CARE HOME ADULTS 18-65
Lethbridge Road 2 Lethbridge Road Southport Merseyside PR8 6JA Lead Inspector
Orla Murphy Unannounced 10 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Lethbridge Road Address 2 Lethbridge Road Southport Merseyside PR8 6JA 01704 531385 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) Autism Initiatives Mrs Jacqueline Christine Emmett Care Home 7 Category(ies) of Learning Disability registration, with number of places Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 7 Learning Disability Date of last inspection 30 September 2004 Brief Description of the Service: The home has places for up to seven adults with a learning disability, specifically those with Aspergers syndrome. It is an asssessment centre for people with Aspergers syndrome and the average stay of each resident is 2 years. Aspergers syndrome is on the Autism Spectrum but is usually a high functioning condition. The company running the home is a charity, called Autism Initiatives. Each resident has their own bedroom and share 2 lounges, a kitchen and three bathrooms. The home is on Lethbridge Road, which is off Scarisbrick New Road, in Southport. There are several buses that run along Scarisbrick New Road to Southport, Liverpool and Preston. There is a mainline train station in Southport town centre. The home is ten minutes by car or bus from Southport town centre where there are an wide variety of shops, bars, leisure activities. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspection was unannounced and neither residents nor staff knew the Inspector was coming. The last inspection report was examined but no requirements needed to be followed up on this visit. The Inspection was the first in the home’s required visits, which are 2 inspection visits per year. 2 residents and three staff were spoken to at the inspection. One resident was “case tracked”. Case tracking means that the Inspector concentrates on the care given and experiences of one or more residents to get an idea of what is like to live there and how that person’s needs are being met. Case tracking also shows the inspector where needs aren’t being met. A variety of records (care plans, medical notes, complaints records, assessments, medication sheets, meeting minutes, menus, timetables, staff rotas and significant events) were examined. The bedroom of the resident case tracked and communal areas were also examined. What the service does well:
The home specifically looks after people with Aspergers syndrome and helps them to learn to manage areas in their life they may need support with such as socialising, travelling, assertiveness, employment and independence skills (cooking, cleaning, budgeting, self development). Because it is such a complex condition, staff at the home, who are trained in and understand Aspergers syndrome, provide excellent support to those living there. The home has a positive key working system. The resident case tracked said his key worker was “Brilliant, helps me a lot” and “I know I can say what’s bothering me and they wont laugh at me or think I’m stupid”. Staff work hard at helping residents to find out what their strengths and needs are, and to work with residents to get to a stage where they can move on to more permanent or independent homes. The resident case tracked said the best things about living there was that “ Staff understand Aspergers and me; I’ve never had that before I came here”. He also said “ its good living with other people who have the same problems; you don’t feel like the only one”. The home’s ethos is very consistent and whilst residents are supported, negative attitudes are also explored and challenged where needed. Residents are helped and encouraged to understand Aspergers and to see the benefits in the condition as well as the areas they need help with. Discussions & observations showed that staff have a very positive attitude to Autism and Aspergers syndrome. The house is very relaxed with a welcoming atmosphere and “feels” like a home. Staff attend training enthusiastically and 80 are qualified in or undertaking vocational training.
Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 6 Records showed that staff communicate very well in writing/handover and in meetings. This all benefits the residents. 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. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 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 Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 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) 2 The Service carries out detailed and skilled assessments of residents which identifies their needs, and develops good plans to meet those assessed needs. EVIDENCE: The assessment of the resident case tracked was examined in detail. Assessment of Aspergers syndrome needs to be very specific and this assessment was. It looks at 3 areas; social interaction, social understanding & social communication. It concentrates on these 3 areas because these are where the Aspergers condition needs the most input. The resident case tracked explained his ideas about the areas he needed help in. these were the same as those written in his assessment. Staff spoken to knew a lot about the resident and his strengths and needs. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 7. The service supports residents through their care plans to develop skills and strengths in areas they need support in. The service encourages residents to be independent and make decisions in their lives. EVIDENCE: The care plans for the resident case tracked recorded a plan for all staff and the resident to follow in the areas of cooking, routines, socialising, budgeting, counselling and medicines. This resident told the inspector he talks about these areas with his key worker every month and talks about his progress. He’s very happy with the progress he’s made. If he doesn’t agree with the discussions he said, “ staff tell me to say what I think, even if I think they wont like it”. He said the group has a monthly residents meeting where they talk about lots of things; food, activities, events, staff and things they are annoyed or concerned about. He also said he prefers other people to decide things for him, but because he needs to be more independent, staff remind him he should make his own decisions. He said they help by telling him the pros & cons to the issue. This was recorded in the care plan seen. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 10 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, 15 and 17. The service enables residents to be involved in every day experiences and opportunities. Relationships are recognised as important and encouraged. The service encourages residents to be skilled and confident in purchasing and cooking food. EVIDENCE: The resident case tracked had a weekly timetable, which was seen and was discussed with him. Routines are extremely important to many people with Aspergers syndrome. The timetable showed that his week was varied and full. He attends college (2 subjects studied), carries out household chores, attends an Autism day service, goes bowling, to social groups & to the cinema, attends football matches and has relaxation time. The resident was very pleased with the amount of activities he was involved in; as he said before living there he didn’t do much. Records showed that families and friends visit the home a lot and staff help residents to visit them. The resident case tracked said, “ I couldn’t stay here if I didn’t see my family because they are very important to me”. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 11 He cooks all his own meals with help from staff. He feels he has improved a lot since he first moved in. Once a week staff cook a meal for all residents as a “night off” which he enjoys too. He described his weekly menu as a “healthy eating plan”. The weekly menu was seen and was written by the resident and was varied and healthy. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 12 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) 20. The service enables residents to be as independent and safe as possible, whilst taking medication. EVIDENCE: The resident case tracked takes his own medication with monitoring. It is stored in the home’s office and he collects it daily and takes it. Records examined showed that all medicines are signed for when administered and the resident case tracked signs the administration sheet with staff to say he’s taken his medication. A pharmacist monitors the storage (lockable metal drugs cabinet) and administration of medicines 2 times per year and writes a report. This report was seen and there were no concerns recorded by the pharmacist. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 13 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. The service encourages, listens to and acts upon complaints made to them. EVIDENCE: The complaints book was seen and this showed there was one complaint made by a resident since the last inspection. This was made to the manager and was sorted out quickly. The resident was happy with how the complaint was dealt with. The resident case tracked said he didn’t have any complaints. He said he would talk to any staff member if he did. Through talking with him it was clear that he had a good idea of the complaints procedure. He also said the resident’s meetings were a good place to mention anything that was annoying him. He also said staff encouraged him to be assertive & say when he wasn’t happy. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 14 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. The home is comfortable, well furnished and suited to the residents who live there. EVIDENCE: All of the communal areas were clean, well decorated and looked very homely. There was lots of seating and nice furniture. There were 2 televisions and DVD’s downstairs in 2 separate lounges. The resident case tracked showed me his room which was personalised and had nice furniture. He said he really likes the size of the house; it’s big enough to have space if you want it. There is a timetable to use the kitchen in the evenings, so that every resident, has time to make his or her own meal. This is important in relation to Aspergers, as it is very important to have space and no distractions when carrying out tasks. The resident case tracked wants to live independently in the next 18 months and said, “ ill be able to cook healthy meals and snacks in my own flat”. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 15 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) 32 and 35. Staff are trained in various aspects of Aspergers, Autism and qualifications and have a high number on duty, which tailors the care given to residents to meet their needs. EVIDENCE: The staff rota was examined and showed there were up to 4 staff on duty during all parts of the day. Waking night staff are on duty at night. The resident case tracked said staff were helpful and always made time to listen to or help him. He said, “ The banter between us is really good; I trust them to tell me the truth and we have a laugh too”. Key worker sessions are recorded and were examined. These showed staff had very good skills in monitoring and addressing needs with residents; helping them to solve problems and to be positive about their lives and their achievements. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 16 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) 39. Quality is part of the service and is important to staff and the service. Residents are empowered to lead the service they receive. EVIDENCE: The home’s quality audit was examined and looked at all aspects of the home and service. The resident case tracked said he didn’t really want to read quality reports but understood that where residents do not like something, they can change it. He said staff were very supportive about any concerns he or the others had. He said the monthly residents meetings were good and they were always asked by staff to suggest things that might make the home better. Key worker sessions seen showed that staff encouraged assertiveness and taking responsibility with residents. There was a definite feeling from residents and staff during the visit that everyone has an equal part to play in the service. Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x 4 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 4 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 4 x x 3 x 4 Standard No 31 32 33 34 35 36 Score x 4 x x 4 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Lethbridge Road Score x x 4 x Standard No 37 38 39 40 41 42 43 Score x x 4 x x x x F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 18 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Lethbridge Road F53 F03 S5309 Lethbridge Road V228338 10.05.05 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Burlington House South Wing 2nd Floor Crosby Road North Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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