Inspection on 02/05/07 for Raby Hall

This inspection was carried out on 2nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Raby Hall 29/06/06

Raby Hall 22/02/06

Raby Hall 10/12/05

Raby Hall 21/01/05

Raby Hall 04/08/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Raby Hall Raby Hall Road Bromborough Wirral CH63 ONN Lead Inspector Beate Field Key Unannounced Inspection 2nd May 2007 10:00 Raby Hall DS0000018929.V331986.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 Raby Hall DS0000018929.V331986.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. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Raby Hall Address Raby Hall Road Bromborough Wirral CH63 ONN 0151 334 7510 0151 334 1762 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) Wirral Autistic Society Mr Carl Joseph Kipling Care Home 27 Category(ies) of Learning disability (27) registration, with number of places Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th March 2007 Brief Description of the Service: Raby Hall is registered to provide personal care and accommodation to 27 adults who have autism. The home consists of four units. Old Hall, Respite Unit, The Courtyard and The Lodge. All residents are accommodated in single bedrooms and have access to sufficient communal bathrooms and toilet facilities. Lounges and dining rooms are available for communal use. There is access to a domestic style kitchen within each of the units. The home is set within extensive grounds. Residents are accommodated in the unit of Raby Hall most suited to their needs and a programme of education, employment or training is provided as appropriate. The home is close to local shops and to public transport services. Parking is available. At the time of the inspection, the weekly cost for the service ranged from £1148.00 to £2315.00. A statement of purpose, which describes the services offered at Raby Hall is available for relatives and social and health care professionals to refer to. A service user guide that is suited to the needs of the residents is in the process of being developed. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 8 hours and is based on a visit to the home, information received about the service since the last inspection and by questionnaires completed by the manager, residents, relatives and health and social care professionals. During the site visit to the home time was spent in the office looking at a sample of records and policies and procedures and talking to the person in charge. A tour of the home was undertaken. The inspector spoke with staff and made observations of staff delivering care to the residents. The inspector spoke to the manager following the visit. What the service does well: The assessment process ensures that the service is only offered to individuals whose needs can be met at the home. Residents have opportunities to test drive the home to make sure it is right for them. The health care needs of residents are well met. Links with the community are good and support and enrich residents’ social and educational opportunities. The dietary needs of residents are well catered for with a balanced and varied selection of food available. A comfortable home environment is provided. Residents are supported by competent staff who have access to good training opportunities. Staff are appropriately deployed to meet the needs of the current residents. Observations of staff indicated that they are caring and respectful of the residents. The staff spoken with were very knowledgeable about the needs of the residents and appeared to have a very good relationship with them. Residents appeared relaxed and content with the staff. Staff said, “I enjoy working here, staff work well together,” “residents get a good service.” Residents are supported by the quality assurance systems in operation at the service. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service user guide should be more suited to the needs of the residents who live at the home to enable residents to better understand this information. Improvements need to be made to the practices around the management of medication. A record must be made of all medication administered at the home to ensure there is no mishandling. The current practices for administering medication at day services need to be reviewed to ensure that they fully safeguard residents. Improvements need to be made to the recording practices around complaints. A record needs to be made of all complaints and the action taken to investigate them to show that complaints are being dealt with appropriately and that the rights of residents’ are being promoted. Some behaviour management plans need to be improved to ensure that they give staff the guidance they need to support residents appropriately and keep them safe. The adult protection procedures must be followed in order to fully safeguard residents. The record keeping around residents’ finances needs improvement so that there is a clear audit of how their money is managed at the home. Improvements are needed to the opportunities residents have to make decisions about their lives. Further residents need to be provided with communication guidelines and records should show the choices that residents can make. Staff need to be provided with regular supervision to ensure that they are carrying out their roles and have the support and guidance to do so. The management arrangements at the home should be reviewed to ensure that there are clearer lines of accountability. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 7 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. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process ensures that the service is only offered to individuals whose needs can be met at the home. Residents can test drive the home to make sure it is right for them. The contracts/terms and conditions support the interests of residents. The information available about the home would not be suitable for all prospective residents. EVIDENCE: A Statement of Purpose and a Service User Guide are available for Raby Hall, The Courtyard, The Respite Unit and The Lodge. These documents contain all the required information regarding the home and the services provided. Some information needs to be updated following staff changes at the service. The service user guide and statement of purpose are available on request and are included in the information pack that is sent to local authorities and other persons who are looking towards making a placement at the home. It continues to be recommended that the service user guide be presented in a format that would be more suited to the needs of the residents. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 10 There has been no new residents to the service since the last inspection. A sample of assessments seen at previous inspections indicate that they are comprehensive and provide a good basis for care planning. New residents are assessed by the manager for the home and by a representative from day services. The manager visits a prospective resident where they are living. Information is gathered from the residents’ carers, social worker and any other relevant agencies. An assessment is made if a resident moves to the home from another home within the Society to make sure that the residents’ needs can be met there. Introductions to the home are on an individual basis and designed to be specific to meet the needs of the resident. Some residents stay for an afternoon or a meal, whilst some stay overnight. Family members are also encouraged to visit the service together with social workers from the funding authorities. The home does not take unplanned admissions. A sample of contracts/statement of terms and conditions between the home and the residents were seen. These documents contain the required information. Representatives of the residents had signed these documents. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with the information they need to satisfactorily meet residents’ care needs. Some behaviour management plans do not give staff the guidance they need to support residents appropriately and keep them safe. Improvements are needed to the opportunities residents have to make decisions about their lives. EVIDENCE: A sample of resident’s care plans were examined and contained detailed and clear information to enable staff to provide appropriate support around day-today living and personal goals. The care plans had been reviewed. The documentation available from reviews indicated that the resident, their relatives, social worker and other relevant individuals are invited to contribute Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 12 Daily records of resident’s well being and any activities they have taken part in were available in diary form. However, some of this information is repeated in the communications book. Care needs to be taken to ensure the Data Protection Act is observed by keeping personal information about residents confined to their own files. Questionnaires received from 2 relatives indicated that a good quality service is provided and that the home always meets the needs of their family member. One relative commented “we cannot speak highly enough of the care and attention which has resulted in amazing progress being made.” Questionnaires were also completed by health professionals and a social worker and were positive about the service provided. It was stated, “the staff team are conscientious. They work well as a team and are professional. They appear to provide a high quality of care to a group of individuals who have very complex needs.” Staff spoken with could describe the opportunities that residents have to make choices at the home. This information is not fully recorded. Written communication guidelines were available for some of the residents whose records were seen. These were very comprehensive documents that clearly identified the communication needs of the residents. Communication guidelines are being drawn up for all residents. This will further assist in helping residents to make choices about their lives at the home. Pictorial communication aids were seen to be available for some residents. All the records seen contained a decision making form, this included information about self administration of medication, managing finances, going out without staff, staying in without staff, being allowed to cook without staff. The resident, staff member and parent/guardian have signed some of these documents. Some of these documents were incomplete and should be completed for all residents. The home does not use an independent advocacy service that could also help with informed decision making. Personal risks assessments have been updated and new ones formulated where necessary. Some information is duplicated on files, which can be confusing for staff to follow. Discontinued care plans and risks assessments should be clearly marked or archived to avoid confusion. Behaviour management plans are available. Most provide clear guidance to staff. One care plan referred to “isolating” a resident in their bedroom. Guidance around this was not detailed and a discussion with a member of staff indicated that this practice is not occurring at present and is not appropriate given the needs of the resident. This does not provide clear guidance to staff. The behaviour management plans seen had in general been regularly reviewed. One plan had not been reviewed following incidents of a resident causing a physical injury to other residents at the home. It was discussed Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 13 with the manager following the visit that this behaviour management plan needs to be reviewed without delay in the light of the incidents to see if there is any additional support that can be given. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including visiting the service. Residents are able to take part in appropriate activities that provide opportunities for their educational, social and personal development. Links with the local community are promoted. The daily routines and arrangements for promoting relationships with family and friends support the residents. Varied and well-balanced meals are provided. EVIDENCE: The majority of residents attend day services from Monday to Friday, where they are provided with opportunities for social, educational and communication support and development. Daily living skills are taught at the day services by appropriately trained staff, and by care staff within the home on a daily basis. Residents have the opportunity to demonstrate individual preferences for a Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 15 range of activities within day services subject to risk assessments. Some of the opportunities available are horticulture, craftwork, community work experience, drama and physical education. Residents are provided with work experience opportunities and attend local college courses in accordance with their wishes and abilities. Residents have an activities programme during the evening and at weekends. There are opportunities for residents to become involved in the local community and staff assistance is given to promote this. For example, the residents visit local shops, go to the gym, cinema and bowling. Where necessary risk assessments are available around community outings. 2 questionnaires were returned by residents and indicated that they can make choices about the activities they do. Discussions with the staff and observations confirmed that the home’s routines are flexible as much as possible. The weekday routines are influenced by the day services and work placements. Many of the residents benefit from a structured lifestyle and it is understood that some residents do not relate well to change. Most residents develop their own routines. Records and a discussion with staff indicated that residents maintain contact with their families. Residents can see visitors in their own bedrooms or in one of the communal areas in accordance with the residents needs and wishes. Care plans indicate the dietary requirements of residents. Advice is obtained from a dietician if this is required. The cooks have recently attended a training course on preparing healthy foods. The records showed that well-balanced and varied meals are provided which meet the cultural background of the residents. A greater use of communication aids would improve residents’ decision making around meals. Meals are in general taken in homely surroundings. The large dining room at Raby Hall is not homely. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health needs of residents are well met, however, residents are not fully safeguarded by the home’s handling of medicines. EVIDENCE: There is clear information available for staff on resident’s personal care routines that indicate their preferences. Consistency and continuity of support for residents is provided through the key worker system. Staff receive training on promoting privacy and dignity during their induction. Discussions with staff indicated that the privacy of residents is respected. All residents are accommodated in single bedrooms. The home has an ‘Intimate Care’ policy, which is issued to all care staff. Records indicated that residents have access to medical/health care professionals as needed. Residents are supported to attend health care appointments. The staff at the care home access support and advice from a speech therapist, psychologist and other specialist health professionals as necessary. Staff interviewed were very aware of the support needs of residents. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 17 A questionnaire completed by healthcare professionals showed that the home always seeks their advice and acts upon it to improve the health care needs of residents. The questionnaire also indicates that the home manages medication appropriately. A medication procedure is available which provides clear guidance. Medication is stored securely. Staff who administer medication have all received training around the safe handling of medication. The medication administration records and corresponding medication were inspected. A record had not been made of whether 5 tablets that were not in their container had been administered. A record must be kept of all medicines that are administered or the reason for them not being administered to ensure there is no mishandling and to safeguard residents. During the visit a member of staff was observed preparing to administer medication. The medication for one resident could not be located. It took around 20 minutes for the medication to be found. The medication had been transferred to the day services site and not returned to Raby Hall. The practices around medication leaving the home to go to day services and being returned to the home by day services needs to be reviewed to ensure that this fully safeguards the well-being of residents. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The practices at the home do not fully protect residents from abuse. EVIDENCE: The home has a complaints procedure. CSCI has not received any complaints since the last inspection. The home has received one complaint. A discussion with the team leader indicated that this had been appropriately managed. However, the records relating to this could not be located during the visit. A discussion with a member of staff indicated that some complaints being raised by a resident were not being recorded as such. As a result there was no record of the steps taken to resolve the issues raised. 2 residents and 2 relatives who returned questionnaires said that they would know who to speak to if they were unhappy with the service. Both relatives said that the service has responded appropriately when issues have been raised about the care given. A copy of Wirral Borough Council’s adult protection procedure was available. All staff are given training in the prevention of abuse during their induction training. Training in the prevention of abuse is part of Wirral Autistic Society’s compulsory training. The training includes identification of the different types of abuse and how to recognise the signs of it occurring. Members of staff interviewed were clear about what to do in the event of a suspicion of abuse. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 19 Records showed two incidents where a resident had caused an injury to two residents. Further records showed an incident where a resident had “slapped” another resident. The manager reported that steps had been taken to prevent further incidents, however this was not documented, the behaviour management plans had not been reviewed and a safeguarding referral had not been made to Wirral Borough Council. This does not sufficiently safeguard residents. Following the visit the manager confirmed that a safeguarding referral had now been made. The manager reported that he was not clear that this action needed to be taken and had also contacted Wirral Social Services for advice. A senior member of staff is not signing incident reports. This should take place as it provides evidence of managerial overview of the operation of the service. Following the last key inspection thirty four staff members have undergone training in up to date methods of intervention and managing challenging behaviour by a member of staff who has taken the British Institute of Learning Disabilities accredited training course. Annual updates have also been arranged. Personal allowances are held at the home, on behalf of residents. Personal allowances are held collectively. Receipts are kept and a note is made on the receipt as to which resident this refers to. No other records are held at the home. Receipts are returned to the finance department on a weekly basis and what a resident has spent and the monies remaining are calculated. This practice does not fully safeguard the residents’ finances, as it does not allow for an audit of the residents monies to take place by staff at the home and by the home’s manager. This practice does not allow for fully accountable practice to take place. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 20 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, 25, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, pleasant and safe environment for residents. Some areas of the home could be made more homely. EVIDENCE: The home consists of four units, Old Hall, Respite Unit, The Courtyard and The Lodge. A tour of these units was undertaken. The premises provide a comfortable environment to residents and are well maintained. Some of the decoration is showing signs of wear and tear. There was evidence of maintenance and decorative works having been undertaken since the last inspection. A sample of bedrooms were seen at the units. Bedrooms are furnished and personalised, in accordance with the residents’ preferences, needs and risk assessments. Some of the bedrooms were bare due to the individual needs of the residents and other rooms were personalised with photos, posters, soft furnishings and electrical equipment such as televisions and music centres. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 21 The Lodge, The Courtyard and the Respite Units have access to communal lounges/dining areas and kitchens that appear homely and were well maintained. Each flat at Old Hall has access to a communal kitchen, which is domestic in appearance. There is a communal dining area and three lounges at Old Hall. The dining area does not appear homely in appearance due to its size, furnishings and decoration. A few doors are in use at Old Hall and The Courtyard, which open in two sections. These doors are not domestic in appearance. A risk assessment around the use of these doors has been made available. Consideration should be given to replacing these doors with alternative doors that are not institutional in appearance. At present some communal areas of Raby Hall are accessed by people who use the day services offered by Wirral Autistic Society and who are not resident at the home. A discussion with the team leader indicated that plans are in place to address this. People who use the day services should not be able to access the communal areas of Raby Hall that are part of the residents’ home as this does not provide a homely atmosphere. A tour of the home showed that the home was clean. There are procedures for staff to refer to about hygiene and infection control. 2 questionnaires were returned by residents and indicated that the home is always fresh and clean. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 22 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent staff who have access to good training opportunities. Staff are appropriately deployed to meet the needs of the current residents. The recruitment practices safeguard residents. The lack of regular supervision leaves the staff without appropriate direction. EVIDENCE: The staff team spoken with were able to demonstrate a good understanding of the autistic spectrum disorder and all commented about how much they enjoyed their job. Staff were observed interacting positively with residents. They said that the manager and team leaders are supportive and would listen to any concerns raised. A number of staff have worked at the service for several years, which promotes continuity of care. Observations of staff indicated that they are caring and respectful of the residents. The staff spoken with were very knowledgeable about the needs of Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 23 the residents and appeared to have a very good relationship with them. Residents appeared relaxed and content with the staff. 