home that comprises of three separate units. Carlton House provides accommodation for up to eight service users. Opposite Carlton House, separated by a driveway, are two, four place houses, Greenway and Sycamore. All bedrooms are single and have en-suite facilities. An additional adapted bathroom and toilet is provided in Carlton House. Carlton House has a small communal lounge and separate dining room and also has a sensory room. Spacious hallways both on the ground and first floor of Carlton House add to the feeling of space. A passenger lift to the first floor is provided in Carlton House ensuring that any relatives or visitors with mobility difficulties can access the first floor if necessary. Both Sycamore and Greenway have a large kitchen with space for dining, a separate dining room and good sized lounge. A small laundry room is available in all three houses. Carlton House has it’s own secure garden, and a shared garden is available to the rear of the two fourbedded homes. A driveway with parking separates the main house from the four-bedded houses. The home is situated approximately five miles from Huddersfield town centre. There are some local shops within a two-minute walk. Milnsbridge and Golcar offer a range of amenities and are within easy reach. There is a bus stop opposite the home. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted between the hours of 10.55am and 7.40pm. Two inspectors undertook this inspection. Service users were participating in a range of community-based activities throughout the day. The inspectors had the opportunity to talk to four service users during the course of the inspection. The inspectors also spoke with the responsible individual, registered manager, deputy manager, an advocacy worker, two senior staff members and two support workers. One inspector had the opportunity to meet with a relative of a service user. Records were examined and inspectors accessed communal areas of the home during the visit. The inspectors did not go into the service users’ bedrooms on this occasion. This service was last inspected on 22 March 2005. A number of shortfalls were identified at this inspection, some of which have been positively addressed. A number of requirements made following the last inspection have not been met and are therefore repeated. This service is still relatively new, having been first registered on 31 August 2004. At the time of inspection, eight of the sixteen places had been occupied. The service sets out to offer a specialist service to people with autistic spectrum disorder. What the service does well: Service users live in a modern, spacious home. Service users can decorate their bedrooms how they like and they can have a key to their rooms if they want to. On weekdays, during the day, there are lots of staff around to help service users do activities they want to do. There is an activities co-ordinator whose job it is to make sure there are enough activities for service users to do. Service users can be involved in interviewing new staff if they want to. The home has an advocacy worker who is there to talk to service users and families. The advocacy worker is working on making the complaints procedure easier to understand by putting it onto a ‘talking book’. Staff at the home are enthusiastic and positive with service users. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: All service users must have an up to date assessment before they move into the home so that the home are sure they can meet the persons needs. The registered manager must make sure that assessment information is used when writing the care plans and risk assessments to make sure that service users needs are being met. All service users should have a signed contract so they are clear about the terms and conditions of their stay. Service users’ individual care plans and risk assessments need to be much clearer and more detailed so that the staff team are clear about how to meet all of the service users’ health and welfare needs whilst they are living at the home. The registered manager needs to make sure that there are agreed ways of dealing with challenging behaviours so that service users and staff are kept safe. More staff need to be available at weekends and during the evenings so that service users can do activities outside of the home if they want to do so. More fresh fruit and vegetables need to be available to make sure service users have a balanced, healthy diet. Food storage needs to be improved so that service users do not get food poisoning; staff need to make sure that out of date food is thrown away. The registered manager must make sure that referrals are made to specialist services when necessary. A record must be kept of medicines that are received into the home. Staff must not give out medication using a method they have not been trained to use, as this is not safe. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 7 Action taken to ensure that vulnerable services users are protected is inadequate. Staff have not all had the necessary checks before starting work with service users therefore the service users are being put at risk of harm or possible abuse. This was raised at the previous inspection. If the provider continues to fail in this area, the CSCI will consider taking enforcement action. The floor covering in the dining rooms needs to be re-stuck so that service users do not trip. Staff must have more training in autism and learning disabilities to improve their confidence and skills when working with service users. Staff also need training in physical intervention to make sure that service users and staff are kept safe. The registered manager must make sure that all the policies and procedures are followed. These are in place to make sure that service users are kept safe and their needs are met. Fire safety must be improved. Staff are not conducting weekly checks of the fire alarm to make sure it is working properly. This was raised at the last inspection, and the home must meet this requirement. Staff must not wedge fire doors open but arrange for self-closing devices to be fitted on those doors that need to be kept open. 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. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.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 Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.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) 2,3,4,5 Pre-admission assessment information needs to be improved and systems developed to ensure that this information is in place, is current and informs the care plan. Individually tailored introductory visits are offered to service users prior to them moving into the home, which is positive. Staff are enthusiastic and positive but need more specialist training about autism and learning disabilities. In order to make sure that service users and/or their representatives are aware of the terms and conditions of their placement, the home must ensure that contracts are signed by all relevant parties. EVIDENCE: Three service user files were examined and within these the inspectors found evidence of pre-admission assessments in two of the service user files. The inspectors were concerned that assessment information relating to one service user was dated February 2003. More current information was not available and it was unclear what assessments had been conducted. Risk assessments provided as part of pre-admission information regarding serious risks to one service user had not been included or referred to as part of the service users care plan. Service user plans were not consistently based on assessment information that was available. There was a lack of evidence to demonstrate that all limitations on choice, freedom of movement, services or facilities had Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 10 been discussed and agreed with service users or their representatives. Community Care Assessments were not available in two of the three files sampled. Carlton Autistic Services aim to deliver a specialist service to people with autistic spectrum disorder. Whilst staff receive a week’s induction period upon appointment, which includes a basic overview of the service user group, no staff have received any further training about learning disabilities or autism. A significant number of staff have not had previous experience or training in these areas. It was said that the senior care coordinator is in the process of arranging training through Kirklees Metropolitan Council. Staff were observed to communicate positively and respectfully with service users. Service users are given the opportunity to visit the home on an introductory basis before making a decision to move there. A trial period is offered and the option of service users accessing the respite facility initially is also available. A relative of a service user confirmed this. Contracts stating terms and conditions agreed between the service user and the home were not in place in two of the three files sampled. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 11 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) 6,8,9 Service user care plans do not fully meet the personal, social and healthcare support needs of service users. The inspectors are not confident that identified risks to service users are being responded to appropriately. There has been unsafe practice in the home in that untrained staff have been administering medication using invasive procedures. The inspectors are concerned that management oversight of care planning, risk management and administration of some medicines is inadequate. The home is good at involving service users when interviewing new staff. The home is working towards making policies and procedures more understandable for service users. The advocacy worker is exploring how service users and their relatives can become more involved in having a say about how the home is run. EVIDENCE: Three service user care plans were examined. These did not cover all aspects of the service users’ personal, social and healthcare support needs. One of the care plans examined at this inspection was also looked at during the inspection in March 2005. Whilst there had been some improvement in the quality of Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 12 information, further detail is still required. Crucial information gathered during the assessment process had not been included as part of the service user plan and risk assessments. The inspectors were impressed with a talking book that has been developed for one service user. Photographs are used with comments recorded relating to each picture. As at the last inspection, information that is no longer relevant was filed with the current plan. There was nothing to indicate what was current and what was no longer applicable. Inspectors found that untrained staff member had administered medication rectally. The care plan contained no information in respect of this medication and no risk assessment or policy had been developed. The registered manager and deputy manager were unaware that this practice had taken place. There was no evidence to show that the agreed actions following one service user’s review had actually taken place. No individualised physical intervention plans were in place within the records that were sampled, although there was evidence that physical intervention had been used with one service user. Information regarding service users’ behaviours and how to manage these was inadequate. Some restrictions on choice and freedom were described satisfactorily, though some were not. Care plans did not all contain evidence that restrictions had been agreed with the service user or their representative. There is no keyworker system in place at this home. The manager reported that this is because the home is not fully occupied. Service users are offered the opportunity to participate in staff recruitment and a number of service users have chosen to participate in interviews. This is positive. An advocacy worker is employed by the organisation. He explained to the inspectors that he was developing a ‘talking book’ version of the complaints procedure in order to make this accessible to all service users. This is good practice. The advocacy worker explained that this system would then be extended to other policies and procedures. Service user meetings have not as yet been established, although