Inspection on 28/06/06 for Hoffmann Foundation for Autism 45a Langham Gardens

This inspection was carried out on 28th June 2006.

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 no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hoffmann Foundation for Autism... 02/05/07

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hoffmann Foundation for Autism 45a Langham Gardens 45a Langham Gardens Sudbury Court Estate Wembley Middlesex HA0 3RG Lead Inspector Julie Schofield Key Unannounced Inspection 28th June 2006 09:00 Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.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 Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.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. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hoffmann Foundation for Autism 45a Langham Gardens 45a Langham Gardens Sudbury Court Estate Wembley Middlesex HA0 3RG 0208 964 6650 TBA Address 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) Hoffmann Foundation for Autism Miss Caroline Casey Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: 45a Langham Gardens is a registered care home for 6 adults with learning disabilities. At the time of the inspection there were 5 residents accommodated in the home. 45a Langham Gardens is an extended semidetached house in a quiet residential road close to East Lane. It is within walking distance of bus routes and 2 underground railway stations are close by. The area to the front of the house has been paved over to provide off street parking and parking is available in the street. At the rear of the property is a garden with a lawn and decking area. Access to the garden is through the lounge or the conservatory. The property consists of ground, first and second floors. The ground floor consists of a laundry, communal toilet, shower room, open plan kitchen and dining room, lounge and 3 residents’ bedrooms (1 of which has access to the garden). There is a lift that connects the ground and first floor. On the first floor there are three residents’ bedrooms, a dining room, a lounge, a bathroom (including toilet) and a medication room. The office (which includes a sleeping in facility) and a shower room (including toilet) are on the second floor. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in June 2006 and consisted of 2 visits, on consecutive days. The first visit began at 9.00 am and finished at 5.45 pm. A lunch break of 1 hour was taken. The second visit began at 9.25 am and finished at 1.50 pm. The Inspector would like to thank the manager and members of staff for their assistance during the inspection. During the inspection discussions with the manager and staff took place, records were examined, the preparation of a meal was seen and a site visit was carried out. The Inspector met each of the 5 residents. Residents varied in their ability to give verbal feedback and so part of the inspection included observation of residents and staff and of care practices. The Inspector would like to thank the residents for their participation in the inspection. What the service does well: This is a newly registered home which has been refurbished to a high standard. It provides a comfortable and homely environment for residents and there are communal areas both on the ground and first floor. Bedrooms are light and airy and reflect the personality of the resident. Three of the residents have moved into the home after transferring from another of the company’s care homes. The transition was handled with care and systems were in place to make the transition as smooth as possible for the residents. The residents had the opportunity to visit the new home, choose their new bedrooms and choose the colour scheme for the rooms. Some of the staff that worked in the previous care home transferred to Langham Gardens with the residents to help with the settling in period. The manager had in the past been the deputy manager in the previous care home and so was already known to the residents. Residents have the opportunity to take part in activities and to lead an interesting and stimulating life. However the home respects the wishes of the older residents that may wish to lead a more relaxing lifestyle. There was a good rapport between residents and members of staff and residents said that the staff were good and that they were satisfied with the support given. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Eighteen statutory requirements were identified. A copy of the needs assessment and care plan are required as part of the admission procedure and the record of the transitional visits to the home need to include observations and feedback from the prospective resident, staff team and current residents. Carpet cleaning is to be paid for by the home and not by a resident. Window restrictors must be fitted to certain windows where a risk of self-harm has been identified and where the use of a monitoring/listening device has been agreed this is to be installed in the bedroom of the resident who wanders at night. A chest of drawers needs to be replaced. Loose wires protruding from a wall in the lounge need safely covering. Items being stored in the conservatory need to be removed so that this may be used as a communal area. Garden furniture needs to be purchased for next spring. Paper towels need to be provided for each communal wash hand basin. Bedrooms must be free of the odour of urine. The home must set up a contract for the removal of clinical waste. The staff team needs to achieve the target of 50 of members holding an NVQ level 2 or 3 qualification and the manager needs to achieve an NVQ level 4 qualification. Staff administering medication must be appropriately trained and all staff must undertake training in safe working practice topics. The home needs to seek the advice of the LFEPA in respect of the current system for locking and unlocking the door. If there is a need for a work permit this must be clearly stated on the staff file, with evidence that one has been produced if the member of staff is required to hold one. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 7 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. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 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 the following standard(s): 2, 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment of the needs of the resident and a copy of the care plan from the placing authority, assists the home in determining whether a service tailored to the individual needs of the resident can be provided. A programme of pre-admission visits to the home enables the prospective resident to sample life in the home and to decide whether the service provided is acceptable. A record of these visits must be kept so that the home can demonstrate that the needs of the prospective resident are compatible with those of existing residents. EVIDENCE: Of the 5 residents living in the home, 3 residents transferred from another Hoffmann Foundation for Autism care home. The case files of the remaining 2 residents were examined. Although the Autism Co-ordinator had assessed the needs of 1 resident, and a copy of her report confirmed that the resident’s needs could be met by the home, the file did not contain a copy of the assessment of need or of the care plan produced by the placing authority. The second resident is self-funding and the report produced by the Autism Coordinator provided evidence of a thorough assessment of need. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 10 There was a transition plan on file for both of the residents and the manager confirmed that the prospective residents had visited Langham Gardens, prior to admission to choose their room, meet staff and residents and to see the premises. One of the residents had also had a meal in the home on one of the visits made and the other resident had a programme of overnight stays. Both residents had been supported by a family member and by their advocate during the transition process. The home had not recorded the observations of staff that were on duty during these visits or the reactions of the existing residents or any responses from the prospective resident. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, 9 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and guidelines for supporting residents have been drawn up for each resident so that the service provided can meet the individual needs of the resident. The home is able to demonstrate that changes in the needs of residents are identified and addressed through a system of review meetings and monthly evaluations. The resident’s right to make decisions about their life in the home is respected. Residents’ monies enable them to purchase personal items and must not be used for services that the home would be expected to provide. Responsible risk taking contributes towards the resident leading an independent lifestyle and risk assessments have been drawn up. However action needs to be taken to ensure that the likelihood of a risk occurring is reduced. EVIDENCE: The case files of the residents who had transferred from another Hoffmann Foundation for Autism care home were examined. Information was contained Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 12 in a number of documents. There was a care plan, which contained information on Autistic Spectrum Disorders, an assessment of self-help skills and what the resident was saying. Care plans were evaluated on a monthly basis. PCP’s were in the process of being drawn up by the key worker. Support needs were in a separate document. The support plan included an identification of basic needs, the support to be given, the timescale, who provides the support and a date for review. Placement took place 6 weeks after the transfer for 4 of the residents. (The fifth resident had been admitted to the home 2 weeks ago). There was evidence of a review of the care plan by the care manager from the local authority on case files and these included growth points. The manager was able to describe the progress being made to achieve the targets set. It was noted that case files would benefit from some information being archived. A discussion took place with the manager in respect of opportunities for residents to make decisions about their lives and being offered choice. She said that residents were involved in the planning of the menu, which took place on a Sunday. Residents could choose whether or not to take part in activities, they could choose what clothes to wear, how often they wanted their hair washed, whether they wished to spend time in their rooms and whether they wished to have a busy or a quiet day. Some of the residents attend an advocacy group each fortnight, if they wish. None of the residents are able to independently manage their finances and an appointee from the company provides assistance. Records of residents’ finances were examined. They were up to date. It was noticed that one resident had paid for the carpet to be cleaned in their room. Files contained evidence of recently completed risk assessments for residents new to the service, which varied according to the needs of the resident. Residents who had transferred from another of the company’s care homes had risk assessments that had been drawn up within the last 12 months. There were risk assessments for access to the community, taking a short holiday, falling, aggressive behaviour, absconding from the home. The risk assessment consisted of an identification of the risk, an assessment of the frequency of occurrence, how to minimise the risk, what could be a negative outcome and the support needed. One case file contained a risk assessment in respect of self-harm and it was noted that the resident might try to jump out of upstairs windows. Restrictors had not been fitted on all the upstairs windows that the resident had access to although the manager said that the resident was supervised when using these rooms and that the rooms were kept locked when not in use. One case file contained a risk assessment in respect of the resident going into another resident’s room at night. The manager said that a monitor had been installed into the other resident’s room to alert staff. On some case files there were risk assessments which had been drawn up prior to 2005 but which had been reviewed and were still valid. The format that is now in use is more comprehensive. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Taking part in activities, developing new skills and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. By maintaining contact with their family and friends the resident’s need for company and fellowship is met. Residents are encouraged to become more independent by making decisions and by having their wishes respected. Residents are offered a balanced diet to promote their well-being and the diet respects their religious and cultural needs. EVIDENCE: It was noted that the case files of residents included an identification of need in respect of counselling, social skills and developing independent living skills. Residents are encouraged to develop their emotional skills and the support given to a resident during a bereavement period included accompanying the resident to attend the funeral. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 14 Three of the residents have a structured day care programme, which includes day centre and college attendance. Two of the residents attend day centre on 5 days per week and the third resident attends on 3 days a week, as it is their wish to have a more relaxing week due to their age. College courses include horticulture and one of the day centres includes a session on “life skills” in their programme. The fourth resident has a more flexible programme due to their frailty. The fifth resident was admitted to the home 2 weeks ago and an assessment of their interests is being carried out. One of the support workers said that residents went to the cinema, pubs, restaurants, shops, banks, out for a walk etc. A resident confirmed that they used facilities in the local community. They also attended discos held in the evening. The manager said that the home was developing a system of pictures of activities to assist residents in making a choice and then making their wishes clearly understood. Residents were able to use taxis, public transport or a company vehicle. This is a new care home and the manager said that the names of residents would be entered on the electoral roll. Residents enjoy varying levels of contact with their relatives and the home supports residents to maintain these links. Some residents have received visits from their relatives and some residents, have in the past, been supported in visiting their relatives. If relatives do not visit a resident the home keeps the relatives informed of important events in the resident’s life. If a resident receives a visitor they can entertain them in their room or in one of the lounge areas. It was noted that during the inspection staff respected the privacy of the residents and knocked on bedroom doors and waited to be invited into the room before entering. Residents are encouraged to take part in the daily routines of the home by helping to set and clear the table at mealtimes, making themselves a cup of tea or a snack (under supervision), dealing with their laundry (with assistance) and sitting with staff after returning from the day centres and discussing the menu, any activities taking place that evening and sharing their news. The manager said that staff had received training as part of a team meeting in respect of diabetes and diet by a qualified dietician and there was information on file for staff to refer to. At present the home is in the process of developing a 4 week menu cycle. Menu sheets were seen and these showed a varied and balanced diet with alternative choices listed. The record of food consumed by individual residents is kept in the daily log. One of the residents was at home on the first day of the inspection and said that they had had spaghetti bolognaise for lunch and that the staff were good cooks. An evening meal was prepared and served during the inspection. It consisted of cod fillets in a sauce with boiled potatoes and sweet corn. It is recommended that the home develop a system of pictures of food items, drinks, meals etc to assist residents in making a choice. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 15 Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 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 the following standard(s): 18, 19, 20 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive assistance with or prompting with personal care in a manner, which respects their dignity. Residents’ health care needs are met through access to health care services in the community. Residents’ general health and well-being is promoted by staff that assist the resident to take prescribed medication in accordance with the instructions of the resident’s GP. Training the staff that administer medication to the residents minimises the risk of an error occurring. EVIDENCE: A member of staff spoke of maintaining a resident’s dignity by promoting continence. It was noted during the inspection that assistance with personal care was offered discreetly and took place in private. A female member of staff provides assistance to female residents. Residents were clean and tidy and one of the residents said