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Inspection on 12/03/07 for National Autistic Society (Gillitts Road)

Also see our care home review for National Autistic Society (Gillitts Road) for more information

This inspection was carried out on 12th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The organization have previously gathered full information on service users prior to their admission, and this information is available at the home and could lead to the creation of the care plans necessary to provide consistent quality care to this client group. Some care plans viewed were of a good quality. There is a thorough recruitment and induction procedure, which supports new staff effectively.

What has improved since the last inspection?

The National Autistic Society has, to some degree, responded to the seriousness of the concerns that were identified at the last inspection and have rectified the specific urgent matters that were drawn to their attention at that time through the inspection process. There has been a high input of support from the National Autistic Society, and a "progress group" which includes the Director of Services (National Autistic Society), the Head of Adult Services (National Autistic Society) and the Responsible Individual has been formed to overview improvement and review progress. The Responsible Individual is personally visiting the unit at regular intervals and is currently joining in the Regulation 26 visits with the Appointed Visitor. The staff team report improving staff morale and a better structured day for service users. Other specific improvements are noted through the body of the report.

What the care home could do better:

Although some improvements in management areas were seen at this inspection, there is a still a need for improvement to be continued and consolidated. Many of the previous requirements and recommendations have not been fully met despite a generous allowance of time to do this since the last inspection. The Registered provider (The National Autistic Society) needs to review the overall management of the service to ensure its effectiveness in delivering a quality of care concomitant with the homes Statement of Purpose. It is noted that some of the previous requirements from November 2006 have been partially met in that a particular area of shortfall raised by the inspector at the previous inspection has been acted upon. However the overall issues have not always been sufficiently reviewed or addressed, and the requirement and thereby the regulation is considered to remain unmet. For example: Requirement to update the Fire Risk Assessment, made in November 2006 (timescale December 2006): An addition was made to the Fire Risk Assessment in relation to a particular problem raised in November by the inspector. However a quick review of this "updated" document showed that it had not been properly and fully updated in relation to other matters. There is still a great deal of work to do, to ensure systems work effectively and that records support and evidence good care practices. There may be a need to refine the records system to ensure it is workable and able to be properly maintained by staff. There is currently building work in process at the home. It is expected that this will ultimately improve facilities for service users, and office space for staff. It appears to be being well managed. However there has been a lack of maintenance, repair and decoration, or replacement of damaged furnishings inthe two main units since the last inspection. These have been allowed to deteriorate to an unacceptable degree, in some cases causing risk to service users, and premises do not meet minimum Standards at the present time.

CARE HOME ADULTS 18-65 National Autistic Society, Gillitts Road Gillitts Road Wellingborough Northants NN8 2HX Lead Inspector Sarah Jenkins Key Unannounced Inspection 12th March 2007 07:10 National Autistic Society, Gillitts Road DS0000012863.V331463.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 National Autistic Society, Gillitts Road DS0000012863.V331463.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. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service National Autistic Society, Gillitts Road Address Gillitts Road Wellingborough Northants NN8 2HX 01933 275525 01933 275524 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) National Autistic Society Position Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. All service users have a diagnosis of an Autistic Spectrum Disorder The home may only admit service users aged 18-45 The total number of service users must not exceed twelve Date of last inspection 20th November 2006 Brief Description of the Service: Gillitts Road Project is a home run by the National Autistic Society. It is situated approximately a mile from Wellingborough Town Centre, with easy access to local community facilities and services. The Unit has two purpose built and self-contained six-bed houses, and a shared administrative block within the same building. There is a pleasant enclosed garden area. Service user bedrooms are all single rooms on two floors; there is no lift at the home. The Home admits people with Autistic Spectrum Disorders and related conditions who have a high level of dependency, and in one of the houses, service users also often suffer from disturbed behaviour that is challenging to staff. Current weekly fees are set at 1766.65 and are mainly inclusive although there are additional charges for some health care aids, and some extra charges when holidays are taken with the home. Details about the home in the form of a Statement of Purpose and Service Users Guide can be obtained from the Registered person at the home or through the National Autistic Society. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting two service users and tracking their care through meeting with the service user, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the early morning, in order to observe the morning routines in each house and meet with staff, including those on night duty. Service users have Autistic spectrum disorders and thereby communication difficulties. Establishing their choices and informed decisions is dependant to a large extent upon observations of their apparent satisfaction with their daily routines and the quality of their interactions and communication with staff. The inspection was conducted with the assistance of an Acting Manager and team leaders, as there is no Registered Manager at present. An application for this post is expected shortly. There was no recent self-assessment questionnaire from the home nor feedback forms, as these were completed at the last inspection in November. What the service does well: What has improved since the last inspection? National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 6 The National Autistic Society has, to some degree, responded to the seriousness of the concerns that were identified at the last inspection and have rectified the specific urgent matters that were drawn to their attention at that time through the inspection process. There has been a high input of support from the National Autistic Society, and a “progress group” which includes the Director of Services (National Autistic Society), the Head of Adult Services (National Autistic Society) and the Responsible Individual has been formed to overview improvement and review progress. The Responsible Individual is personally visiting the unit at regular intervals and is currently joining in the Regulation 26 visits with the Appointed Visitor. The staff team report improving staff morale and a better structured day for service users. Other specific improvements are noted through the body of the report. What they could do better: Although some improvements in management areas were seen at this inspection, there is a still a need for improvement to be continued and consolidated. Many of the previous requirements and recommendations have not been fully met despite a generous allowance of time to do this since the last inspection. The Registered provider (The National Autistic Society) needs to review the overall management of the service to ensure its effectiveness in delivering a quality of care concomitant with the homes Statement of Purpose. It is noted that some of the previous requirements from November 2006 have been partially met in that a particular area of shortfall raised by the inspector at the previous inspection has been acted upon. However the overall issues have not always been sufficiently reviewed or addressed, and the requirement and thereby the regulation is considered to remain unmet. For example: Requirement to update the Fire Risk Assessment, made in November 2006 (timescale December 2006): An addition was made to the Fire Risk Assessment in relation to a particular problem raised in November by the inspector. However a quick review of this “updated” document showed that it had not been properly and fully updated in relation to other matters. There is still a great deal of work to do, to ensure systems work effectively and that records support and evidence good care practices. There may be a need to refine the records system to ensure it is workable and able to be properly maintained by staff. There is currently building work in process at the home. It is expected that this will ultimately improve facilities for service users, and office space for staff. It appears to be being well managed. However there has been a lack of maintenance, repair and decoration, or replacement of damaged furnishings in National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 7 the two main units since the last inspection. These have been allowed to deteriorate to an unacceptable degree, in some cases causing risk to service users, and premises do not meet minimum Standards at the present time. 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. The summary of this inspection report can be made available in other formats on request. National Autistic Society, Gillitts Road DS0000012863.V331463.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 National Autistic Society, Gillitts Road DS0000012863.V331463.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although good admission processes are in place they have not always been effective in achieving good outcomes for service users. EVIDENCE: There have been no new admissions to the home since the last inspection when a shortfall was established in relation to the organization of information. I.e. Relevant information on the assessment form had not always been transferred to the care plan, thus compromising the quality of care. At this inspection, discussion revealed that the quality of the admission process itself remains good but the poor use of records generally, to support good care practices, leaves in doubt whether the admission process could be effective in supporting a smooth transition and consistency of care for a new service user. The Inspector was informed that there are no plans to admit any new service users to either of the two vacancies until building work is completed. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made in this area since the last inspection, but the security of, and access to, relevant information needs to be improved to ensure the necessary consistency of care for service users. EVIDENCE: There was a calmer atmosphere observed in each unit at the time of the inspection. Service users appeared to be being appropriately supported in their daily routines and there was no obvious disruption caused by staffing changes. Staff themselves felt that the quality of service users lives had been improved since the last inspection and that they had more structure in their daily activities. Although some Care plans are full and comprehensive, care plans do not always evidence the detail of information required to ensure consistent care delivery to this vulnerable client group in all areas of need. For example, it was National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 11 not possible to find the essential detail relating to how a service user preferred personal hygiene care to be undertaken by staff although the team leader assured the inspector that this detail had previously been on the service users file. The main files for service users are now stored in the offices on each unit which is an improvement as these are now easier for staff to access. However it is still difficult for staff to quickly access some of the important relevant information in care plans, including up to date risk assessments. With new staff employed recently, it is essential that this information is easily accessible to secure a good quality of care and to properly manage risk areas. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the standards relating to the potential for service users to have active and fulfilling lifestyles are properly met. EVIDENCE: Records were indicative of the active and satisfying lifestyles provided to service users. Staff confirmed that service users enjoyed their activities and daily lives. The introduction of TEACCH system (Treatment and Education of Autistic and Related Communication Handicapped Children) should add to the quality and consistency of the care delivery to service users including their security in the routines that they have chosen, but there have been long delays in fully implementing this, and the necessary staff training for staff to feel confident with the system. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 13 Individual care plans show detail of service users interests and evidence that the home works hard towards providing appropriate enjoyable activities and some community based outings. Staff commented that they felt this area had been improved since the last inspection and that the structure of the day and service users activities were now better organized. Service users relatives are valued and welcomed to be involved and participate in supporting the lifestyles of service users and communication diaries have been implemented although these do not appear to have been kept up to date. The Inspector was informed that a parents evening was being held on the evening of the inspection day to keep parents informed about progress. Meals and menus showed service users eat a varied and appetizing diet and staff felt that the provision of food now fully meets the standards. Service users were enabled to have breakfasts of their choice and these were presented to them at a time and in a manner that they preferred. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users healthcare needs are generally responded to but the system of overview is still not secure and occasional mistakes are made, affecting the quality of care delivery to service users. EVIDENCE: Service users healthcare records do not always evidence secure systems to ensure service users healthcare needs are consistently and promptly responded to, and that managerial staff are able to track responses. This issue was identified as a problem at the last inspection in November. Again, at this inspection the Inspector had to clarify with a senior what response had been given to a health issue raised on behalf of a service user by a staff member. The Senior assured the Inspector that the response had been appropriate, but this was not evidenced in the records. From the records reviewed, observations and discussions with staff, there was no evidence of any current major shortfall in general healthcare. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 15 The management and overview of the medication system is considerably improved since the last inspection, and improvements are ongoing. Issues such as PRN (as required) procedures are being developed. Despite these improvements there was an issue at the time of the inspection where an essential medication was not available for a service user due to a senior staff member not having correctly followed the procedure for booking in, or administering medication the previous evening after home leave. An evening dose of the medication had been missed and thereafter the medication remained unavailable for the morning dose. Advice was also given for directions on Medication Administration Sheets. Medication profiles had not been updated since this shortfall was identified at the last inspection, and thereby profiles are not serving the purpose for which they were designed. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Processes and procedures relating to complaints and adult protection issues, including staff training and awareness are not sufficiently prioritized and structured to fully protect service users. EVIDENCE: There was evidence at this inspection that there have previously been some poor practices by staff at the home compromising service users dignity. These are now being properly addressed and care plans clarify the expectations of appropriate staff responses to specific situations. The Acting Manager was advised by the inspector of the need to ensure that all staff are fully and openly advised in supervision, where their practices may have been in question, and that staff are all made fully aware of the professional expectations of the organization. The inspector understands that the National Autistic Society has received a formal complaint about the home since the last inspection. The complaint raised issues of cleanliness of the home, staffing and management, and service users hygiene routines. The Acting Manager stated that the complaint referred to was raised informally with the service, but agrees this was not logged. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The premises have deteriorated and do not provide a homely environment for service users at the present time. Prompt Maintenance and repair work is not being promptly undertaken and is leaving service users at risk. EVIDENCE: The environment of the home is disrupted by the current changes and building work in process. The building work appears to be being well managed and disruption to service users from this is being minimized. A full programme of Risk Assessment and Hazard Identification in relation to the building work alterations and extensions has been copied to the inspector, but the parts of the house currently used by service users are not being properly maintained. A number of incidents with particular service users, perhaps unsettled by change including changes in staffing, are said to account for the poor condition National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 18 of the service users living space. Additionally the loss a staff member responsible for regular maintenance has led to delays in repairs. A number of issues were identified at this inspection, including unacceptable delay in some repairs. The maintenance book was not being used properly by staff who acknowledged that there were a number of things that needed doing but said that the list of these was in their heads. The outcomes for service users are poor. All the lighting in one service users bedroom was recorded in the maintenance book as being broken in late February. When the inspector checked this room there was no artificial lighting available. When staff were asked how they were managing in the dark to assist this service user she was told that if the bedroom door was left open there was light from the corridor, and sometimes a torch was used. It was not possible to establish if the lighting had been repaired since the entry in the maintenance book and had then broken a second time, but staff said that it had been unavailable for at least “about a week”. This lapse in maintenance and repair is compromises service users rights and dignity and presents a potential Health and Safety risk. The repair was undertaken