the inspectors were informed that this would be arranged in the future. The risk assessments examined did not cover all the risks identified as part of the assessment process or risks identified since service users have been living at the home. Some risk assessments that had been completed did not clearly Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 13 describe what the risk was and how to effectively reduce the risk. Measures to reduce risks are not always adhered to. Care plans and risk assessments were not all signed and dated. Senior support staff had written some risk assessments, however there was no evidence that there had been any management oversight to ensure that less experienced staff were supported in this area. The deputy manager reported that she regularly checks entries in the daily records along with senior support staff. The inspectors noted that some entries were vague, negative and judgemental, for example the words, ‘pleasant’, ‘well behaved’, ‘ignorant’ and ‘making silly noises’ were used. The deputy manager reported that she had identified that some entries were inappropriate and that she would be addressing this with staff. The inspectors were told that staff have had basic information regarding values and attitudes during their induction. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 14 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) 13,17 Good opportunities are offered to service users to go out into the community on weekdays. More staff need to be available at weekends and during the evenings so that service users can go out during these times if they choose to do so. Service users like the food that is offered and help with shopping and cooking if they want to. Food storage needs to improve, as does the range of fresh foods available. EVIDENCE: Since the last inspection a second activities co-ordinator has been employed. One of the activities co-ordinator remains on long-term sick leave. It was said that information is being gathered by the activities co-ordinator about activities that service users would like to participate in. Service users are being consulted about where they would like to go on holiday this year. The activities coordinator recently arranged a sports day, which is reported to have been a success. During the inspection, service users were engaged in a range of community-based activities including swimming, local park, shopping and going to the photography museum in Bradford. Service users spoken to reported that they enjoyed going out. Evidence that service users regularly Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 15 access the local community was seen within daily records and activities records. The home has its own transport and the inspectors were informed that enquiries are being made into getting further transport for the service. Through examination of rotas and discussion with staff, it was noted that service users have limited opportunities to access community based activities with staff in the evenings and at weekends as staffing levels do not allow for this. Service users are supported to participate in food shopping. Each house is responsible for their day to day shopping and menu planning. Service users are supported to make choices about what they would like to eat. Some foods are bulk bought and then distributed amongst the houses. Food stocks are currently stored in a vacant bedroom within Carlton House. The inspectors noted that supplies of margarine had not been stored in a fridge as per the storage instructions. Food supplies, storage and hygiene within in each house varied. One house had a good range of food and storage was hygienic. Food hygiene practice and food supplies in one home were inadequate. Service users told inspectors that they liked the food at the home. Fridge temperatures were recorded daily, however freezer temperatures are not monitored. Errors in fridge temperature records were found during the inspection. Records of menus and food actually consumed were examined and found to be satisfactory. The inspectors were told that service users are supported to participate in cooking although the inspectors did not have the opportunity to observe this. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 16 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) 18,19,20 Service users’ healthcare and personal care needs are not being met consistently. Care plans and risk assessments do not provide clear information to make sure that all staff are clear about how service users needs should be met. Decisions about whether specialist support is necessary need to be based on formal risk assessments and assessment information. Most service users can choose when to go to bed, have meals etc. Medication is generally managed well by staff, although better oversight and communication would improve practice in this area. Untrained staff have administered medication rectally. This practice is unsafe. EVIDENCE: Service users at the home require varied levels of personal support. It was not always clear within care plans how or what support should be offered. Service users spoken to said that they choose when they want to go to bed, and the inspectors observed that mealtimes are flexible dependant upon what service users are doing. Agreed limitations in respect of how much time one service user spends in his bedroom were unclear. The care plan was reportedly out of date however there was no record to indicate this. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 17 Service users looked well cared for in their appearance. The home has experienced difficulty in accessing GP services for all service users as some surgeries are refusing to take service users onto their lists. The deputy manager reported that she intends to contact the PCT to discuss these difficulties. There was evidence within some service user records however that healthcare services have been accessed. Medication management at the home was satisfactory in general. The Boots monitored dose system is in place. Each house stores, handles and records medicines separately; medication is not stored and administered centrally. The staff were not recording medicines that are received into the home and advice was given regarding this at the time of inspection. It was positive to note that the senior care co-ordinator has taken on the role of a weekly audit of all medicines. Medications stored tallied with records kept at both Greenway and Sycamore. At Carlton House, two tablets were missing from one service users supply of Paracetamol, and a ‘stock’ bottle of Paracetamol was ten tablets short according to the records kept. It was unclear from staff spoken to who ‘stock’ tablets were given to, staff or service users. Untrained staff had administered medication rectally and this practice is unsafe. Records regarding this were inadequate. Most staff have received medication training from Boots, and senior staff then undertake further assessment. Good records were available in respect of this. As previously discussed, some staff had administered medication rectally without having been trained in this procedure. This practice is unsafe. A homely remedies policy is in place. Records examined showed that GPs had been consulted and two had provided written agreement. It is positive that a service user is supported to manage his own medication. Staff and management informed the inspectors that one service user’s medication had been reduced significantly since moving into the home. This is reported to have had a positive effect on the service user’s quality of life. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 18 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) 22,23 There is a clear complaints procedure and positive steps are being taken to make sure this is accessible to service users. There is an adult protection procedure, and staff receive training as part of their induction. Insufficient action is taken to protect service users through the use of robust recruitment procedures for staff EVIDENCE: No complaints have been received at this home. A satisfactory complaints procedure is in place. The advocacy worker is in the process of transferring the complaints procedure into a ‘talking book’ format so that it is accessible to all service users. This is good practice. One service user told the inspectors that he would tell his mum if he had any worries or concerns. The service user told the inspectors that he would use the phone in the office to do this. An adult protection procedure is in place. The registered manager has informed the inspectors that protection training is delivered as part of the induction. Two staff described appropriate action that they would take if a service user reported abuse to them. The inspectors were very concerned that the homes recruitment practice does not protect vulnerable people. Six staff were found to be working at the home without evidence of the required CRB and POVA checks. This was raised at the previous inspection and the CSCI had been assured that this matter had been resolved. The registered manager reported that CRB checks are returned to the organisation’s head office and that some may have in fact been received. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 19 Tracking systems need to be developed to ensure that satisfactory CRB checks have been received for all staff. A number of staff did not have the required references. It is unacceptable that staff continue to work at the home without having had the required recruitment checks. A comprehensive physical intervention policy and procedure is in place, however has not been adhered to. The inspectors saw evidence in records of physical intervention, however staff have not received training in this area and records kept were not in line with Department of Health guidance. Individual physical intervention plans are not in place. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 20 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) 24,25,28 Accommodation provided is of a high standard and provides plenty of space for service users. EVIDENCE: The home is purpose built and provides modern, good quality accommodation in line with current standards. Service users told the inspectors that they liked the home and their bedrooms. Since the last inspection, fast growing trees and shrubs have been planted around the high metal fence at Carlton House so that it can be disguised and therefore better blend in with the surroundings. The deputy manager reported that funds have been secured to erect wooden panel fencing in the garden at Carlton House to create a more domestic look. This is positive. Each of the three houses was clean and well maintained with the exception of the dining room floors in each of the houses. The floor coverings have lifted causing a trip hazard. Efforts have been made to address this problem and the suppliers of the floor covering have unsuccessfully attempted to re-seal the floor coverings. Risk assessments have been carried out and identified that this causes a high risk at sycamore and a minor risk at Carlton House. The space requirements are met. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 21 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) 31,32,33,34,35,36 Further training and management oversight is necessary to ensure that a high quality, specialised service is delivered to all service users. More staff are needed at weekends and evenings so that service users can enjoy an active life outside of the home during these times. The recruitment practice at the home does not protect vulnerable service users. EVIDENCE: Job descriptions were available in those staff files that were examined. As the home is still relatively new, roles are still being developed. The former deputy manager is developing his role as advocacy worker and described positive ideas and plans for the service; these include a parent/relatives support group. The inspectors will discuss progress in this area at the next inspection. A senior carer has taken on a new role of senior care co-ordinator. This role involves oversight of medication and rotas. Service users appeared to be relaxed in the company of staff. Staff presented as approachable, enthusiastic and positive with the service users. The team is Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 22 relatively young and inexperienced, and