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Inspection on 17/08/05 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 17th August 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 is leading to the creation of the care plans necessary to provide consistent quality care to this client group (care plan information still in process). There is a thorough recruitment and induction procedure which supports new staff effectively.

What has improved since the last inspection?

There have been improvements in a number of areas. Staff report improved morale and are becoming more confident in the way in which the home is being managed. Service Users are benefiting from this increased stability. Staff are being encouraged to attend necessary training and refresher courses. There is better organization of records, which are gradually reaching the standard required to secure consistent professionalism and care for the client group.

What the care home could do better:

Staff response to issues arising relating to the Protection of Vulnerable Adults has not yet reached the level of professionalism required. This is being addressed by the Registered Manager, and is subject to a requirement. Staff still need to be reminded to ensure care plans are followed at all times and to this end the Registered Manager is in the process of introducing quick reference guides for staff on Service Users needs. Staff must be vigilant to protect Service Users from known risks. There needs to be increased clarity of information in this area.

CARE HOME ADULTS 18-65 National Autistic Society Gillitts Road Wellingborough Northants NN8 2HX Lead Inspector Sarah Jenkins Unannounced 17 August 2005 @ 14:00 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service National Autistic Society Address Gillitts Road Wellingborough Northants NN8 2HX 01933 275525 01933 275524 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) National Autistic Society Ms Rosana Goodyear CRH 12 Category(ies) of LD - Learning Disorder x 12 registration, with number of places National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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 25th April 2005 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. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A Manager has recently been registered following a long period of management instability. There has been a history of serious shortfalls in management and due to this the home continues to be subject to monitoring visits. Since the last unannounced inspection on 25th April 2005, there have been two further unannounced visits on 19th May 2005, and 22nd June 2005. There was also an arranged meeting at the home with the new Registered Manager on 9th August. The purpose of this meeting was to review progress on previous Requirements and Recommendations and a Protection of Vulnerable Adults issue that had arisen. Previous Requirements and Recommendations from the most recent monitoring visit are included in this report because the timescales for completion had not been reached at the time of this inspection. The Responsible Individual initiated an independent review of the service, prior to the Inspection in April, and this process will be completed shortly. The Responsible Individual has agreed to meet with the Inspector when the completed report is available to discuss the outcome. 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 one service user and tracking that persons 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 afternoon, in order to meet with staff prior to observing the practices for settling Service Users in the home on their return from their day placements. Service users have Autistic spectrum disorders and thereby communication difficulties. Establishing their choices and informed decisions is dependant to a large extent upon the consistency of staff, service users relationships with staff, and the quality of communication. The Inspector observed practices relating to a service user from the “Green house”. It was a quiet time of the afternoon and there were opportunities to interview 2 members of care staff privately and to meet with a recently appointed staff member who was shadowing a more experienced staff member in the unit. The Inspector also met with the Registered Manager. There was no self-assessment questionnaire nor were comment cards available to the inspector at this inspection. The Inspector was however able to meet with a relative attending a review and with the Care Manager concerned, and there was recognition by these visitors that the management of the home had improved. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 6 What the service does well: 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. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None This area was not reviewed at this inspection. EVIDENCE: National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Service Users assessed and changing needs are generally recognized. More attention needs to be given to the recognition, assessment and management of risk factors. EVIDENCE: A good response by staff to Service Users choices was observed. There was evidence from the interactions observed that service users had good relationships with the regular staff. Staff spoke knowledgably about Service Users individual needs and the ways in which they demonstrated their choices and preferences. However there was evidence that staff remain more dependant on word of mouth communication than on the detail in the care plans and records. There is a risk therefore of communication shortfalls which will effect the quality of care to Service Users. Records showed details of Service Users recognized needs and preferences on their care plans. Consideration is being given to the organization and accessibility of this information, and the Registered Manager informed the Inspector that there are plans to introduce summary front sheets. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 10 Risk areas are not always properly documented. For example there was no detail in the risk assessments of the danger for one Service User who may swallow any medication or tablets that they have access to, and has done so twice in the recent past (when outside the home). There was no detail on the risk assessments of the knowledge that a Service User will put foreign objects in his ears. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 16 and 17 Service Users generally lead active and satisfying lifestyles. EVIDENCE: Service Users generally appear to have lifestyles conducive to their happiness and wellbeing. Staff are alert to Service Users satisfaction with their lifestyles and are responding properly to the recognition that current day placements do not always fully meet all the Service Users needs. The Registered Manager is aware of some issues that are being addressed. Records show that staff at the home and staff at the day placement communicate effectively about Service Users daily activities and enjoyment of these. Staff are aware and responsive to Service Users rights, and respect their choices as far as is appropriate and commensurate with good care practices. For example a Service User who may wish to shower in the middle of the night in order to cool down is enabled to do so. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 12 Service Users were offered a refreshments on their return from their day placement and the evening meal being prepared was nutritious, appetizing and in suitable quantity to meet good appetites. An alternative was available. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 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 standard(s) 18, 19 and 20 Service Users healthcare is now properly monitored. There were some shortfalls in the overview of their personal care. EVIDENCE: The improvement noted in healthcare records at the last inspection has been maintained. There was evidence of prompt and effective response to Service Users healthcare issues. The standard of support for Service Users with their personal care does not yet fully meet Standards. For example one Service User has skin care needs and should be using specific products on his hair and skin. Staff were unable to find these products in his room and other less suitable products appeared to be being used. The administration of medicines was generally well managed and recorded. Some advice was given on good practice (See Recommendations) National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 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 standard(s) 23 There has been a recent breech in the Protection of Vulnerable Adults. EVIDENCE: There has been a further incident since the last inspection relating to Protection of Vulnerable Adults. This was not reported properly by staff in the absence of the Registered Manager, and an investigation is currently underway. One Senior Staff member interviewed did not seem to be fully confident that he was fully trained in this area. Further training is planned. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 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 standard(s) 30 The areas of the home sampled were clean and hygienic. EVIDENCE: The Inspector sampled the public areas in the “Green House” including the kitchen and a Service Users room. These were found to be clean and hygienic. Some staining on the carpets was noted. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 and 36 Staffing issues are not yet fully resolved. EVIDENCE: There were three staff on duty in the “Green House” and a newly recruited staff member “shadowing”. Staffing was judged to be sufficient in this unit for the needs of the client group at the time of the inspection. Staff confirmed to the inspector that they felt staffing at the home was “usually” sufficient, but indicated that some staff teams on duty occasionally did not have the levels of knowledge and experience necessary to provide good team work and support. This was said to be as a result of sickness, holidays or training. For example there had recently been a new agency staff member who had no previous experience of the home. Whilst the regular Agency staff were fully competent and respected by staff, it is not likely that a new agency staff member can offer the required level of support to the staff team on duty. Staff informed the Inspector that this new agency staff member was working with a “strong team” The homes recruitment process and induction programme for permanent staff was discussed with a member of staff recently appointed and was judged to be very full and professional. This area would have been judged as of exceptional quality except that there is inconsistency in relation to the agency staff. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 17 The Registered Manager is recognizing shortfalls in the practice and/or commitment of some staff members (e.g. to training) and is following up these matters through supervision. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The new Registered Manager is competently addressing the management needs of the home. EVIDENCE: There are evident ongoing improvements in the running of the home. The management response to all recent Requirements and Recommendations has been prompt and comprehensive. The Registered Manager has also recognized and implemented necessary improvements to systems that had not been picked up at inspection. It was noted that there has been a prompt and effective response by the Registered Manager to Requirement 2 as detailed on this report. This Requirement was made at the visit of 9.8.05. Staff show confidence in the Registered Manager and staff morale is improving. National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 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 ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x x 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 National Autistic Society Score 2 3 2 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 3 x C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 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 42 Regulation 13 Requirement A risk assessment must be undertaken to establish if there is a need to replace locks at the home in view of the number of missing keys. (From monitoring visit 9.8.2005) Fire safety must not be compromised at any time and to this end staff must have the necessary keys on their person at all times. (From monitoring visit 9.8.2005) Details of staffs’ qualifications and experience must be available to the Registered Manager in the home. (From monitoring visit 9.8.2005) The care plan relating to the physical contact needs of a Service User should be reviewed and clarified to ensure professionalism by staff. (From monitoring visit 9.8.2005) Risk assessments must identify all the main areas of risk for individual Service Users. All staff training, processes and procedures relating to the Protection of Vulnerable adults must be reviewed with view to ensuring staff are all fully Timescale for action By 31st August 2005 2. 24 13 By 24th August 2005 3. 41 17(2) Sch4 6a By 30th September 2005 By 30th September 2005 4. 6 15 5. 6. 9 23 13 13 By 30th September 2005 By 30th September 2005 National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 21 competent to respond promptly and appropriately to any such issues arising. 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 39 Good Practice Recommendations The Registered Manager should have access at the home to the staff supervision records of all staff who are currently employed. (From monitoring visit 9.8.2005) Multi disciplinary professional input from the relevant personnel should be sought in relation to the above mentioned care plan to ensure practices are confirmed as constructive and useful prior to implementation (Additional visit report). The new care plan should be properly discussed with the advocate for the Service User prior to implementation. (From monitoring visit 9.8.2005) Staff training in relation to the above mentioned care plan (Additional visit report) must be in place to ensure consistency and professionalism. (From monitoring visit 9.8.2005) Care plans should be properly followed by staff at all times. There should be increased clarification in the directions relating to as required and occassional medications. Staff training and experience and thereby the competence of each team of staff on duty should remain under continual review by the Registered Manager. 2. 15 3. 35 4. 5. 6. 18 19 35 National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB 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 National Autistic Society C51 C08 S12863 Gillitts Road V238951 170805 Stage 4.doc Version 1.40 Page 23 - 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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