Inspection on 13/02/09 for Echo Square House

This inspection was carried out on 13th February 2009.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Echo Square House 06/02/07

Echo Square House 08/12/05

Echo Square House 04/07/05

Echo Square House 15/02/05

Echo Square House 21/07/04

Echo Square House 11/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Echo Square House 70 Parrock Road Gravesend Kent DA12 1QH The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Montgomery Date: 1 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 25 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Echo Square House 70 Parrock Road Gravesend Kent DA12 1QH 01474332224 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): National Autistic Society Name of registered manager (if applicable) Mrs Valerie Anne Barker Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admisison to the service are within the following category : Learning disability (LD) The maximum number of service users to be accommodated is 3 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 25 A bit about the care home Echo Square House is a care home providing personal care for three adults with Autistic Spectrum Disorders (ASD). The National Autistic Society (NAS) operate the service but Hyde House Corporation owns the property. The home is a detached property situated about two miles from the centre of Gravesend. Gravesend has many amenities, including shops, pubs, main post office, banks, places of worship and an adult education centre. The home is also in close proximity to a number of local shops and public transport is easily accessible from the home. Resident accommodation comprises one sitting room, a separate dining room and three single bedrooms. None of the bedrooms have ensuite facilities. All bedrooms are situated on the first floor. The home does not have a stair or passenger lift. There is a garage and small-enclosed patio area at the rear of the property. The home blends into the surrounding area and there is nothing to suggest it is anything other than a family house. Free parking is available nearby. In addition to the residential accommodation the NAS provides workshop activities in a variety of locations in the Gravesend area for residents from this home. The weekly fees range from £1200 to £1300 Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 25 How we did our inspection: This is what the inspector did when they were at the care home This Key Unannounced inspection was conducted by Sarah Montgomery, Regulatory Inspector, who was in Echo Square House from 2pm until 6pm. Judgements about quality of life and choices were taken from discussion with the manager and a resident, inspection of records, and a tour of the building. The manager had previously completed an annual quality assurance assessment, from which information was used to inform the inspection process. What the care home does well Staff support residents in taking risks. Staff ensure that residents experience the lifestyle of their choice. Residents healthcare needs are very well met. Residents views on the service inform any changes made. The home is well managed and staffed. Residents are protected from harm through the homes safeguarding vulnerable adults and complaints procedures. Care Homes for Adults (18-65 years) Page 7 of 25 Staff are well trained. What has got better from the last inspection What the care home could do better Completion of person centred plans with up to date information would benefit the residents. Care Homes for Adults (18-65 years) Page 8 of 25 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sarah Montgomery 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective service users can be confident they will have the information they need in order to make an informed choice about the home. Evidence: Standards 1 and 2 were assessed. To assess these standards we looked at the statement of purpose, service user guide, care plans, and the homes admission criteria documentation. We also spoke with the home manager regarding future and past admissions, and a service user about life at the home. The statement of purpose is specific to the resident group, and provides comprehensive information about the home and the services provided. The service user guide has been developed in an accessible format, and ensures that prospective service users have information about the home which is meaningful. The weekly fees need to be added to the statement of purpose. Discussion with a service user, and inspection of review and person centred planning meeting notes, evidenced that the services offered in the guides translate into day to day opportunities. This evidences that the home ensures that residents are regularly assessed, their needs met, and their aspirations and wishes acted upon. Care Homes for Adults (18-65 years) Page 11 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be assured that the staff know their assessed needs and personal goals, but would benefit if all of this information was recorded in a care plan. Evidence: Standards 6, 7 and 9 were assessed. To assess these standards we looked at care plans and risk assessments, and also inspected documents which told us how residents are supported to make decisions, for example review meeting notes. We also spoke with the home manager and a resident. The home manager told us how the staff at the home ensure that all residents needs and aspirations are known. This includes regular formal assessment of individuals, weekly one to one time with residents to talk about their needs and aspirations, and to look at what support is needed, and regular consultation with important people in individuals lives. For example, day centre staff, healthcare professionals, friends and family. The manager told us that all this information is used to inform care plans, risk assessments, and support with lifestyle choices. We spoke with a resident who told us he was happy at the home, and that staff help me if I need it. The resident described his lifestyle. It was clear it centred around things he had chosen to do, and that staff provided support to achieve goals Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: when necessary. Inspection of individual care plans evidenced some shortfalls in maintaining accurate records. Although it was clear from conversations with the manager and the service user that needs are being assessed and met, current care plans lack sufficient detail, and aspirations noted at review meetings had not been carried forward into formal care planning. The manager assured us that the implementation of person centred plans would mean that recording would improve. Inspection of risk assessments evidenced a thorough process, which recorded the assessed risk, and provided support needs for residents and guidelines for staff. All risk assessments inspected took into account the specialist needs and age of the individual, and were balanced in terms of aspirations for independence, choice and normal living. Care Homes for Adults (18-65 years) Page 13 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be confident they will be supported to lead valued and fulfulling lives. Evidence: Standards 12, 13, 15, 16 and 17 were assessed. To assess these standards we spoke with a resident about how the home supports him to fulfil his lifestyle choices, looked at documentation which told us how the home gathers information about residents lifestyle choices, and spoke to the manager about how the home achieves positive outcomes for residents in meeting their lifestyle needs and aspirations. The home prides itself on being a person centred service, based around meeting the assessed needs and aspirations of the residents. Evidence gathered from the annual quality assurance assessment, records viewed at the home, and discussions with a resident and the manager demonstrated that the home excels in supporting residents to have valued and fulfilling lives. All residents attend a