further specialist training would be beneficial. This would help them to have a good understanding of the needs of the service user group and develop their confidence in supporting people with autism effectively. Fewer than 50 of care staff have achieved NVQ level 2 or equivalent, however all staff are registered on TOPPS induction and foundation courses and will complete NVQ training once this is completed. The inspectors did not have the opportunity to examine progress in this area as staff hold their own workbooks and these were not available. There was no evidence that staff were using the Learning Disability Award Framework to provide underpinning knowledge and this should be considered. For most of the time, high staffing levels are provided offering 1:1 support to service users. This is positive as it allows service users to access a range of activities that are individually tailored to their needs. Evenings and weekends are not consistently covered with this level of staffing and it was reported that this impacts upon the activities that can be offered to service users. The registered manager has assured the CSCI that he will look into this matter and pointed out that some service users stay with families at weekends and this is therefore reflected in the staffing levels. Managers and senior support workers do not currently work at the weekends, although a manager is always on call for emergencies. The registered manager reported that he would be addressing this so that a senior member of staff is on shift at weekends. Given the nature of the service, the complex needs of the service users, and the staff team it would be preferable that there is always a senior member of staff on duty. The recruitment procedure is not thorough and does not protect vulnerable service users. Required checks have not been completed for all staff. This was raised at the previous inspection and it is concerning that positive steps have not been taken to address this matter. The CSCI will consider enforcement action if the home continues to fail to comply with the Care Homes Regulations concerning staff recruitment. Staff receive an in-house induction during their first week at the home. This provides a basic overview of a range of topics, for example, fire safety, health and safety, record keeping, breakaway techniques and learning disabilities and autism. There was little evidence that any further training had been provided. Training in protection of vulnerable adults, movement and handling, first aid, food hygiene and service specific training has not been provided. The senior care co-ordinator was said to be exploring a range of training events that are provided free of charge by Kirklees Metropolitan Council. The inspectors had the opportunity to speak with a relative of a service user who was impressed at the amount of training about autism that she had been told had been provided to staff. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 23 Records examined showed that most staff are receiving supervision on a regular basis, although records were incomplete in two of the files sampled. Staff reported that they felt well supported by the management team. Service user specific procedures for dealing with physical aggression towards staff are not in place, and it is vital that these be developed in order to protect staff and service users. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 24 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) 37,38,41,42 The management style at this home is reported as supportive and approachable. Improved management oversight is necessary however, to make sure that the service users benefit from a well run home. The home’s record keeping needs to improve in some areas, and the manager needs to make sure that all policies and procedures are followed so that service users are kept safe. The health and safety of service users is not adequately protected in all areas. Fire safety and food hygiene must improve. Agreed physical intervention plans must be developed where necessary. EVIDENCE: The registered manager has significant management experience and is qualified as a Registered Mental Nurse (RMN), Registered General Nurse and holds a Diploma in Behavioural Forensic Science (Dip BFSC). A relative of a service user spoken to as part of the inspection felt that the management team Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 25 were approachable and that the registered manager and advocacy worker had a good knowledge of autism. Staff also reported that they felt the management team to be approachable and supportive. There was evidence that some policies and procedure were not being implemented at the home, for example: recruitment, protection, physical intervention and the provision of written contracts setting out terms and conditions for each service user. It is the registered manager’s responsibility to ensure that all policies and procedures are implemented. The inspectors’ impression was that the registered manager did not have sufficient oversight of the day-to-day running of the home. Some tasks have been delegated to senior staff, however there is a lack of monitoring systems in place to ensure that all tasks have been completed satisfactorily. It is acknowledged that this remains a relatively new service (first registered on 31 August 2004) however; progress in developing systems for record keeping, implementing policies and procedures and monitoring is crucial. Records are stored securely, although during the inspection it was noted that some filing systems were not good. The manager was unable to locate a number of records and the office was disorganised. Some records were detailed and clear, whilst others were not. These have been referred to elsewhere in the report. None of the service users living at the home require support with mobility although physical guidance is needed for some service users. Clear guidance for staff must be agreed and recorded to ensure that a consistent and safe approach is used when physically intervening with service users. Fire records for Carlton House were examined. Weekly tests of the fire alarm had not been completed, the last test being 14 April 