Inspection on 20/11/06 for National Autistic Society (Gillitts Road)

This inspection was carried out on 20th November 2006.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

National Autistic Society... 24/07/07

National Autistic Society... 12/03/07

National Autistic Society... 17/08/05

National Autistic Society... 25/04/05

National Autistic Society... 26/08/04

National Autistic Society... 17/06/04

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Beech Lodge

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Hunter`s Lodge

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

CARE HOME ADULTS 18-65 National Autistic Society, Gillitts Road Gillitts Road Wellingborough Northants NN8 2HX Lead Inspector Ms Sarah Jenkins Unannounced Inspection 20th November 2006 07:20 National Autistic Society, Gillitts Road DS0000012863.V314645.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.V314645.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.V314645.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) Vanessahalfacre@nas.org.uk National Autistic Society Mrs Rosana Goodyear Care Home 12 Category(ies) of Learning disability (12) registration, with number of places National Autistic Society, Gillitts Road DS0000012863.V314645.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 17th August 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. 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.V314645.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. 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 a Senior Manager from the National Autistic Society who came in to assist when informed by staff that an inspection was in process. This enabled a full review of the management of the home at the time of the inspection. The deputy manager also came in to assist the process. This enabled the Inspector to speak with staff privately whilst the Deputy covered their duties in the houses. The Inspection was also informed by a self-assessment questionnaire submitted by the home, and there was feedback from three relatives. What the service 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. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 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 National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 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. 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 are not always effective in achieving good outcomes for service users. EVIDENCE: The assessment documentation available at the home shows the potential for full and sensitive admission processes as have been evidenced in previous inspections. However although a service user had had a full assessment prior to admission, the relevant information on the assessment form had not always been transferred to the care plan. There was evidence in the inspectors observations that the information available to staff on the assessment form was not being used to ensure a good quality of care. A service users relative was dissatisfied with the admission process as there had been no written information about the home given in the form of a Service Users Guide, and although staff were said to have been very nice and helpful the process had felt rushed and inadequately supported. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Processes relating to care plans do not demonstrate security of quality in these areas. Observations and discussions with staff confirmed the failure of the homes staff to provide consistently adequate quality of care at the time of the inspection. EVIDENCE: 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, details on how to assist a service user with the cutting of finger and toe nails, had not been properly transferred from the service users initial assessment and from the record of personal care there was a shortfall in checking and National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 10 dealing with this aspect of the service users care. His nails had apparently not been checked since 6/11/06 when they were recorded as not needing cutting. The Inspector observed a staff member failing to follow the correct procedure, as identified in a service users care plan, when dealing with the service users challenging behaviour i.e. instead of moving away and giving certain defined verbal prompts, she moved towards him sharply and said nothing. There was evidence in the communication book that care plan details concerning a service users dietary requirements had not been properly followed by night staff relating to the sandwiches provided at lunchtimes, but that this mistake had luckily been noticed by the staff at the Daycentre. Staff consistently reported that they rarely had enough time to read the details in care plans and relied mainly on word of mouth reports from other staff. There was evidence from records and observations that service users are enabled to make choices in their lives, for example about what to wear, what to eat for breakfast and what to do during the day. Some choices, for example the time when a service user was enabled to follow her early morning hygiene routine were restricted by the staffing on the morning of the inspection, and the service user had to wait until a staff member was available from the other “house” to come to assist her. The service user was seen by the Inspector to be moving from chair to chair and occasionally expressing dissatisfaction during the time when there were no female staff on the unit and this may have been related to the delay in her routine. Such alterations to routines are generally not conducive to the happiness, security and wellbeing of service users in this client group. Risk taking is an area that could not be properly evaluated at this inspection due in part to a missing record. It was not possible to establish how the management and staff of the home had responded to the unexplained absence of a service user. The record of this event was not available and the incident had not been properly notified to the Commission for Social Care Inspection at the time. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This outcome area is subject to the other comments and concerns raised on this report. Generally the potential for active and fulfilling lifestyles is maintained. EVIDENCE: Records were indicative of the active and satisfying lifestyles provided to service users. It was not possible to fully evaluate this area in the absence of the individual daily records, which had been sent with service users to their day placements as part of the continuity of care offered by the home. However 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 staff report that they do not yet feel National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 12 confident with the system as it has only recently been implemented and they and the service users are still getting used to it. 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. Service users relatives are valued and welcomed to be involved and participate in supporting the lifestyles of service users but there have been some recent shortfalls in communication and low staff morale has probably contributed to some of these problems. Meals and menus showed service users eat a varied and appetizing diet although staff felt that the organization of shopping did not always support them in their duties, as sometimes they had to go shopping to obtain the ingredients for the menu. Food stocks and storage was seen to meet Standards at the time of the inspection. 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.V314645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor. 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 not secure and mistakes are made. EVIDENCE: Staff told the inspector that they were designated to a particular unit for their duties since reorganization in the management of staff teams. Some staff said that they felt that this could leave them out of touch with service users needs in the other unit. The Area Manager said that this was not common practice but had occurred due to staff shortage at the time of the inspection. Two staff were observed to change their duties to provide female cover in the Green House. The staff member who delivered personal care to a service user in the green house did not usually work with that service user. Staff were aware of general privacy and dignity issues for service user from their training which they felt was good. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 14 Service users healthcare records do not evidence secure systems in ensuring service users healthcare needs are consistently and promptly responded to, and that managerial staff are able to track responses. It took some time to establish the response to a service users recorded healthcare needs. From the two records reviewed, there was no evidence of any current major shortfall in general healthcare. However, the failure to transfer detail from assessments to care plans, for example details about a service users digestive system needs, could ultimately compromise service users wellbeing, and cause health risk. Medication was observed to be administered properly by the senior on duty in one of the houses in accordance with policies and procedures. However a review of a Medication Administration Sheet showed shortfalls in the recording and administration of a prescribed antibiotic and lack of detail about the administration of an anticongestant. This shortfall may have caused avoidable risk to a service users wellbeing. Medication profiles had not been kept up to date and were inaccurate, and thereby not serving the purpose for which they were designed. A senior in charge in one of the houses had not received training in the administration of medicines, and the need for staff to swap duties to cover this shortfall in training led to some disruption for service users. The Inspector observed that systems that were judged to be secure at the time of the last inspection appeared to have “slipped” National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 15 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. The National Autistic Society has recently identified serious shortfalls, which have occurred, and has responded sufficiently promptly to ensure that these are now being addressed appropriately. This outcome area is also subject to the other comments and concerns raised on this report. EVIDENCE: There were no records of any recent complaints having been, made although there was evidence from discussion with relatives that “concerns” had been raised with staff. Whilst there had been no request for these concerns to be dealt with formally under the Complaints procedure it is important that the home can evidence a response to issues arising through recording these and through robust Quality Assurance systems. Service users had been put at risk through a garden gate being left open on more than one occasion and, at the time of the inspection, the Inspector was informed that an incident had occurred recently that had compromised the safety of a service user. This incident was not notified to the Commission for Social Care Inspection, and although the issue had been properly addressed by the time of the inspection the details of the incident were missing and it is not National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 16 clear how long the risk had continued due to apparent shortfalls in management. A possible safeguarding issue (the injury of a service user possibly as a result of an incident between service users) had not been notified or reported with sufficient detail to establish whether the management response, and the seeking of medical advice, was prompt or sufficient. Staff have received training in safeguarding adults but a poor response to a service users challenging behaviour was observed at the time of the inspection, and there was evidence that low morale among some staff may sometimes be detrimentally affecting the quality of care delivery to this very vulnerable client group. A problem identified with service users finances (apparent missing monies) was not notified to the Commission for Social Care Inspection, but was otherwise properly responded to by the National Autistic Society and thoroughly investigated. The Inspector saw the investigation report. The findings of the investigation were that there had been a failure in processes and that no money was actually missing. The Inspector was assured that recommendations from the investigation, including double signatures, on transactions are now being included in the policies and procedures. National Autistic Society, Gillitts Road DS0000012863.V314645.