at the time of the inspection on instruction from the inspector. Some of the issues identified by the inspector are detailed below. This is not a complete list of necessary repair and full responsibility to resolve all the issues must be taken by the Registered person. Some issues are a risk to service users and need to be prioritized. At the time of the inspection there was broken splintery wood on the doorway to the upstairs corridor in Beige Unit, presenting a risk to service users. There were no toilet seats on several toilets around the unit and no clear plan of how to satisfactorily manage the problems leading to this, and provide adequately for service users. Some service users had broken items of furniture in their rooms and there were no curtains or curtain rails in some of the rooms and public areas. The bottom panel of the fridge in Beige unit had been broken, and what appeared to be the ventilation grill was blocked with dust and debris. A member of staff said that the fridge was possibly faulty due to temperature variation, but there was no evidence of the temperatures being checked and no thermometer available in the kitchen to do so. A radiator cover had been damaged and it was noted that pieces of paper and debris had been stuffed down between the blades of the radiator itself. This may have been a fire or safety hazard and when pointed out by the inspector the staff member removed it at once. At the time of the inspection staff were observed to be having difficulty with the security lock on Beige Unit. The lock appeared to be spinning in the barrel and could not always be opened promptly. At one point a staff member had to leave by the back door to go round and open the door from the outside. Action was taken to resolve this at the time of the inspection, but from discussion with staff it appears that this problem had occurred for a few days and there National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 19 had been a lack of a prompt response in recognizing the potential degree of risk from this problem and properly resolving it. One of the issues relating to the Fire risk assessment identified at the last inspection had been addressed, but the Fire Risk assessment as a whole had not been properly updated. The inspector advised the Acting Manager that there appeared to be a bland acceptance of general shortfalls by the staff in the units and although senior staff said that they did react to serious issues and call in maintenance where necessary. The action taken was not felt by the inspector to have been sufficient to maintain a safe environment for service users. An improvement in the environment was noted, being the provision of private office space for staff on each unit. The home was basically clean but some areas were not fully acceptable in terms of “deep cleaning” e.g. refrigerator surrounds in kitchen area. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall this area has been judged as adequate since most staffing Standards have been satisfactorily improved since the last inspection. However there are still issues to address, to secure good outcomes for service users, such as the adequacy of night cover and staff training. EVIDENCE: The Inspector arrived in the very early morning when night staff were still on duty. There were three waking staff in total on the premises, two in Beige Unit and One in Green Unit. There is no longer a staff member sleeping in, and this change in staffing since the last inspection may not be adequately protecting service users or staff. Staff members, including day staff were asked about the perceived level of risk regarding lone working on a unit within the home given the known needs and behaviours of current service users, and from these discussions and from records of past incidents it appeared that this risk was not being properly managed. The inspector advised the Acting Manager that the use of a radiophone to alert staff from the other unit, may not be feasible or practical mid-incident, and that staff going to assist from the second unit National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 21 would be leaving service users and the remaining staff member on Beige unit at risk. The Inspector was not satisfied that one staff working alone in the Green Unit was adequate to protect service users. Staff training issues were identified with the Acting Manager. These included ensuring the details of current staff training, and staff training needs, were up to date. For example the file of a staff member who was listed as a First Aider for planning purposes (organization of the rota), showed that her First Aid Certificate was out of date. Although all staff appear to have received training in the protection of vulnerable adults, the level of their understanding in this area in relation to the particular client group needs may be, in some instances, lacking in depth. See also comments regarding “TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children), under “Lifestyles”. A full staff-training matrix should be developed. The Acting Manager has put some thought into the motivation of staff, and staff morale was notably higher than at the last inspection. Most felt that the management of the home had improved considerably and that service users were receiving a better quality of service. However, this has been at the cost to some senior staff of working some very long hours, including their days off, and they spoke of being very tired. Incident reports are not always read and acted upon promptly by senior staff/ management and this delay may effect both the quality of care and the necessary supervision of staff. There is also some anxiety among senior staff about how the rota will properly support service users or the new staff when these staff are started shortly, given the input that new staff will need. Longer term staff are aware and distressed about previous occasions where they feel they have lost staff with great potential due to a shortfall in support for staff working with this complex and vulnerable client group. Staff turnover was not fully reviewed at this inspection although the Acting Manager informed the inspector that it has been much lower over the last 6 months. Evidence from speaking with two staff who have been recently appointed and from staff records showed that proper processes in relation to recruitment were being followed, and recently recruited staff members confirmed that they had received a proper induction and introductory period. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42,43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management has been improved and has been supported by external National Autistic Society staff over recent months. There is still a long way to go for the home to demonstrate adequate compliance with the National Minimum Standards and thereby reasonable outcomes for service users. EVIDENCE: The Registered Manager has left since the last inspection and the National Autistic Society are in the process of recruiting to the post. There has been a great deal of input to the home from senior National Autistic Society personnel since the last inspection in recognition of the management needs of the home, National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 23 and some aspects of management are now better secured. Staff and service users have benefited from these improvements. However there is still a long way to go. The management of the home does not yet meet the National Minimum Standards, and some basic matters such as service users Health and Safety have not been sufficiently monitored or fully addressed. There remain question marks about the outcomes to service users in relation to the day-to-day security of management, and the realism of the workloads that some staff are carrying. The failure to maintain adequate safety in relation to the premises used by service users, despite the good management and detailed Risk assessment on the new building work is an example of the paradox and inconsistency in management that may ultimately compromise service users quality of life. Improvements implemented by the Acting Manager which were noted and discussed at this inspection include: Improved Hygiene processes in relation to control of infection; improved management of service users medications; improved communication processes and morale within the staff team including more effective team meetings and an updated Induction file for agency staff; and improved communication processes and activities structures for service users. Areas that still need some considerable management input and/or further improvement are the management of staff training, rotas and support; Health and Safety; maintenance of the premises; and records organization, maintenance and overview. The inspector was unable to complete the cross check on some details in the inspection process due to the poor maintenance of the records system, which often does not support consistency or even show adequate care and thereby leaves both the service users and the organization vulnerable. The internal Quality Audit processes need to be fully implemented to ensure such issues are picked up and responded to earlier by the Registered Provider. National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 24 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 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x 1 x 1 x x 1 1 National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 25 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 YA9 YA42 YA23 Regulation 13 Requirement Service users must be protected from unnecessary risks to their health and safety, and from avoidable harm inflicted by other service users. Carried forward from last inspection as not met Medication must be administered and recorded as administered in line with the General Practitioners instructions. Carried forward from last inspection as not met The premises must be maintained to ensure the Health and Safety of service users There must be sufficient staff on duty in each of the two areas of the home to meet the needs of service users. Carried forward from last inspection as not met The home must be conducted so as to make proper provision for the health, welfare, care and supervision of service users. Carried forward from last inspection as not met The homes Fire Risk Assessment must be updated. DS0000012863.V331463.R01.S.doc Timescale for action 30/04/07 2 YA20 13 30/04/07 3 4 YA24 YA33 12.23. 18 30/04/07 30/04/07 5 YA37 12 30/04/07 6 YA42 23 30/04/07 National Autistic Society, Gillitts Road Version 5.2 Page 26 7 YA42 13 Carried forward from last inspection as not met In view of shortfalls identified a full audit of areas of risk at the home including risk relating to premises should be undertaken as soon as possible. 30/04/07 8 YA43 YA39 24 Effective quality assurance and 30/04/07 monitoring systems need to be implemented as soon as possible. These should include processes to ensure the home is functioning in accordance with its Statement of Purpose. 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 YA2 Good Practice Recommendations Improvements should be made to records and admission processes to ensure that the outcome for service users is good. The initial care Plan drawn up from assessment information should include all relevant aspects of need and how these are to be met. (Issue carried forward from last inspection) Service users choices in relation to personal care should not be compromised, and to this end staff should have access to and be fully aware of the information in service users care plans. (Issue carried forward from last inspection) Records should properly evidence that service users healthcare needs are being fully met. It should be possible to track the response and the dates of the response to service users identified healthcare needs. (Issue carried forward from last inspection) The management of the home must demonstrate that staff deemed to be trained and experienced to deal with medication matters, are undertaking their duties effectively. Senior staff at the home should be made sufficiently aware DS0000012863.V331463.R01.S.doc Version 5.2 Page 27 2. YA6 YA18 3 YA19 4 YA20 5. YA22 National Autistic Society, Gillitts Road 6 YA23 7 YA35 8. YA24 of formal complaints where appropriate to ensure service users care is being properly undertaken Staff training and supervision needs should continue to be monitored and addressed to ensure service users are receiving high quality professional care and responses from staff. A full matrix of training required or due for renewal in relation to individual staff should be developed to enhance the management of necessary training for staff and to ensure National Minimum Standards are not breeched. The plan with timescales of maintenance and refurbishment of the current premises in use should be submitted to the inspector as soon as possible. (Issue carried forward from last inspection) National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 National Autistic Society, Gillitts Road DS0000012863.V331463.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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