2005. It is concerning that despite this being brought to the attention of the registered manager at the inspection in March 2005; this matter has not been addressed. The inspectors advised the registered manager to arrange for the fire alarms to be tested that day. A fire drill had been carried out on 9 February 2005. It was noted that the fire doors leading from the kitchens to the dining rooms in both Sycamore and Greenway were propped open. Staff reported that this is usual practice when meals are being served, however the evening meal was over at the time. If it is necessary for some fire doors to be left open, self-closing devices must be fitted. Satisfactory arrangements are in place for the disposal of clinical waste. Food hygiene was not consistently good. For example, a rotten cucumber and out of date food was in the fridge at Greenway, and large supplies of margarine had been stored in an unused bedroom rather than the fridge. Staff Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 26 are not recording freezer temperatures to ensure that food is being stored at the correct temperature. As the home is a new build, all electrical and gas equipment have been newly installed and meet current safety standards. The inspectors were shown a new risk assessment format that will be used to complete general risk assessments in the home. Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 27 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 1 2 x 1 Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x 3 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 x x 3 x x Standard No 11 12 13 14 15 16 17 x x 1 3 x x 1 Standard No 31 32 33 34 35 36 Score 3 2 1 1 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Carlton Autistic Care Centre Score 1 1 1 x Standard No 37 38 39 40 41 42 43 Score 1 2 x 1 1 1 x J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 28 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. 2. Standard 2, 41 5 Regulation 14(1)(a)(d) 5(1)(b)(c) (3) Requirement All service users must have an up to date assessment prior to moving into the home. Each service user must be provided with a contract setting out the terms and conditions, services and facilities provided by the service. Each service user must have an up to date written plan as to how their health and welfare needs are to be met. The plan must be implemented. Timescale of 31/5/05 unmet. A record must be kept of any limitations agreed with the service user as to the service user’s freedom of choice, liberty of movement and power to make decisions. This must include limitations on cigarettes. Where physical intervention is necessary, an agreed plan must be included as part of the individual care plan and staff must receive the relevant training. Training provided should be accredited by Bild as per Department of Health guidance. Timescale for action 15/7/05 15/7/05 3. 6, 18, 41 15 31/7/05 4. 6, 41 17(1)(a) 15/7/05 5. 6, 23,42 13(6) 31/7/05 Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 29 6. 9, 41 7. 13, 33 8. 17 9. 20, 41 10. 19, 41 11. 23, 34, 41 12. 24 Identified risks to service users must be assessed appropriately and actions to minimize risks to service users agreed. Timescale of 31/5/05 unmet 18(1)(a) The registered person must ensure that at all times, including evenings and weekends, suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 13(4)c Freezer temperatures must be monitored to ensure food is stored at the correct temperature; foods must be stored in accordance with instructions; food past its use by date must be discarded. 13(2) Staff must not administer medicines using invasive procedures unless they have received training from a suitably qualified and competent person and the individual care plan and risk assessment reflects the treatment required. 13(4)c (6) Service users mental health must be monitored including prompt referrals to appropriate specialists when necessary. Risk assessments must be completed in respect of specific risks and the individual care plan updated to reflect any changes. 19 Information and documents as Schedule detailed in regulation 19 and 2 Schedule 2 of the Care Homes Regulations 2001, must be kept in respect of persons carrying on, managing or working at a care home. Timescale of 31/5/05 unmet. 13(4)c Floor coverings in the dining room of each house must be repaired to reduce the risk of 13(4)( c) J51_J01_44408_Carlton Autistic CC_v232176_070605.doc 31/7/05 15/7/05 7/7/05 7/7/05 7/7/05 15/7/05 15/7/05 Carlton Autistic Care Centre Version 1.30 Page 30 tripping. 13. 37, 40 12(1)(a)( b) The registered person must 15/7/05 ensure that standard 37.3 is complied with by ensuring that the required management and recruitment systems are in place to ensure the well being of the service users. 17(1)(a) The registered person must 31/7/05 Schedule ensure that all records specified 3 under Schedule 3 are kept in respect of each service user. 23(4)(a)(c Fire doors must not be wedged 7/7/05 )(v) open. Self-closing devices should be fitted to doors where it is necessary to keep them open. Fire alarms must be tested weekly and a record kept. Timescale of 7/5/05 unmet 14. 41 15. 42 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 3, 32, 35 Good Practice Recommendations Further training relating to learning disablities and autism should be provided to all staff by a suitably qualified and competent person. Training and development should be linked to service users needs and their individual care plans. Staff should be provided with Learning Disability Award Framework accredited training to provide underpinning knowledge. Systems should be developed to enable the registered manager to have a good oversight of the running of the care home and ensure the completion of all necessary records, and implementation of all policies and procedures. 2. 3. 3,35 38 Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 31 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse. HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carlton Autistic Care Centre J51_J01_44408_Carlton Autistic CC_v232176_070605.doc Version 1.30 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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