Inspection on 13/09/05 for Lorne Terrace (14)

This inspection was carried out on 13th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lorne Terrace (14) 28/06/07

Lorne Terrace (14) 24/01/06

Lorne Terrace (14) 17/02/05

Lorne Terrace (14) 24/08/04

Lorne Terrace (14) 17/03/04

Lorne Terrace (14) 26/09/03

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

CARE HOME ADULTS 18-65 Lorne Terrace (14) Ashbrooke Sunderland SR2 7BU Lead Inspector Mrs Katie Tucker Unannounced Inspection 13th September 2005 02:00 Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 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 Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 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. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lorne Terrace (14) Address Ashbrooke Sunderland SR2 7BU 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) 0191 564 0951 0191 563 7711 European Services for People with Autism Limited Mrs Amanda Catherine Morris Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th February 2005 Brief Description of the Service: Lorne Terrace is an end house that has been adapted to provide a care service. The home provides personal care for 4 adults who may fall within the Autism Spectrum or have Asperger’s. The house has four large bedrooms, one office/sleep-in room, 2 lounges, a dining room, kitchen, bathroom/shower and two toilets. These are divided throughout the home. However a toilet is not available on the ground floor and a few steps lead up to the entrance of the home. Therefore the home is not suitable for people who use a wheelchair. Lorne Terrace is in the Ashbrooke area and is within walking distance from the city centre. Corner shops can be found in the area, as well as pubs and an art centre. Backhouse Park is within walking distance plus there are ample bus routes, which travel to the city centre and other cities such as Durham. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The majority of people who use services dislike the term service users therefore in this report people will be referred to as residents. This was an unannounced inspection of Lorne Terrace and was conducted as part of the routine yearly programme. An inspector visited Lorne terrace and spent the majority of the visit speaking to service users, staff and a small part of the time looking at records. A sample of service user plans, behavioural guidleines risk assessments were examined. The staff were asked about the care plans, the complaints procedure, access to training and any changes to working practices. The residents were asked about life at Lorne Terrace and the activities that they joined in. The general maintenance of the building was checked. Lorne Terrace provides a service for younger adults either with Asperger’s Syndrome or an Autism Spectrum Disorder. People at the home experience difficulties forming emotional relationships and comprehending abstract thoughts such as people’s emotional lives. Also people find changes in routine difficult to deal with and other people’s needs and feelings difficult to comprehend. People are able to discuss their experiences whilst living at the home and express views about the service that they are receiving. A part of the inspection however does look at staff practice and attitude. This type of observation did form a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by residents and the staff. During this inspection key standards were focused on but not all were checked. What the service does well: The manager has greatly assist staff improve the range of skills and techniques they use to promote residents sense of well being and independence. The manager and assistant unit leader consistently review practices to ensure they are recognised as current good practice. The manager is extremely competent at identifying where the service can be further developed. This type of leadership has lead to Lorne Terrace consistently working well in excess of the minimum. The staff have a very in depth knowledge of the people using the service and their needs. They work very closely with people to assist them to achieve their goals, reduce inhibiting behaviour and develop skills needed to live as independent life as possible. Residents’ are encouraged to develop the skills they require to look after themselves and when appropriate go shopping by Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 6 themselves, cook and complete household tasks. Some of the residents have been enabled to develop the skills needed to stay at the house on their own. This is clearly written down in care plans and risk assessments, which are fully shared with the service user, their representatives and staff. Staff constantly challenge their practice and review how they compile the records. The ethos of the home is very much based on family living and everyone works as a team with little evidence of any division between staff and residents others than those absolutely needed for the efficient operation of the service and maintenance of the people’s well-being. ESPA employs and has access to a range of specialists such as psychiatrists and psychologists. These specialists regularly visit residents and provide support in all aspects of people’s lives including sex education, managing anxiety, and social skills. They also provide support and advice to staff. Staff’s in depth knowledge of the difficulties that people with Asperger’s and autism spectrum disorders experience allows them to actively promote people’s wellbeing. ESPA has a range of services, which includes day service (the Croft Centre) that has been specifically designed to meet the needs of this client group. It features a café were people can serve and provide meals, performing art facilities as well as craft and aromatherapy facilities. A dedicated and appropriately qualified staff team work at the Croft Centre. Residents from Lorne Terrace regularly use these facilities and staff accompany people to offer support if it is needed. What has improved since the last inspection? ESPA has a training department and over the last few years they have been working hard to ensure at least 50 of the care staff team hold a NVQ in care. 45 of the staff team at Lorne Terrace hold a NVQ qualification, a further staff member has nearly finished this qualification and the remaining staff have started the course. The manager is working toward the Registered Manager’s Ward. The registered manager and assistant unit leader are completing assessors’ courses so they can determine whether staff meet the criteria to be awarded the NVQ qualification. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 7 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. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 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 Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 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): 1 and 2 The way in which the assessment material is collected and recorded means residents’ needs can be met at Lorne Terrace. The various styles of service user guide makes it useful to all but lack of information about fees flaws this record. EVIDENCE: An assessment panel (which consists of experts in the field of understanding the autism spectrum) determine whether people’s needs can be met by ESPA and the service that will be the most appropriate for that individual. This process ensures that when people move to Lorne Terrace the manager can be confident that all of the information has been obtained and that the service is appropriate for that particular individual. ESPA has also developed a full and comprehensive assessment tool (the living plan) for the home. Information from the initial assessment via the panel is included, which ensures full background information is available to the staff working with the individual. Staff have completed the assessments for all of the residents and have involved them and their relatives within this process. The assessments are extremely detailed, well written in plain English and outline all aspects of the individual needs and aspirations. Staff ensure information on past behaviour is kept but say whether it is current or not. Thus anybody working with a person would know what works well and what does not. If a new behaviour develops whether this has happened before, if so how it was extinguished or if it is cyclic behaviour that disappears of its own accord. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 10 The service user guide clearly outlines the service provided at Lorne Terrace and is provided in a range of formats. It also contains a summary of the items listed in Schedule 1 of the Care Home Regulations 2001. Thus people have the full information needed to make a decision about whether they like the sound of the service. A generic the terms and conditions of residence is included in the service user guide for specific individuals, which does provide space for the inclusion of the amount of fee however individual agreements do include this information. Also copies of the local authority placing agreement are not provided. These are not only required by regulation 5 of the Care Home Regulations 2001 but without them people cannot make informed decisions about whether the feel that the service they are getting is value for their money. ESPA has stated that relatives have copies of their terms and conditions, which includes the fees and at present they are working with local authorities to ensure agreements are provided. The evidence that representatives have signed the terms and conditions and know the fee levels is not provided at the home so this cannot be verified. Also the local authority placing agreements often stipulate specific conditions such as the number of staff that needed to be provided for an individual. By not having a copy at the home the manager, residents or relative cannot check that contractual agreements are being met. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 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 and 9 The service user plan and risk assessments are comprehensive and meet the needs of residents. EVIDENCE: The staff have a very in depth knowledge of the people using the service and their needs. They work very closely with people to assist them to achieve their goals, reduce inhibiting behaviour and develop skills needed to live as independent life as possible. This is clearly written down in care plans and risk assessments, which are fully shared with the service user, their representatives and staff. The style of writing allows sufficient information provided for staff and service users to be given a very clear picture of the actions that are to be taken. Staff constantly challenge their practice and review how they compile the records. As a minimum each year staff revisit the service user plans and have checked each record to see that it is as clear as it could be. The manager and owner have decided that this year, as part of the review the behavioural guidelines will be reviewed to ensure triggers, the primary and secondary actions staff need to take if someone starts to display challenging behaviour are clear. The assistant unit leader was aware that when physical interventions occurred these needed to be recorded in a bound book. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 12 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): 12, 14 and 15 The skilled work of staff and the range of experiences offered both by ESPA and Lorne Terrace have allowed residents to greatly widen their expectations. EVIDENCE: Staff work well with residents enabling them to reach toward their full potential. Residents experience difficulties forming emotional relationships and comprehending abstract thoughts such as people’s emotional lives. However staff have continued to work with the organisations psychologist, exploring coping mechanisms that service users or staff can adopt in this area and these appear to be having a good affect. Staff re-enforce strategies with people and remind them of how to approach situations. From conversations with people it was evident that these practices were assisting residents to develop their social skills. One resident is paid to complete the monthly financial audits for Lorne Terrace, as well as other administrative work. They also run a catalogue and are responsible for ensuring all of the customers receive up-to date copies. All of the service users regularly go out for meals, use local leisure facilities, go to see local shows and football matches. Residents also go on various holidays and staff have tailored these trips to meet people’s specific needs. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 ESPA and staff have demonstrated an in depth knowledge of the difficulty that people within the autism spectrum experience and this means they can actively promote people’s wellbeing. EVIDENCE: ESPA employs and has access to a range of specialists such as psychiatrists and psychologists. These specialists regularly visit the residents at Lorne Terrace and provide support in all aspects of people’s lives including OCD, sex education, managing anxiety, and social skills and also provide support and advice to staff. The staff have acted upon the interventions the specialists have suggested and asked for further support when necessary. Also staff have worked closely with GP, community nursing services and hospital staff when someone is physically unwell. The staff work with residents in a sensitive and skilled manner. They have always ensured that appropriate medical help is sought. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The complaints procedure is available in various formats and all using the service can understand it. EVIDENCE: ESPA developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. They have considered all of the communication needs of the residents who use their services and developed a comprehensive range of formats. These formats include tape, pictorial and written styles. The speech and language therapist employed by ESPA has been involved in developing these accessible formats. Thus staff can be confident that people with a range of needs can understand the complaints procedure. This is reproduced in the service user guide and made available to all the residents and their representative. The manager and staff recognises the importance of dealing with minor concerns in a proactive manner. The staff and ESPA actively encourage residents and relatives make their views known. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The building meets the needs of the residents and visitors. EVIDENCE: The design and location of the home is a positive feature as it blends in well with the community. The home exceeds the current space requirements of the national minimum standards for bedrooms but none offer an en suite facility. One bathroom is provided, which is below 3:1 requirements made of new homes being built and registered after 2002. A separate laundry is not provided but a good robust risk assessment and associated actions to minimise risk are in place. When the environmental changes were completed which stipulated that homes in operation prior to April 2002 would not have meet the timescales for making sure the building was comparable to new services the Government set certain requirements. One of these was that the statement of purpose/service user guide must reflect where the home does not meet the requirements of the standards for new registrations. Lorne terrace is not suitable for someone who has a physical disability because of the access to and throughout the home is via stairs. ESPA have considered what reasonable adjustments could be made to meet Part 3 of the Disability Discrimination Act 1995 should someone visit who has a disability. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 33 and 35 Staffing levels meet the needs of the residents. The staff team are effective and are in the process of completing appropriate NVQ Awards to demonstrate their competency. The physical interventions training, at present leaves ESPA vulnerable, as it prevents them from being fully insured. EVIDENCE: At all times during the day at least 2 care staff inclusive of a senior care are at work during the day but often 3/4 staff are on duty. At night 1 sleep-in staff member is on duty. Without the placing contracts being available it is uncertain whether Lorne Terrace is complying with any specific contractual arrangements that have been made. Care staff with residents’ complete domestic and catering tasks. ESPA provides an in depth training programme, which is specific to autism specific disorders and newly appointed staff receive induction and foundation training. All mandatory training is covered in the first six months. Training is delivered centrally and in-house and most trainers have completed qualifications to make sure they are the appropriate person to teach a particular course. However the person who completes physical intervention training had not received accredited training in this area for some years. This means staff using these techniques cannot be confident that they are following current good practice also they do are not insured. Thus should any injury Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 17 occur when staff are using an intervention ESPA is not covered by their public liability insurance and cannot demonstrate they meet the requirements of Health and Safety legislation. The numbers of physical interventions that have been needed is extremely limited. Any incidents have been successfully resolved and appropriately recorded plus the staff members have been debriefed. Staff regularly use a range of primary and secondary interventions to ensure incidents have not needed to be used. Also staff explore any underlying reason why such incident might be occurring and taking action to reduce triggers. This type of proactive approach reduces levels of stress for all concerned. 45 of staff now hold a NVQ Award and the remaining staff are either on their way to completing a course or about to start one. By December this year, the date required by government for 50 of staff to hold this type of award, Lorne Terrace will have more than 50 of staff with this award. The manager has nearly completed the Registered Managers Award. Since the last inspection staff have also been given access to further training around Autism Spectrum disorders, emotive language and healthy eating. Also ESPA is ensuring that all of the senior staff members complete the four-day at work course in first aid. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 18 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 and 42 Health and safety needs are being met. EVIDENCE: There were no health and safety issues noted at the time of the inspection. Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 4 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 4 13 X 14 4 15 4 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lorne Terrace (14) Score X 4 X X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000015775.V250276.R01.S.doc Version 5.0 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 (3) Requirement Timescale for action 27/12/05 2 YA35 18 (1) (c) 17 (1) (a) The organisation must provide a copy of the local authority placing agreements to service users or their representative and should keep a copy in the service user plan. (Requirement made at the last inspection –timescale for action 22.02.05) All staff who use physical 21/02/06 interventions must have accredited training and this must be refreshed on a yearly basis. All incidents involving physical intervention must be recorded in a bound book with numbered pages. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lorne Terrace (14) DS0000015775.V250276.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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