Inspection on 09/09/05 for Eastcliffe

This inspection was carried out on 9th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Eastcliffe 07/09/09

Eastcliffe 08/03/07

Eastcliffe 19/01/06

Eastcliffe 08/03/05

Eastcliffe 12/10/04

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Dilston College Of Further Education

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

CARE HOME ADULTS 18-65 Eastcliffe Sidecliff Road Roker Sunderland Postcode Lead Inspector Katie Tucker Unannounced Friday 9 September 2005 at 9.00 am 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. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Eastcliffe Address Sidecliff Road Roker Sunderland 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) 0191 5484548 0191 5488678 Autism North Limited Michael Winter Care Home 8 Category(ies) of LD Learning Disability (8) registration, with number of places Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8 March 2005 Brief Description of the Service: Eastcliffe is a very large detached domestic house, which was built during the turn of the 20th century. The home had been registered as a care home for the elderly up until April 2002 at which time the registration ceased. Autism North has completed considerable refurbishment works to Eastcliffe prior to its registration in July 2004. Eastcliffe is registered to provide personal care for young adults who have an Autism Spectrum Disorder. The home has three floors. The eight bedrooms, lounges, dining room, kitchen and laundry are located on the first two floors. The staff room, office, regional manager’s office, and facilities for visitors are located on the third floor. A sloped drive leads to the main entrance to the home and a large yard is at the rear. People with a physical disability could not be admitted to the home, as they cannot get to all of the communal rooms. Steps lead from the main entrance up to the dining room and lounge. A second lounge and toilet are adjacent to the front door and prior to these steps. A lift provides access to two floors but there are mezzanine landings throughout the home. Eastcliffe is located just up from the main road running along the sea front at Roker, Sunderland. It is opposite a large park and close to shops and local entertainment. Bus routes to Sunderland and South Shields are located on the main road close to the home. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Eastcliffe and was conducted as part of the routine yearly programme. An inspector visted and spent half a day at the home talking with s and staff. A sample of risk assessments and behavioural guidlelines were examined. The staff were asked about the care plans, the complaints procedure, access to training and any changes to working practices. The service users were asked about life at Eastcliffe and the activities that they joined in. The general maintenance of the building was checked. Eastcliffe provides a service for younger adults with an Autism Spectrum Disorder. People at the home have difficulty understanding abstract thoughts and emotional context. Also people find changes in routine very difficult to deal with and other people’s needs and feelings difficult to understand. A number of the residents find meeting strangers extremely challenging and if given the option would not like to spend time talking to new people. These people’s wishes were respected. A part of the inspection however does look at staff practice and attitude. This type of observation did form a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by residents and the staff. During this inspection key standards were focused on but not all were checked. What the service does well: Eastcliffe has now been open for just over a year and in that year the service has been well managed. The manager has demonstrated a range of competencies in many areas and has helped staff develop similar skills. The service users have been readily assisted to work through the natural anxieties they face during transition and all have been supported to successfully settle into agreed routines. The staffing levels at Eastcliffe means that people can be readily supported in all situations. Thus when people have complex and challenging needs they can still go out and join in activities they like because two staff are available to accompany them. Service users are given access to a very wide range of activities and experiences and benefit from having stimulating life styles. Autism north has recently opened a day centre, Gorse House, which has rock climbing facilities, cinema, a swimming pool, cafe and craft workshops. This means that even people with extremely challenging behaviour can try something new and experience things many take for granted. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 6 Autism North has provided a care service specifically for people who have an Autism Spectrum disorder and have an excellent understanding of these people’s needs. Autism North constantly strives to ensure their services improve and that staff continue to develop their practice. The company employs a range of health care professionals including a psychiatrist and these professionals actively assist staff to meet the needs of the people who use the service. Eastcliffe is a converted private residence but Autism north has provided facilities above those required in the standards. Thus all of the bedrooms are well in excess of 12m² and are equipped with an en suite bathroom. Also large and spacious communal areas are provided. Eastcliffe is decorated to a high standard and already plans are in place to redecorate and up grade parts of the home. 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. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 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 standard(s) 1 and 2 The way in which the assessment material is collected and recorded means service user’s needs can be met at Eastcliffe. The service user guide is available and useful but lack of information about fees flaws this record. EVIDENCE: Autism North has developed a full and comprehensive assessment tool for the home, which service users can complete with staff. The assessments tools are designed to be extremely detailed, well written in plain English and outline all aspects of the individual needs and aspirations. Staff have to ensure information on past behaviour is kept and say whether it is current or not. Thus anybody working with a person would know what works well and what does not. If a new behaviour develops whether this has happened before, if so how it was extinguished or if it is cyclic behaviour that disappears of its own accord. The staff have been working hard to produce extremely detailed and outline all aspects of the individual needs and aspirations. The terms and conditions of residence are included in the service user guide for specific individuals. But the copies of the local authority placing agreement are not provided. These are not only required by regulation 5 of the Care Home Regulations 2001 but without them people cannot make informed decisions about whether the feel that the service they are getting is value for their money. Autism North has stated that they are working with local authorities to ensure agreements are provided. The evidence that representatives have signed the terms and conditions and know the fee levels Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 9 is not provided at the home so this cannot be verified. Also the local authority placing agreements often stipulate specific conditions such as the number of staff that needed to be provided for an individual. By not having a copy at the home the manager, residents or relative cannot check that contractual agreements are being met. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 7 Staff have adopted a style of writing that allows people to meet the needs of the residents. The manager constantly reviews plans and develops new tool as appropriate. EVIDENCE: Staff have continued to develop their recording practices and plans have been put in place to meet people’s social and emotional needs. Staff are starting to record information in a way, which sets out all of the actions that need to be taken to meet people’s needs. Since the last inspection staff have reviewed the way behavioural guidelines are written and are making them clearer. Work continues to provide detailed information about all the steps staff take to work with service users that display challenging behaviour. Having this level of information will make sure all of the staff use the same approach. Staff do identify primary and secondary actions to be taken prior to the use of physical interventions. Staff are also encouraging residents and their relatives to help complete their plans. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 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 standard(s) 12, 13 and 16 The staff are demonstrating a wide range of skills and the opportunities offered both by Autism North and Eastcliffe have allowed residents to greatly widen their life and expectations. EVIDENCE: Over the year service users have been encouraged to widen the range and types of activities they join in. People regularly go to the pictures, shops, and local pubs as well as the Gorse House a day centre Autism North has recently opened. Gorse House has rock climbing facilities, a swimming pool, cinema, art and crafts facilities and café. This will give service users the opportunity to develop the skills necessary to use these facilities in the community. Also autism north employs an activities co-ordinator who works with staff and service users in each of the homes to design and tailor-make a programme of activities that will be stimulating and enjoyable. The staff are not entrenched in common assumptions about people within the Autism Spectrum Disorder not liking or being able to change routines. They Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 12 have skilfully worked with people to work with to find out their preferred routine and gradually introduce different activities. Family are constantly involved in the care of residents and are aware of how staff are working with people. The residents regularly write and visit their relatives. The staff accompany people on the home and return trips when relatives cannot pick people up. The way staff and Autism North promote the full involvement of relatives helps to ensure residents and relatives fell valued by the service. People with Autism Spectrum Disorders find it difficult to form meaningful relationships and understand other people’s needs. However staff have worked within the boundaries of each person’s social and emotional skills so that they can live with the other people in the home. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff make sure service users receive support in ways that meet service users’ needs. EVIDENCE: The service users require different levels of support and help with daily living tasks. Some of the people require one-to-one support from staff throughout the day whereas other people can lead fairly independent lifestyles. Staff are very aware of how to meet those needs. Also people with an Autism Spectrum Disorder find routine helps them cope with the challenges of daily living and staff respect this need. The service users can become very overwhelmed if they are presented with sudden changes to their routine or too many choices. Thus staff have been trained to assist people make choices. The staff throughout the visit worked with people in sensitive and supportive ways. Staff were very aware of the approaches people prefer and the routines they like. Thus one person prefers to get up at a set time in the day and staff ensure his wishes are adhered too. One person uses sign language to communicate some of the wishes. Senior staff know what signs mean and routinely sign to the person. They have been training other staff and undertook to produce a pictorial tool of the signs used and what they meant for all of the staff to refer too. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 14 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 A robust complaints procedure is in place. The manager has demonstrated a good understanding of the importance and value of information people provide about how to improve the service. EVIDENCE: Autism North developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. This is reproduced in the service user guide and made available to residents or their representative. The manager recognises the importance of dealing with minor concerns in a proactive manner. Since the opening of Eastcliffe the manager has actively encouraged service users and relatives to make their views known. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 15 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 Eastcliffe has been thoughtfully up graded and refurbished to meet the needs of this service user group. It is also well maintained. EVIDENCE: Eastcliffe is a converted private dwelling. Prior to April 2002 it was used as a care home for the elderly but closed because of market forces. Autism North have completed extensive works to up grade the home. The number of bedrooms has been markedly reduced, with eight places now being offered. All of the bedrooms are in excess of 12m² with one bedrooms layout making it ideal to use almost as a bed sit. All of the bedrooms have en suite bathrooms. The layout of the home has mezzanine landing including one on the ground floor and a lift, which does not go to all of these landings. An access officer visited prior to registration and confirmed that Eastcliffe met the Disability Discrimination Act 1995 for visitors. Eastcliffe is compliant with the Disability Discrimination Act Part III, as visitors with a physical disability can gain access to the building and a suitable toilet has been provided. However Eastcliffe could not cater for the needs of a service user with a physical disability. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 16 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) 33 The staffing levels readily meet the needs of service users. EVIDENCE: Eastcliffe is a new registration so the Residential Forum Guidance for adults with a learning disability in conjunction with specific placing requirements have been used to generate the required number of staffing hours. The manager determines how the staffing hours will be allocated throughout the day and for the majority of time during the day six staff are on duty. Waking night staff are employed. Many of the service users have very complex needs and without these levels of support they would not be able to participate in the range of activities they do. Also to help people deal with the extreme stress they experience when dealing with daily life a higher staffing ration is often needed so that one-to-one support can be readily offered. Plus some service users need to have two staff accompany them when they go out so that they remain safe when navigating traffic and in crowded areas. Eastcliffe employs a housekeeper, who prepares the meals. She is very knowledgeable about people’s needs and has ensured that the menu is tailored to each person’s nutritional requirements. The manager is supernumerary. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 17 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 and 42 Eastcliffe is well managed and provides a safe environment for service users to live in. EVIDENCE: The operational director has over recent months delegated much of the tasks needed to operate the home to the manager. He is now able to organise training for the staff team and has found that this makes it easier to ensure all of the staff have received mandatory training. Also he is able to seek out additional specialised training such as sign language courses. He also manages more of the budget. All of these recent developments were seen to be working well and actively assisted the staff to continue to develop the service. The manager is now registered for the adjacent home and gives general management support. A deputy manager runs the day-to-day operation of the adjacent home with regular contact from the manager. The buildings are conjoined and access is gained through a gateway between the two homes. There were no health and safety issues noted at the time of the inspection. Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 18 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 2 3 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x x x x x x Standard No 11 12 13 14 15 16 17 x 4 4 x x 3 x Standard No 31 32 33 34 35 36 Score x x 4 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Eastcliffe Score 3 x x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 19 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 1 Regulation 5 (3) Requirement Timescale for action 16.12.05 2. 6 13 (7) 3. 7 12 (2) Schedule 3 (3) (q) The organisation must provide a copy of the local authority placing agreements to service users or their representative and should keep a copy in the service user plan. (Requirement made at previous inspections –timescale for action 15.02.05) Behavioural guidelines must step 10.02.06 out the actions needed to take to meet primary and secondary interventions as well as physical interventions. The staff must continue to 10.02.06 compile information on all areas of service users lives where are limitations occur because of people’s needs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 32 Good Practice Recommendations Consideration should be given as to how 50 of care staff will achieve a NVQ Level II by 2005. (Recommended at the last inspection.) B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 20 Eastcliffe 2. 37 The registered manager should achieve the Registered Managers Award by 2005. (Recommended at the last inspection.) Eastcliffe B52-B02 S61443 Eascliffe V219538 090905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Baltic House Port of Tyne South Shields Tyne and Wear NE34 9PT 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. 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