that they had been to the hairdresser. There was evidence on file of access to health care facilities in the community. Residents had appointments with the GP, chiropodist, psychiatrist, dentist and optician. Residents were supported to attend out patient appointments both locally and in central London. Training is provided to staff in respect of Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 17 diabetes and diet and information on this topic is included in the relevant resident’s case file. The physiotherapist visited the home on the second day of the inspection to assess a resident. The storage of medication was inspected. It is kept in a locked facility. The pharmacist supplies weekly dosette boxes. These are identified by the residents’ initials. (No 2 residents share the same initials). The empty compartments in the boxes were appropriate for the time of day and for the day of the week on which the inspection visit took place. Records of the administration of medication were inspected. They were up to date and complete. Two staff are present for the administration of medication. It is the role of the second person to check that the records have been signed and that that all the tablets have been removed from the correct compartment in the dosette box. Not all staff involved in the administration of medication have received training. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 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 the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place to protect the rights of the residents. An adult protection procedure and training in protection of vulnerable adults procedures help to promote and protect the welfare and safety of residents. EVIDENCE: The home has a complaints procedure in place, which has timescales for each stage of the process. If a complaint cannot be resolved locally a senior manager within the company deals with the complaint. The policy advises the complainant of their right to contact other agencies who are involved in the process e.g. the CSCI, the local authority and the Ombudsman. The manager said that no complaints have been recorded since the home was registered. The home has an adult protection procedure in place and has a copy of the local authority’s interagency guidelines. Induction training held at head office includes protection of vulnerable adults training. The manager said that no incidents or allegations have occurred since the home was registered. She confirmed that restraint is not practiced in the home. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 19 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, 30 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a comfortable and “homely” environment with pleasant communal facilities. The provision of patio furniture and the removal of items stored in the conservatory would increase the range of facilities for residents to enjoy. Single bedrooms provide residents with privacy and a room sufficient in size in which to relax. Residents live in a home where standards of cleanliness are good and where bathing and toilet facilities are appropriately placed although odour control needs to be maintained in all bedrooms. EVIDENCE: A site visit took place during the inspection and it was noted that all parts of the building were clean and tidy. The home was recently registered and has been decorated and furnished to a good standard. The home was bright and airy. There was a fan in the lounge as the weather was hot. The home is situated in a quiet residential road with transport facilities close by. Less mobile residents are accommodated on the ground floor, which offers level access. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 20 Each resident has their own single bedroom. Each room is sufficient in size to accommodate the necessary furniture and any personal items belonging to the resident. Five of the 6 bedrooms were inspected. These were smartly decorated and furnished. The manager said that the residents had been involved in the choice of colour schemes. The bedrooms reflected the personality of the occupant. It was noted that a new chest of drawers was needed in one of the ground floor bedrooms. Each bedroom has an ensuite toilet and wash hand basin. Two bedrooms also have an ensuite shower. In addition there is a bathroom, including a toilet on the first floor, and a shower room and a separate toilet on the ground floor. The staff sleeping in room has an ensuite shower and toilet. There is an open kitchen and dining area on the ground floor and a separate lounge. There were wires poking through the wall of the lounge above the door leading to 2 of the ground floor bedrooms. On the first floor there is a lounge and a separate dining room. With a lift in the building communal areas are accessible to all residents. The lounge on the first floor can be used for private visits from friends and relatives. There is a conservatory on the ground floor but this is currently being used for storage. The manager said that a shed, barbecue and patio furniture were on order for the garden. Although all areas in the home were clean and tidy here was an odour of urine in one of the ground floor bedrooms. There were no paper towels in the first floor bathroom. There is a laundry room on the ground floor. The washing machine has a sluicing facility. The home does not have a contract for the collection of clinical waste. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. NVQ training enhances the general skills and knowledge of carers and the home needs to meet the target of at least 50 of carers achieving an NVQ level 2 or 3 qualification. The rota demonstrated that there were sufficient staff on duty to support the residents and to meet their needs. Recruitment practices, which include checks and references, protect the welfare and safety of residents and the home needs to ensure that evidence of all of these is kept on the staff file. Residents benefit by being supported by staff who have access to both induction training and training to meet the needs of the particular client group. Individual supervision sessions enhance the overall support available to staff and are an opportunity to discuss working practices and to encourage personal development. EVIDENCE: A review of the staff team and of their NVQ training took place. There are 7 full time support workers and 3 part time support workers. Of the 10 members of staff 4 members of staff are undertaking level 3 training and 1 member of staff is undertaking level 2 training. A support worker said that patience, understanding and communication skills makes a good carer. Staff have undertaken training to develop their awareness of the needs of the residents and how to meet these. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 22 A copy of the rota was seen. There are 3 support workers on duty in the morning and 3 staff on duty in the afternoons. At night there is 1 waking member of staff on duty and 1 member of staff sleeping in but on call. Staffing levels are maintained at weekends. Bank staff are used in the home and the manager said that after the new resident’s initial 6 week review a decision would be taken on the need for permanent staff. There is always a permanent member of staff on shift. The deputy manager works shifts at weekends. The manager’s hours that are recorded on the rota are during the day, Mondays to Fridays. She said that if there were gaps on the rota she would cover a shift during the evening and at weekends or if a driver is needed for an outing she will cover this but has not recorded these on the rota. Four staff files were examined. It was noted that each file contained a CRB disclosure but on one file the disclosure had been obtained by a previous employer. This file contained a “pova first check”. Each file contained 2 references. All files contained proof of identity i.e. passport details. Two passports were non-UK passports and files did not specify if a work permit was required and if so, if one had been obtained. A member of staff said that they had to wait before starting work in the home until all the checks had been returned. A programme of training has been arranged for staff to enable them to support the residents. The programme includes training on conflict management, personal safety and mental health issues. The company has a training programme, which covers the period of a year and a copy of the training scheduled for the 3 month period, July to September, was seen. It included sessions on fire safety, makaton, first aid and manual handling. The home has a training budget, which can be used to purchase external training. The manager said that as the staff working in the home had either previously worked as bank staff or had transferred from another care home within the company, they had all completed their induction training. The manager and the deputy manager share the task of giving individual supervision sessions to support workers. Two support workers confirmed that they received individual supervision sessions on a monthly basis and they attended staff meetings, which are held on a fortnightly basis. One of the support workers said that in addition to this, the manager had an “open door” policy if staff needed support. The other support worker said that they attended meetings at head office where they represented the staff working in the home. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 23 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, 39, 42, 43 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager continues to develop her knowledge through further training and this contributes towards understanding the needs of residents and staff. Completion of the NVQ level 4 training will develop the manager’s skills. Service satisfaction questionnaires, forums and meetings help to monitor the quality of the service provided to residents and contribute towards the development of the service. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents and this must be undertaken by all members of staff on duty. In the event of an accident or incident occurring in the home the displaying of a valid certificate of insurance reassures the residents, members of staff and visitors that their safety is protected. EVIDENCE: The manager has previously worked as a deputy manager and as a manager in other Hoffmann Foundation for Autism care homes for approximately 3 years. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 24 She holds an NVQ level 3 qualification and said that she will start in September 2006 to study for her NVQ level 4 and RMA qualifications. She has recently undertaken training in report writing and in managing teams. The company has a number of ways in which feedback on the quality of the service is obtained. Feedback from relatives is obtained during their visits to the home. The company organises a forum (which is held on a quarterly basis) for relatives and residents and 2 of the residents attended the meeting held in April. Comments can also be given during the review meetings, to which relatives are invited, if the resident wishes. In addition, on a quarterly basis a sample of relatives are sent a quality assurance feedback form. In respect of the placing authority a sample are sent a quality assurance feedback form. Comments can be given during review meetings and there is contact between the home and the placing authority by email. Residents attend a daily meeting in the home, after returning from their day care programmes, and this is used to obtain feedback from residents. In addition meetings take place between the