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 adequate. This judgement has been made using available evidence including a visit to this service. The premises mainly met Standards and improvements are being implemented. EVIDENCE: A partial tour of premises revealed that some improvements had been made since the last inspection such as the provision of more suitable furniture in the “Beige House”, and offices are in the process of being provided in each house. However there is an ongoing need for decoration and refurbishment (carpets, bathrooms and toilets) and it is understood that this will take place as the imminent improvements to the building are made. The National Autistic Society has agreed to forward to the Commission for Social Care Inspection a plan showing appropriate timescales for these improvements. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 18 Some service users have not adjusted well to the loss of the downstairs quiet areas, but the Inspector was informed that there are plans replace these facilities with upstairs lounges as soon as possible. Meanwhile areas under stairwells have been adapted for quiet time. Most areas met cleanliness Standards although the Inspector was concerned at the tea/coffee stains on the ceilings of both lounges and the mildew in one of the bathrooms. It is understood that better ventilation is proposed in the refitting of the shower room. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 19 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): 32,33,34,35,36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some staffing Standards are met but there is a serious shortfall of staff allocation on the rota and staff morale is low. Lack of leadership, support and supervision for staff has been affecting the quality of care delivery to service users. EVIDENCE: The allocation of staff in the “Green House” was not properly meeting the needs of service users. Two service users in this part of the building are detailed as requiring one to one support. One to one support was not being given consistently, or by a nominated staff member, to at least one of these service users. There were only three staff allocated to the unit in total. This allocation (which is shown as regular on the rota) assumes that one staff member can deal with all the care needs of the other three service users during the busy early morning period. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 20 The turnover of staff at the home over the last year is as follows: 4 support staff have left the service, 2 support staff have transferred or been seconded to other parts of the service. This amounts to a 28 turnover of support staff, which is judged to be higher than is conducive to the consistency of care required for this client group. Although the use of Agency staff is said to have been reduced over the year, there is still high usage with some agency staff not being regularly employed but only working a few hours to cover shifts. The detrimental impact of staff change is greater in this client group, who need routine and consistency, than in others. Also, staff need time to get to know service users and become thoroughly familiar with their care plans, and senior staff need additional time to properly support new staff in their duties. Senior staff on duty were seen to be very busy at the time of the inspection, and were not able to observe the care practices of other staff that required follow up and supervision, as observed by the inspector. Supervision “on the floor” is lacking and formal supervisions do not always meet the Standards in terms of frequency. The Inspector spoke with most staff on duty at the time of the inspection including the night staff, who were on duty at the time of her arrival. There was clear and consistent evidence of low morale; uncertainty or lack of trust in the management of the home; a sense that over recent months staff had not been properly consulted or listened to; and a sadness that some staff who they had felt were “very good” had left due, it was thought, to the poor management of the service and thereby the lack of job satisfaction. Two relatives who spoke with the Inspector confirmed that they felt staff were caring but recently seemed to have low morale. Some staff acknowledged that to some extent the quality of delivery of care to service users had gone down since the last Inspection and that this had contributed to the lowering of morale. Although staff were properly trained there was evidence that some were not putting their training into practice and that this was affecting care delivery. Two staff indicated a lack of confidence in raising their concerns appropriately, and did not feel that until very recently they would have been listened to fairly, or be able to talk in confidence. Prior to the inspection the National Autistic Society had received grievances from staff, which were under investigation at the time of the inspection, and additional management support in the form of experienced staff, had been brought in from elsewhere in the National Autistic Society. Evidence from the two staff records reviewed showed that proper processes in relation to recruitment were being followed, and a recently recruited staff member confirmed that she had received a proper induction and introductory period. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 21 National Autistic Society, Gillitts Road DS0000012863.V314645.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management has deteriorated and become poor over recent months. Problems identified at this inspection had not been sufficiently resolved to deem management adequate at this time. EVIDENCE: The Registered Manager was not available at this inspection, which was conducted with the assistance of senior management from the National Autistic Society. It was evident at the time of the inspection that there have been recent serious shortfalls in the leadership and management of the home. National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 23 It was apparent that the National Autistic Society has recently recognized that there were problems at the home and shortfalls in meeting legal requirements after a staff member drew a matter to their attention. The Inspector was informed that an attempt had been made to notify her of this the previous week but the Inspector had not received any message left. At the time of the inspection some action had been taken to resolve some of the recognized management shortfalls, and extra management hours were being provided. Notifications have not been made promptly to the Commission for Social Care Inspection concerning at least two serious incidents that have occurred at the home. One had required police intervention and another had required General Practitioner advice and was possibly a safeguarding issue. Staff have not been appropriately and consistently supported in their duties, and there is a lack of confidence from staff in the management of the home. Records and files have been reorganized and some information improved, but access to specific information is difficult and some records lack detail, are out of date, misfiled or lost. The Fire Risk Assessment has not been properly updated in relation to alterations made in the premises. A risk was identified at the time of the inspection in relation to the use of a coded lock on the upstairs corridor, and is now being addressed by staff. Advice has now been sought by staff from the fire officer. Staff are not always aware of issues of diversity recorded in service users records, and are therefore not necessarily following the appropriate guidelines. Staff put this down to there being a lack of time to read files or care plans properly. Rotas are not always being drawn up appropriately due to staff vacancies and the need to use agency staff. At the time of the inspection there was no female staff member allocated to the Green House and this caused delay in a service users personal hygiene routines. There was evidence of there being either insufficient leadership, organization or numbers of staff to properly meet service users needs in a manner consistent with their wellbeing and development. Staff should not be rushing, agitated or stressed as this atmosphere quickly spreads to and affects service users adversely. National Autistic Society, Gillitts Road DS0000012863.V314645.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 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 1 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 x National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 25 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 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. Medication must be administered and recorded as administered in line with the General Practitioners instructions. There must be sufficient staff on duty in each of the two areas of the home to meet the needs of service users. Staff must be appropriately supervised in their work The home must be conducted so as to make proper provision for the health, welfare, care and supervision of service users. The homes Fire Risk Assessment must be updated. Notifications of events in the care home that adversely affect the wellbeing or safety of service users must be made to the Commission for Social Care Inspection promptly Timescale for action 04/12/06 2 YA20 13 04/12/06 3 YA33 18 04/12/06 4 5 YA36 YA37 18 12 04/12/06 04/12/06 6 7 YA42 YA42 23 37 04/12/06 04/12/06 National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 26 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 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. Staff should be fully aware of the information in service users care plans and should be following the care plan instructions on how to work with service users. Service users choices in relation to personal care should not be compromised, and to this end staffing shortfalls should be avoided. 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. There should be evidence that concerns raised with staff are properly addressed. People who raise concerns should be offered the opportunity to make a formal complaint. The plan with timescales of building work and refurbishment should be submitted to the inspector as soon as possible. Staff morale needs to be addressed and staff need to be properly supported and supervised through this difficult time. Effective quality assurance and monitoring systems need to be implemented as soon as possible. These should include contact with relatives and advocates, as well as processes to ensure the home is functioning in accordance with its Statement of Purpose. 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. 2 3 4 YA6 YA7 YA18 YA19 5 6 7 8 YA22 YA24 YA30 YA32 YA39 9 YA42 National Autistic Society, Gillitts Road DS0000012863.V314645.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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. 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