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Inspection on 25/04/05 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 25th April 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 National Autistic Society has responded professionally to the concerns raised over the last few months both through the Inspection process and through a serious complaint. The Registered Person has agreed a voluntary freeze on admissions to the two vacancies, as recommended by the Acting Manager, until such a time as better processes have been implemented. The organization have previously gathered full information on service users prior to their admission, and this information is available at the home and should lead to the creation of the very good care plans necessary to provide consistent quality care to this client group.

What has improved since the last inspection?

The new Acting manager has been appointed and has submitted an application for registration. The Acting manager has identified a number of necessary improvements in addition to those identified through inspection processes and has produced an Action plan. She has begun to implement these positive changes.

What the care home could do better:

There are a number of areas detailed on previous Inspection reports that continue to require improvement in order that good quality care is delivered consistently to service users. The priorities are to implement improved management systems that properly protect service users wellbeing and to resolve the current staffing issues (numbers, competence and management). Records need to be fully reviewed in order that staff are using them properly to support care practices.

CARE HOME ADULTS 18-65 National Autistic Society, Gillitts Road Gillitts Road Wellingborough Northants NN8 2HX Lead Inspector Sarah Jenkins Unannounced 25 April 2005 08:00 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, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 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 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 (RI Mr T Mooney) Vacant Care Home Only 12 Category(ies) of Learning Disability (12) registration, with number of places National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users have a diagnosis of an Autistic Spectrum Disorder. Date of last inspection 21/02/2005 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, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home has been in a state of flux for some time and there is an urgent need for stable and effective ongoing management. It is hoped that the new Acting manager whose application for registration is in process, will be able to provide this. The recent background of the home is that a Registered Manager from another facility was seconded to the home for a short period in April 2003, following an inspection that demonstrated some serious shortfalls. Monitoring visits were implemented by Commission for Social Care Inspection. Another Acting manager was appointed but her application for Registration was withdrawn. Monitoring visits were recommenced shortly thereafter in January 2005 following a serious incident on one of the units when a service user was injured by another service user and Protection of Vulnerable Adults processes were implemented. Recently a further serious complaint has been made to both the National Autistic Society and the Commission for Social Care Inspection. Unannounced monitoring visits on 25.1.05, and 21.02.05 revealed ongoing management problems affecting the wellbeing of service users. The Inspector met with the Responsible Individual and a further new Acting manager on 16.03.05. to discuss the action the organization was taking in response to these issues. The Responsible Individual has initiated an independent review of the service, and this process will commence shortly. Management improvements have been made and are being implemented. 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 2 service users and tracking the care they receive through meeting with the service users, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the early morning period to observe practices by staff and to meet with service users. 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 two service users, one from the “Beige Unit” and one from the “Green Unit”. It was a quiet time of the morning and there were opportunities to speak with 4 members of care staff including an agency staff member during this observation period. The Inspector also met with the Acting manager and the clerical assistant for the home. The National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 6 Responsible Individual arrived during the inspection for his routine meeting with the Acting manager. The Inspector noted that the Acting manager had come in on her day off to evaluate practices in the units and was present during this early morning period prior to the Inspectors arrival. 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, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 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, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 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) 0 This area was not reviewed at this inspection. See comments below. EVIDENCE: The Acting manager informed the Inspector of a voluntary freeze on admissions. She has identified through a problem arising, that admission processes need to be reviewed. The Acting manager is fully aware of the level of change in practices required to fully meet service users needs, and enhance positive outcomes, as detailed elsewhere in this report. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 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) 6,9 Care plans do not yet provide full and up to date information for staff or residents in an easily accessible format. The involvement of service users in their programmes needs to be addressed (TEACCH system: Treatment and Education of Autistic and Related Communication Handicapped Children). EVIDENCE: Information available was fairly comprehensive but not sufficiently well organized for ease of access. Information and Risk assessments in different parts of the main file in the office area were inconsistent and/or undated, and the risk assessments on service users files in the units had not been updated. The Acting Manager has identified the need for information to be much clearer and new formats are to be introduced shortly. Extra administrative assistance (2 days per week) is being given to the Acting manager, to upgrade files. It is anticipated that this task will be fully completed by the end of May. The TEACCH system (Treatment and Education of Autistic and Related Communication Handicapped Children) system has been planned for some time but has still not been properly implemented (This is part of the Acting Managers action plan). National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,17 Service users lead full and active lifestyles including day placements, regular leisure activities and holidays. EVIDENCE: Staff informed the Inspector of the leisure activities that service users were enabled to participate in. These include community activities, such as visits to the local pub, local shopping trips, and parks. These are not fully documented at present. At the time of the Inspection service users were leaving for their work placements, and there was evidence from records of the ways in which individual arrangements according to need and choice are made for and with them. (Day Centre activities were not reviewed) The Acting manager and staff informed the Inspector that service users are offered choices and are encouraged towards healthy eating patterns. Service users were seen to be being offered, and enjoying their chosen preferences at breakfast time. There was evidence from the interactions observed that service users had good relationships with the regular staff. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 11 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, Service users Healthcare was not being adequately addressed at the time of the monitoring visit of 21.02.05. There have since been improvements in the recording of service users healthcare. EVIDENCE: Service users healthcare records have been filled in properly since the time when major shortfalls were identified at the end of February. Staff feel that service users healthcare needs are now being properly met, and that they have good support from community healthcare professionals. Staff feel that they are given proper training in respect of meeting service users needs with dignity and respect and the Inspector noted that a service users need for a carer of the same sex was being met at the time of the Inspection. There have been recent poor practice issues relating to service users medications. A new procedure has been implemented. Some staff have been suspended from administration of medication duties, and all are staff undertaking refresher training. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 12 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 have been improvements made to ensure service users are protected EVIDENCE: A serious incident is currently under investigation at the home. Documentation evidences that the Acting Manager is properly managing this investigation with input and support from the Responsible Individual. A previous serious incident in January was investigated through Protection of Vulnerable Adults procedures and shortfalls in staff following procedures were identified. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 13 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) 24 Service users have comfortable areas in which to relax. The Acting Manager has identified issues relating to premises that are being properly responded to. EVIDENCE: Service users were seen to be relaxing over breakfast time in comfortably furnished lounges. New furnishings have been ordered for both units that will improve health and safety issues that have been identified. There was a burglary at the home in March, when items from the Manager’s office were taken. Since then the Acting Manager is arranging for increased security of the windows. The safe storage of keys is also being addressed. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 14 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) 32, 36 Despite some improvement, staffing issues continue to compromise support for service users. EVIDENCE: 2 staff have recently been recruited and have completed the induction period. There remain 4 Full time staff vacancies at the home. There were only 2 staff on duty in the Green unit at the time of the Inspection, as a staff member was sick and the Acting manager had been unable to contact the staff agency to get agency cover. There was one agency staff member on duty in the Beige unit at the time of the Inspection, who had very limited experience with service users with Autistic spectrum disorders. A staff member who had been injured in a recent incident on an outing organized by the day care service. This incident had implications for the staffing of the home, as staff are employed to work with service users at both venues. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 15 A staff supervision programme is in place, and there was evidence of this on file. One staff member told the Inspector that her training needs to meet her National Vocational Qualifications training were not being properly addressed by the organization and there was evidence of this delay on file. Training and support needs have been identified in relation to violent incidents and a trainer is being brought in to work alongside staff for a period. The Acting Manager is in the process of drawing up individual training plans for staff. 2 staff informed the Inspector that they felt under pressure with respect to some aspects of their jobs, for example working beyond the job specification, and/or lack of support for personal development. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 16 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) 42 Serious issues have been identified over recent months compromising service users Health and Safety. EVIDENCE: The Acting manager has produced action plans on areas that have been identified as problematic i.e. Medication processes and storage, Safe Storage of cleaning products and food, the Audit of service users files, the staff rota, Furnishings and fittings, Documentation, Staffing and Communication systems and the TEACCH system (Treatment and Education of Autistic and Related Communication Handicapped Children). This action plan has appropriate timescales and the Inspector saw from records and heard from staff, evidence of its implementation. The National Autistic Society has acknowledged the shortfalls and is addressing these issues. The Acting manager is being properly supported in implementing the necessary change. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 17 There was evidence of staff dissatisfaction with some of these changes e.g. the rota, but there was also evidence that the Acting manager was responding to staff feelings and negotiating change in a professional manner. There is an ongoing problem relating to the service users access to medical care due to a decision made by the service users family. It was agreed that admission processes should be re-evaluated in the light of these problems, and clear guidelines issued to carers, about the homes accountability, duty of care and criteria for admission. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 18 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 2 x x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score x 1 x x x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 National Autistic Society, Gillitts Road Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 19 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 6 Regulation 15 Requirement Service users care plans must be reviewed and regularized into formats that enable easy access to information by staff Risk assessments on Service users routines and activities must be reviewed and where necessary updated at regular intervals and no less frequently than 6 monthly. The recent improvements in the responses to Service Users healthcare needs (since March 2005) must be maintained. The Responsible Individual must ensure that the current investigation into the incident , which is subject to a complaint, is completed, and that appropriate is action taken to lower the risk of any similar incident occuring. The security of the windows at the home is being evaluated and details of progress made in upgrading security must be forwarded to the Inspector. The inspector must be informed of the progress that the home has made in recruiting to the 4 full time vacancies. DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Timescale for action By May 31st 2005 By May 31st 2005 2. 9 13 3. 19 12 By May 31st 2005 By May 31st 2005 4. 23 13 5. 24 13 By May 31st 2005 6. 32 18 By May 31st 2005 National Autistic Society, Gillitts Road Version 1.30 Page 20 7. 32 18 Full details of the individual training plans for staff must be submitted to the inspector. By May 31st 2005 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 42 Good Practice Recommendations The Inspector should be kept informed of the progress being made in relation to the ongoing review of systems, and the action plan submitted at the time of the inspection. National Autistic Society, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Northamptonshire Office Newland House, First Floor Campbell Square Northants, 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, Gillitts Road DC51 C08 S12863 NAS Gillitts Road V222003 250405 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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