resident and their key worker and between the manager and the resident. There were recorded risk assessments for fire (dated 2006), first aid (2004), infection control (2004) and food hygiene (2006). The manual handling risk assessment (2006) was very brief and the manager said that not all staff had completed manual handling training. Although not all staff have undertaken first aid training she said that there is always at least 1 member of staff on each shift that has been trained. One member of staff who had worked with the company for approximately 5 years said that they had completed their training in all safe working practice topics. Another member of staff on duty confirmed that they had undertaken first aid training but not fire safety, food hygiene or manual handling training. The manager said that she was completing a staff team training record and was matching gaps in the record with sessions coming up on the training schedule. There were documents for the installation of the electrical wiring system (dated 23/8/05 and valid for 3 years), the Landlord’s Gas Safety Record (dated 21/9/05 and valid for 1 year). and for the lift (dated 10/5/06). There was evidence that fire alarm tests were undertaken on a weekly basis and fire drills every other month. It was noted that the front door was kept locked and that each member of staff on duty had a key to unlock the door. There was a certificate of insurance on display in the home in respect of Employer’s Liability. It was dated the 1/4/06 and was valid for the period up to the 31/3/07. The company is supported by centrally based staff that are responsible for financial control. There is a human resources department and quality monitoring of the services provided by the company includes monthly Regulation 26 visits to the home. A copy of the report of the visit is sent to the CSCI. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 25 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 X 2 2 3 X 4 2 5 X 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 3 25 3 26 2 27 3 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000065159.V298576.R01.S.doc 3 2 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 3 Version 5.2 Page 26 Hoffmann Foundation for Autism 45a Langham Gardens N/A 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 YA2 Regulation 14.1 Requirement That as part of the assessment procedure, the home requests and receives a copy of the placing authority’s assessment of need and care plan. That records are kept of the visits made to the home by the prospective resident during the transition plan. These records are to include the observations of managers and staff, reactions by existing residents and feedback from the prospective resident. That the cleaning of the carpet in a resident’s room is paid for by the home and not from the resident’s monies. That window restrictors are fitted on all upstairs windows in rooms to which the resident has access. That the monitoring/listening device is installed in the bedroom of the resident who wanders at night. That all staff administering medication to residents have received medication training. That the chest of drawers in the ground floor bedroom is DS0000065159.V298576.R01.S.doc Timescale for action 01/10/06 2 YA4 12.1 01/10/06 3 YA7 16.2 01/10/06 4 5 YA9 YA9 13.4 12.4 01/11/06 01/10/06 6 7 YA20 YA26 18.1 16.2 01/11/06 01/11/06 Page 27 Hoffmann Foundation for Autism 45a Langham Gardens Version 5.2 replaced. 8 9 YA28 YA28 13.4 13.4 That the wires poking through the wall in the lounge are safely contained. That the items being stored in the conservatory are removed so that residents can enjoy this as a communal area. That residents have the use of patio furniture, including tables, chairs and parasols (for shade), in the garden. That paper towels are provided for all communal wash hand basins. That all bedrooms are free from odour. That the home has a contract for the collection of clinical waste. That 50 of support workers achieve an NVQ level 2 qualification. That if a member of staff holds a non-UK passport the file clearly states whether a work permit is required and if so contains the relevant information. That the manager achieves an NVQ level 4 qualification in management and care. That all staff undertake training in safe working practice topics i.e. first aid, fire safety, infection control, manual handling and food hygiene. That the home contacts the LFEPA for advice on the suitability of the system used for locking and unlocking the front door. 01/10/06 01/11/06 10 YA28 23.2 01/04/07 11 12 13 14 15 YA30 YA30 YA30 YA32 YA34 16.2 16.2 16.2 18.1 19.1 01/10/06 01/11/06 01/11/06 01/01/07 01/10/06 16 17 YA37 YA42 9.2 18.1 01/09/07 01/01/07 18 YA42 13.4 01/10/06 Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 28 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 3 4 5 6 7 Refer to Standard YA6 YA9 YA17 YA33 YA42 YA42 YA42 Good Practice Recommendations That case files are reviewed and information not currently in use is archived e.g. certain documents originating prior to 2005. That risk assessments recorded in a previous format are redrawn with the comprehensive format now in use. That the home develops a system of pictures of food items, drinks, meals etc to assist residents in making a choice. That when the manager works an evening or weekend shift this is recorded on the rota. That risk assessments are reviewed on an annual basis and that the date on which the review takes place is recorded. That the manual handling risk assessment is expanded. That all staff undertake first aid training. Hoffmann Foundation for Autism 45a Langham Gardens DS0000065159.V298576.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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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