CARE HOME ADULTS 18-65
Coolhaze 119 Howard Road Plymstock Plymouth Devon PL9 7ER Lead Inspector
Tina Maddison Unannounced Inspection 19th July 2006 10:00 Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Coolhaze Address 119 Howard Road Plymstock Plymouth Devon PL9 7ER 01803 882296 01803 882296 sgjcoolhaze@hotmail.com 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) Peninsula Autism Services & Support Limited Mr Sam George Johnson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: The Registered Provider for Coolhaze is Peninsula Autism and Support, a limited company managed by a Board of Directors. The organisation states that it concentrates solely on providing care services for people with Autistic Spectrum Disorders. Coolhaze is a large detached property and has been arranged into three separate self- contained units. Service users have usually been assessed as requiring high levels of staffing to access opportunities inside and outside the home. The Registered Manager for Coolhaze is Mr Sam Johnson. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 19th July 2006. The Registered Manager was available throughout the inspection. A sample of service users care plans, risk assessments and daily living plans were seen. Health and safety documentation and staff files were also available for inspection. Two of the staff on duty spoke with the Inspector and were observed on duty working with the service users. Service users were unable to give detailed views regarding their care at the home, but were observed in their areas of the home. Parent questionnaires were seen, and a pre inspection questionnaire had been completed and returned by the Registered Manager. The Company Activity Co-ordinator was present in the home during the inspection and was spoken with during the inspection. What the service does well:
Coolhaze offers a quality, individualised environment for service users, and quality person centred care from staff who are well trained, well supported and understand the individual needs of people who have autism and their behaviours that challenge the service. On the day of the inspection the service users appeared relaxed and happy. Mr Sam Johnston provides clear and positive leadership to the staff team and ensures the home operates in an open and efficient way. The Manager and staff have ensured that documentation such as care plans and risk assessments are detailed, and therefore clearly help the staff to work with the service users in a consistent and positive manner. Risks and choices are very well balanced and the service users enjoy a variety of activities. Due to the way the home has been separated into self contained units service users can pursue their hobbies and interests such as music and videos when at home without disturbance to other residents. They can be as private as they wish, whilst also enjoying company from other service users if they desire. Liaison with other health and social care agencies is good and procedures are in place to ensure regular contact and communication with family and friends. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 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 Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 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): 1,2,3,4,5 Prospective service users can be confident that due to a robust pre admission process that Coolhaze will be able to meet their needs. Service users or their families will have the information they need to establish that Coolhaze can meet their or their relatives care needs. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Coolhaze offers service users a statement of purpose, service users guide and statement of terms and conditions detailing fees and services provided. There have been no new admissions since the last inspection. Pre admission assessments are completed prior to admission to the home, and this documentation was available on individual service users files. If appropriate, prospective service users are able to visit and have a trial stay at the home to establish whether they wish to move there. Close liaison with care and health professionals and the service users relatives was evident in files and this information was also taken into consideration before a decision was made to establish that Coolhaze could meet the individuals care needs. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 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): 6,7,8,9,10. Service users assessed and changing needs and personal goals are reflected in detail in their quality individual plans. Service users make decisions about their lives with assistance as needed. Risks and choices are appropriately and skilfully balanced. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the three service users at Coolhaze had a very detailed care plan, that detailed all assessed care needs and how staff should meet these. The plans also detailed any behaviour that may challenge staff, and how staff should address these. Regular reviews had taken place to update and amend the care plans. Clearly stated were assessed needs, intervention techniques, an explanation about why those interventions were made, and hoped for outcomes. In addition to this, there are progressional plans identifying long term goals, and the steps required to achieve these goals. There was also documented evidence of multi agency involvement in the planning and review of service users. Coolhaze has a good deal of assistance from the challenging behaviour service and representatives of this service are invited to team meetings to assist staff
Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 10 and answer any questions about any behaviours of the service users that are challenging staff. Any restrictions on choice or freedom were based on a risk assessment, had been agreed with the service user and/or representative and were regularly reviewed. Choices are sometimes limited for the service users, as because of their autism too many choices may be too difficult for them to cope with. Due to each service user having their own self contained unit within the house, and high staffing levels, care can be provided in a very ‘person centred’ manner. Physical interventions are only used as a last resort, and staff will use distraction methods and diversion techniques as a primary way of diffusing potentially difficult situations. Any physical interventions are recorded. Service users have weekly activities planners that detail activities for the week, and use symbols that they can make a choice from. Service users participate in the day to day running of the home depending on their abilities. Service user records were found to be stored appropriately, and securely. Staff were aware of the need for confidentiality. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 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): 11,12,13,14,15,16,17. Service users are supported by staff to lead a full and active lifestyle, with opportunities for personal development. Service users rights are respected. Service users enjoy a healthy diet. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The Company employs an activities coordinator who was present during the inspection and explained her role to the Inspector. Activities are individualised, and set out on each service users activity plan. Every six months these activities are evaluated and updated, to establish which activities are valuable, and which activities the service users enjoyed or did not enjoy. When the service user is non verbal, this is established by staff assessing behaviours or non verbal communication. The activities focus on communication, socialization, and independent living skills. Included on these plans are guidelines for staff on how to encourage, motivate the service user to try the activity and how to analyse the outcome. Likes and dislikes of the service user regarding activities are also gained from the service users families. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 12 Contact with families and friends is also encouraged, and the Manager and staff spoken with recognised the importance of maintaining and supporting these contacts. Service users have their own units of living accommodation within the home, and although service users have been assessed as requiring 1:1 or 2:1 staffing levels support staff confirmed that service users privacy is respected, as is their need for their own space. It was observed throughout the inspection that staff demonstrated an awareness of the service users rights, and were respectful at all times. Staff also demonstrated an understanding of each service users care needs and how these could be met. Menus were provided for inspection, and demonstrated that healthy eating is encouraged whilst catering for each service users likes and dislikes. Health records confirmed that the home has referred to a dietician when required. The service users have their own dining and kitchen areas and are supported to partake in shopping and food preparation dependent on their skills and risk assessments. They do have communal barbeques in one of the service users garden, and this event was happening on the day of the inspection. Service users are able to have a holiday, and are encouraged if they find going on holiday a challenging experience. One service user is encouraged to go away for a few days break by being accompanied by his favourite two staff and calling it a ‘relaxing break’ rather than a ‘holiday’. Any activities are fully risk assessed. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 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): 18,19,20. Service users physical and emotional health and personal care needs are met at Coolhaze. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users individual plans provided detailed information regarding service users personal, emotional and health care needs. Daily personal guidelines were provided in a list format with details of service users preferences and routines. A medication round was observed. Staff appeared well trained and knowledgeable about the medication process and administration of medication. Medication is appropriately and securely stored. Medication record sheets were found to be accurate and well recorded. Service users or their representatives have signed an agreement to take medication, medication side effects are noted, and each service user has a ‘why I take (name of medication)….’ So that they can be helped to understand why they are taking a particular medication. Staff have been trained to administer medication. Healthcare needs are documented in detail, and weight is monitored. All personal and healthcare needs are documented, along with interventions and rationale for these. Service users are registered with a local General Practitioner, and have access to all local health services.
Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 14 Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 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): 22,23 Service users and their relatives can be confident that their views will be listened to and any complaints will be taken seriously and acted upon. Service users are protected from abuse, neglect and self harm at Coolhaze. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Neither the home nor the Commission for Social Care Inspection have received any complaints regarding this service since the last inspection in January 2006. The home has a written complaints procedure, and this is displayed in the communal hallway of the home. The manager stated that he makes efforts to speak to the parents of the service users on a regular basis, and the daily communication book outlined several examples of regular contact between the home, parents or relatives of service users, and health and social care professionals. Service users have a range of communication methods, and it was apparent that the staff have positive relationships with them that enables them to communicate their needs. Each service user has a separate file containing in depth daily reports that can be analysed to understand any triggers and respond to non verbal forms of concerns/complaints. The latest alerters guide and prevention of abuse procedures were available to all staff. All staff have received protection of vulnerable adults training and the Manager has received local multi agency training in this area. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 16 The Manager could produce documented evidence that the home regularly liaises with specialist services to agree behaviour management guidelines, and these are regularly reviewed. All physical interventions and restraints are recorded, and all staff members have undertaken Studio 3 (behaviour management) training as part of their induction and this is updated regularly. In addition there are also lone working procedures, debriefing, staff meetings and individual supervision to ensure that staff receive sufficient support and advice when working with service users who may present challenging behaviours. Records relating to service users finances were found to be in good order and up to date. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 17 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): 24,25,26,27,28,29,30. The layout of the home and the accommodation it provides has been well planned and fully meets the individual needs of the service users. Coolhaze is well decorated and homely and provides the service users with a safe and comfortable place to live. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Coolhaze provides accommodation within a large detached house that has been divided up into three separate self contained units that have their own front door, lounge, bathroom, bedroom and garden area. Within the house there is also a communal kitchen, staff office and sleeping in room. Each unit is fitted with emergency call bells, and the doors are alarmed. This is with the agreement of relatives and care managers and is documented. During the inspection all communal areas of the house and two of the service users areas were inspected, and all were found to be clean, tidy and well maintained. Areas of the house have been re carpeted and there is an ongoing maintenance programme. Any changes of redecoration and refurbishment are
Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 18 carefully planned, as the services users, due to their autism, need to be well prepared and supported to cope with any changes. Service users units are personalised and reflect any personal interests and hobbies. It was observed during the inspection that the service users were very much ‘at home’ in these areas, and on the day of the inspection were relaxed and were enjoying watching videos and listening to music. One service user said that he liked his accommodation. Service users do meet on occasions in one of the units, on the day of the inspection a barbeque was planned in one of the gardens. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 19 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): 31,32,33,34,35,36 Service users and their representatives can be confident that enough staff will be on duty to meet service users assessed care needs, and that staffing levels will regularly be reviewed. Not all staff files contained two written references. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff that were spoken with were very aware of their own roles and responsibilities within the home. It was clear that staff are very knowledgeable about the care needs of the service users at Coolhaze and how these needs are to be met. The service users at Coolhaze have complex care needs and present behaviour that may challenge the service. In view of this, the service users are assessed as requiring individual or 2:1 staffing support inside and outside of the home. The homes risk assessments and duty rota confirmed that this level of staffing is in place. There are 4/5 staff plus the Manager on duty during the day, and the home employs a cook and cleaner. There is a four weekly staff rota. Staff confirmed that they were happy with the staff rota and believed that the home is adequately staffed. Staffing levels are regularly reviewed. Staff training profiles indicated that staff have received training in a number of areas including health and safety, medication, food hygiene and fire safety. First aid training is also provided, and specialist training in working with people
Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 20 who have autism and physical restraint training. The majority of staff had completed NVQ 3 training in care. A comprehensive induction programme is available for new staff. Four staff files were examined, and one had two references and three had one reference. It is a recommendation of this inspection that two references are obtained as part of the recruitment process. These staff members without two references were recruited prior to the current managers appointment, and Mr Johnson is fully aware that two references are required and has agreed to ensure that these are sought. All staff files contained a current CRB and POVA check and proof of identification and application forms. Staff confirmed that they receive regular supervision and notes for these were available. In addition to supervision there are regular staff meetings, handover meetings, and debriefing available following a difficult incident. It was observed that staff interaction with the service users was positive and enabling. Staff understood the service users need for consistency and clear boundaries when working with the service users, and this was apparent in their approach. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 21 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): 37,38,39,40,41,42,43 Coolhaze benefits from strong leadership from the Manager and senior staff and service users benefit from a safe, well run home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peninsula Autism Services and Support Ltd., is the Registered Provider for Coolhaze and is managed by a board of senior directors. Mr Sam Johnson is the Registered Manager. Mr Johnson has undertaken a wide range of training and has an excellent knowledge of autistic spectrum disorders. He provides strong leadership and ensures the home is well organised and safe. There is a member of staff that undertakes all health and safety issues are checked, and issues a quarterly report. No health and safety concerns were apparent at this inspection. Policies and procedures have been written and reviewed regularly and cover all the activities in the home. Accidents and incidents have been recorded. Fire safety systems have been properly maintained and tested.
Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 22 The home does not yet have a formal quality assurance system in place, however, the service users and their representatives can complete a questionnaire. The home has an annual audit from the Company, and is accredited by the National Autistic Society. Views are also sought from staff meetings, review meetings, and informal consultation. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 4 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 3 4 2 3 3 3 3 Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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. 2. Refer to Standard YA34 YA39 Good Practice Recommendations Two written references should be sought as part of the staff recruitment process. The Manager of Coolhaze should develop a formal quality assurance system. Coolhaze DS0000053993.V300528.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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