Inspection on 01/02/06 for Montpelier Terrace (3)

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Montpelier Terrace (3) 04/03/08

Montpelier Terrace (3) 15/03/07

Montpelier Terrace (3) 03/02/05

Montpelier Terrace (3) 11/08/04

Montpelier Terrace (3) 23/03/04

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Craigmore House

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

CARE HOME ADULTS 18-65 Montpelier Terrace (3) Ashbrooke Sunderland SR2 7TZ Lead Inspector Miss Andrea Goodall Unannounced Inspection 1st February 2006 01:00 Montpelier Terrace (3) DS0000015737.V253999.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 Montpelier Terrace (3) DS0000015737.V253999.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. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Montpelier Terrace (3) Address Ashbrooke Sunderland SR2 7TZ 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 565 6205 0191 565 6205 European Services for People with Autism Limited Miss Debra Rodenby Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th July 2005 Brief Description of the Service: The home at Montpelier Terrace is a modern 3 storey house that provides accommodation for up to 6 people with Autism. The care service is operated by ESPA (European Services for People with Autism), whilst the building is owned and maintained by New Leaf Housing Association. The home has been registered for over 8 years. The home is close to the City centre and to a number of local facilities such as parks, library, shops and pubs. The house is divided into three ‘flats’, one on each floor. Each flat has 2 goodsized bedrooms, pleasant lounge/dining room, small domestic kitchen and a bathroom. The home has a good sized back garden with access via a ground floor room. The design of the house means that it is not suitable for people with physical disabilities or mobility needs as the entrance and all areas of the home are only accessible via steps. This is clearly outlined in the home’s Statement of Purpose, and ESPA have given every consideration to how this may be addressed. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in February 2006. Some time was spent with some of the people who live here, and looking around some parts of their home. Time was also spent with the Manager and staff talking about how they support the people who live here, and looking at some care records. The people who live here have Autism Spectrum Disorder. This makes it very hard for them to say what they think of the service they get at this home. Sadly, since the last inspection one resident has died. Staff did very well to support him during his illness, as well as looking after the needs of the other people who live here. At this time there are 5 people living here. What the service does well: Some of the people who live here are deaf or find it hard to talk, so they use speech and sign language and gestures. It is good that staff understand all the different ways that people use to talk. Staff also understand how to support people with Autism, and how to help them to learn new skills. There are lots of staff on duty so that everyone has the chance to go out to different places and activities everyday. People here find it difficult to express what they feel about the home, but there is a very friendly feeling in the house. Staff and residents get on well and spend lots of time in activities and or doing household things together. The home has information for residents in pictures and through sign language to help them understand their rights and responsibilities. The house is well looked after, warm and safe. Staff cannot start work here until they have been checked to make sure that they are the right people to help the residents. There has been only new staff to start work in the past 6 months. The Manager and many of the staff have been here for a few years. This has helped residents and staff get to know each other. The Manager and ESPA make sure that the home is run in the right way and that it is a good, safe place to live. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 6 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. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 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 the following standard(s): The key standard was met at the last inspection, and all the standards in this section have been assessed as met at previous inspections. EVIDENCE: Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 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 the following standard(s): 9. Residents are supported to take acceptable risks as part of an independent lifestyle. EVIDENCE: The people who live here are supported to take acceptable risks as part of an independent lifestyle, wherever this appropriate and manageable. There are risk assessment records in place about activities that people carry out that might incur an element of risk, such as preparing food in the kitchen, and being out in the community. In this way residents can work towards their full potential, and staff are clear about the support people need to minimise any risk to them. It was stated that the risk assessments are reviewed at each persons annual review where they can be discussed again with parents. However there is no record that the assessments are reviewed (unless they are updated). In this way most risk assessments are still dated as 2003. The Manager indicated that in future a review form is going to be used at the annual review to record that the risk assessments have been re-assessed. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 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 the following standard(s): 11 & 16. The people who live here have opportunities for personal development. Residents rights and responsibilities are respected and promoted. EVIDENCE: The five men who live here have Autism Spectrum Disorder, which makes it very difficult for them to express themselves or their feelings. Some people have additional communication needs, including one person who is profoundly deaf. The residents use a mix of limited verbal speech, signs, British Sign Language (BSL), and gestures to communicate. It was clear that staff are very conversant with the differing communication methods used by residents. All staff have some knowledge of BSL and signsupported English, and receive training in this from time to time. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 11 The people who live here are supported to lead active, fulfilling lifestyles with a range of daytime occupations and activities ranging from forestry work to pottery. Three people enjoy a wide spectrum of activities at the nearby Croft Centre, which is also run by ESPA. Two people choose not to go to the Croft as they cannot tolerate larger social setting. Instead they engage in local community-based and in-house activities. The home’s good staffing levels allow some periods of 1:1 support (and even 2:1 support for some people with higher needs) in order to meet their individual needs and chosen activities programme. Each person has a structured activities programme to help them to make sense of the pattern of their day. In these ways, the home ensures that each person has opportunities for personal development. Residents are supported to be as involved as they can be in the running of their home. All are involved with daily domestic tasks, with support only where necessary. All are supported to read their own mail, with staff assistance, and there are signed agreements from relatives about this. All are invited to join in at House Meetings (though few take part for long due to their Autism). The residents are occasionally reminded of their rights and responsibilities, and these have been re-iterated both verbally and in sign language at their meetings. Each person has access to the Service Users Guide, Residents Agreement, and Choices and Decisions policy, all of which are in pictorial format to support the communication needs of the people who live here. In these ways the home encourages and promotes the rights and responsibilities of the residents. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 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 the following standard(s): 20. The home has suitable procedures for supporting residents with their medication. EVIDENCE: At this time none of the current residents has been assessed as able to manage their own medication. At this time, all medication is managed by trained, designated staff. Medication is delivered to the home by a local pharmacy in suitable containers. Medication is securely stored in a locked, alarmed metal medication cupboard away from residents accommodation. Records of the administration of medication are in place and up to date, although at this time that incoming medication was received was not completed. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 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 the following standard(s): 22 & 23. Residents have information about how to make a complaint and can express their dissatisfaction. The home has policies and procedures for the prevention of abuse, but staff need training in this and in physical interventions to ensure that residents are fully protected from potential abuse. EVIDENCE: Each resident has been given a copy of the Service Users Guide, which also includes the homes complaints procedure. This information is in pictorial symbols to support the communication needs of the people who live here. Due to the nature of their Autism some people find this information very difficult to comprehend. However it is clear that the home makes every effort to support residents with their rights. The residents do use signs, gestures and noises to express their dissatisfaction with immediate situations, and staff are very knowledgeable about the individual communication skills of each resident. There have been no complaints since the last inspection. As with all adult care services in the City of Sunderland, the home endorses the MAPPVA (Multi Agency Panel for the Protection of Vulnerable Adults) procedures. These are robust procedures for dealing with suspected abuse. A small number of staff have had MAPPVA training. The Manager indicated that she is to attend a MAPPVA Trainers course in the near future in order that she can cascade this training to all other members of staff. In this way staff will know how to deal with suspected abuse. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 14 Due to the nature of their Autism, the people who live here need occasional staff intervention during episodes of behavioural needs to prevent them from harming themselves or others. There are behavioural guidelines in place for each of the residents and these are shared with parents. There are also Intervention Records in place that record any occasions where intervention techniques have been used. Some staff have had brief restraint training sessions. None of the staff have had training in physical intervention techniques from a BILD-accredited trainer (British Institute of Learning Disabilities). In this way staff may not be following current best practice guidance, as outlined by the Department of Health and BILD, in this area of care. Montpelier Terrace (3) DS0000015737.V253999.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. Residents live in a safe, well maintained environment. EVIDENCE: The home is a modern 3-storey house that provides 3 ‘flats’ for the people who live here. It is close to the City centre and a good range of local amenities. The internal decoration and furnishings are modern and bright to suit the age and preferences of the residents. The building is owned by New Leaf Housing Association, which remains responsible for any repairs and maintenance. The premises are well maintained and safe. Over the past few years the house has become increasingly cramped and busy due to residents increased needs and the increased number of staff, particularly on the lower ground floor flat where the staff office was sited. Since the last inspection the top flat lounge is now being used as an office, and the former office on the lower ground floor is now a second small lounge for residents. Despite the good quality of accommodation, the house remains too cramped for the 5 people who live here. There are proposals by ESPA to provide a larger, more comfortable house for the residents, which may be in place by Spring 2006. The proposed new home will significantly improve the space and facilities for residents. Montpelier Terrace (3) DS0000015737.V253999.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): 34. Residents are protected by the homes recruitment practices. EVIDENCE: There has been only one change to the staff team since the last inspection, that is the appointment of one new staff. The people who live here benefit from the continuity of care of this consistent staff team, and staff are very knowledgeable about residents needs. The Provider, ESPA, operates very through recruitment and selection procedures. Staff are only employed after all satisfactory references and police checks have been received, and this ensures the protection of the people who live here. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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 & 42. Residents benefit from a well run home. The health and safety of residents is promoted and protected. EVIDENCE: The Registered Manager has been in post for several years. She has many years experience of working in care settings for people with Autism Spectrum Disorder. She is currently working towards NVQ level 4 and the Registered Managers Award. She is supported by 2 senior staff who lead the staff team in her absence. She is supervised and supported by as appropriate management representative of ESPA, who also carries out the required monthly visits to the home to report on its operations. Montpelier Terrace (3) DS0000015737.V253999.R01.S.doc Version 5.0 Page 18 All staff receive statutory health & safety training, and new staff receive this through Induction training. In this way staff understand the practices and procedures to ensure the health and safety of the people who live here. There were no health & safety matters noted to those parts of the premises that were inspected during this visit. Montpelier Terrace (3) DS0000015737.V253999.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 X X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 4 12 X 13 X 14 X 15 X 16 4 17 Standard No 31 32 33 34 35 36 Score X X X 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Montpelier Terrace (3) Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000015737.V253999.R01.S.doc Version 5.0 Page 20 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 YA20 Regulation 13(2) Requirement A record must be made of the date that incoming medication was received into the home. Timescale for action 01/03/06 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. Refer to Standard YA9 YA23 Good Practice Recommendations A record should be kept at each annual review to demonstrate that risk assessments have been reviewed. Staff should have training in physical intervention that is BILD-accredited. 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