local day centre Monday to Friday. They are supported by staff from the home while there. A resident spoke enthusiatically to us about his hobbies, Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: and about day trips, holidays and meals out. Each resident has a memory book. These are filled with leaflets, photographs and postcards of all the places they have visited. On the day of inspection two residents had gone to visit family for the weekend, and another resident was going to spend the weekend with a friend. All residents are supported to maintain friendships and good relationships and contact with important people in their lives. Residents are provided with a good choice of wholesome and varied meals. Care Homes for Adults (18-65 years) Page 15 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be confident their personal and healthcare support needs will be met. Evidence: Standards 18, 18 and 20 were assessed. To assess these standards we looked at individual health care plans, the annual quality assurance assessment, medication policies and practices at the home, and spoke with the home manager. It is evident that residents are well supported with their personal, physical, emotional and health care needs. Their personal preferences and needs are known and respected by the staff. We inspected individual health care plans. They were assessed as being excellent, with clear efficient recording systems detailing assessed support needs, and a clear plan of how this support will be delivered. The home is proactive in preventative health care. All residents have a well man annual health check, and weekly health checks are undertaken by staff with regard to feet and hand care and weight. Medication administration was discussed and documentation viewed. At present only one resident requires support with medication. Records for this are well maintained. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be confident their views will be listened to and acted upon. Residents are protected from harm. Evidence: Standards 22 and 23 were assessed. To assess these standards we looked at the homes complaints policy, spoke with a resident about how to make a complaint, and discussed with the manager how the home ensures residents are protected from harm. We spoke with a resident about what to do if he was unhappy about something. He said I am very happy here, but I would talk to staff if I wasnt. The complaints procedure is in an easy read format. It is kept in the lounge in a general information folder. This folder is looked at regularly by residents as it contains the service user guide, and information and ideas about days out and activities. The manager confirmed that residents are encouraged to give feedback on their home daily. Discussions usually occur naturally at mealtimes or when relaxing in the lounge in the evening. In addition, all residents have weekly one to one meetings with their keyworker and also use the weekly house meeting to air their views. The staff team have all received recent adult protection training. This is updated annually. The manager demonstrated a real commitment in ensuring residents are protected from harm. This is underpinned by her knowledge of adult protection protocols. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents benefit from living in a homely, comfortable and safe environment. Evidence: Standards 24 and 30 were assessed. To assess these standards we inspected all communal areas of the home and one bedroom. We spoke with the manager and a resident about how decisions are made about decorating and furnishing the home, and looked at roles and responsibilities for staff and residents with regard to ensuring the home is clean and tidy. It was immediately evident on entering the home that Echo Square House is homely, inviting and comfortable. There was evidence of individuals tastes and preferences throughout the home, both in decor and items of furniture, and specialist hobby equipment. Conversation with a resident demonstrated how proud he was of his home, and spoke enthusiastically about how all the residents ensure that the home is comfortable, tidy and clean. All residents participate in household chores. Staff ensure that residents receive appropriate support by continual assessment. All hazardous substances are risk assessed and are kept appropriately. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents benefit from being supported by sufficient numbers of competent and trained staff. Evidence: Standards 32, 34 and 35 were assessed. To assess these standards we looked at staff training records, staff recruitment processes, and spoke with a resident and the manager about how staff support people living at the home. Standard 34 looks at recruitment processes for the home. We have scored this standard as not being assessed. This is because we were unable to inspect staff files as they are not kept at the home. Although we were unable to inspect these files, discussion with the manager indicated that the home operates a thorough recruitment process based on equal opportunities, and ensures the protection of residents by carrying out appropriate checks such as acquiring references and undertaking a criminal records bureau check. We will ensure that on subsequent inspections of this home, notice is given so that staff files can be available for inspection. Records viewed demonstrated that staff receive regular training. 80 of staff have national vocational training qualifications. All staff have received recent training in protection of vulnerable adults, equality and diversity and challenging behaviour. The staff team is very stable, and there have been no new staff at the home for three years. The manager spoke highly of the staff team, and described them as professional, dedicated, competent and enthusiastic. This view was confirmed by a resident who told us the staff always help, are kind, and will Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: listen to people at the home. Records viewed evidenced that staff meetings and staff supervisions are regular. It was clear from discussions with the manager that staff views are valued at the home, and that staff work consistently with residents to ensure care plans are followed and residents are being appropriately supported and their needs being met. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be confident they live in a well run home. Evidence: Standards 37, 39 and 42 were assessed. To assess these standards we inspected policies and procedures, looked at how the home assesses the service they are providing, and spoke with the manager about how she ensures minimum standards are met and maintained in the home. The annual quality assurance assessment completed by the manager told us that all appliances in the home are regularly maintained, and that the home has a maintenance programme which ensures a safe environment for residents. Records seen during the inspection, and assessment of the home evidenced that safe working practices at the home ensure that residents health and safety are protected. The manager has several years experience of managing residential services and of working with people with austism. Throughout the inspection she demonstrated significant knowledge of Regulations, and was competent and confident when discussing how residents needs are met. Discussion with the manager and a resident, and examination of documents, evidenced that residents views are central to the way Echo Square House operates. Residents input, suggestions and ideas are sought and acted upon in an effort to constantly review and Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: where necessary improve the service. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 It is recommended that the home completes person centred planning with individual residents within two months of recieving this report. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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