2 questionnaires were returned by residents and indicated that the staff treat them well. One said “the staff make me happy. They help me to do well.” 2 relatives returned questionnaires and made positive comments about the staff team. They said that the staff keep them up to date with important matters affecting their relatives and meet their relatives’ needs. The rotas indicated that there were sufficient staff to support the residents’ needs. Some residents receive one to one support and records and observations show this support is being given. A comprehensive induction and foundation training programme is provided to permanent staff. The training covers health and safety matters, adult protection, equal opportunities, working with adults with autism and promoting the rights of residents. The induction and foundation training programmes have been developed in accordance with the National Training Organisation training targets. This training is also provided to bank staff so as to ensure that they are appropriately trained should they need to be deployed. Staff are encouraged to undertake an NVQ in caring for adults with a learning disability. At present 50 of staff hold a relevant NVQ. Specialist training is provided to staff as necessary. A draft policy around promoting equality and diversity has been drawn up and given to staff for their comments. It is understood that training in this area is being developed. No staff have been employed since the last visit to the service in March 2007. Staff recruitment files were examined at the last visit. At this visit it was reported that the files examined provided evidence that a robust recruitment procedure is in operation at Wirral Autistic Society. An equal opportunities policy is in operation at the service. Records of supervision dates were not available. From discussions with staff and the individuals responsible for supervision it was evident that formal supervision is not occurring at least six times a year. One member of staff reported not having received supervision in the last 12 months. A team leader reported that some supervisions have not been given for 8 months due to other work commitments. There is limited storage for confidential staff information, which is also proving problematic. Staff need to be provided with regular supervision to ensure that they are carrying out their roles and have the support and guidance to do so. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 24 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality assurance systems in operation support the well being of the residents. The management arrangements could be improved to ensure that there are clearer lines of accountability. EVIDENCE: The registered manager has completed an NVQ level 4 in care and management. He is an experienced manager who has developed his knowledge of autistic spectrum disorders through on going training and working with residents with autism over a number of years. Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 25 The manager is registered with CSCI for Old Hall, the Respite Unit, The Lodge and The Courtyard but in effect only manages Old Hall. Another manager is currently managing the Respite Unit, The Lodge and The Courtyard. Both managers are of an equal status and the registered manager does not supervise the manager of the other services he is responsible for. The management arrangements at the home should be reviewed to ensure that there are clearer lines of accountability. This been documented in past inspections and the registered manager said that this has been discussed with their manager. There are a range of quality assurance systems in place. Wirral Autistic Society is accredited by the National Autistic Society which carries out an inspection of services provided. Wirral Autistic Society conducts an internal audit of the society as a whole on an annual basis. Questionnaires are sent to residents’ relatives regarding how the home operates. Visits to the home by the representative of the registered provider are made. These reports are made available to CSCI. As already indicated, Improvements are needed to the opportunities residents have to make decisions about their lives. The views of residents are obtained by key workers and the manager is looking at further ways of seeking their views that are appropriate to their needs. It is understood that questionnaires for health and social care professionals are in the process of being devised. Training around safe working practices such as manual handling, fire safety, infection control and first aid is made available to staff as part of their induction. There is a rolling programme of training opportunities provided and staff can access this when required. There are a range of policies and procedures available that promote safe working practices. Wirral Autistic Society has a health and safety advisor who is available to provide advice and who has responsibility for promoting a safe environment within the homes. A sample of safety check records were examined for the gas, electricity PAT testing and were found to be in order. A tour of the home showed practices are promoted. First floor windows have restrictors, water was safe temperature and radiators are covered in accordance with a assessment. Cleaning fluids were not accessible to residents. and safe of a risk Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 27 Yes 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 Regulation 15 Requirement The registered persons must ensure that behaviour management plans provide clear guidance to staff on how to support a resident. The registered persons must ensure that behaviour management plans are reviewed following any incidents, which indicate that the plan is not keeping other residents safe. The registered persons is required to ensure all personal information in respect of residents is kept securely and confidential (previous timescale of 31/03/06 not met). Timescale for action 02/05/07 2. YA9 15 02/05/07 3. YA10 17. 02/05/07 4. YA20 13 The registered persons must 02/05/07 ensure that a record is kept of all medicines that are administered or the reason for them not being administered. The registered persons must review the practices around medication leaving the home to go to day services and being DS0000018929.V331986.R01.S.doc 5. YA20 13 02/06/07 Raby Hall Version 5.2 Page 28 returned to the home by day services to ensure that this fully safeguards the well being of residents. 6. YA22 22 The registered persons must ensure that a record is made of all complaints and the action taken in respect of such complaints. The registered persons must ensure that the safeguarding procedures are followed in order to safeguard residents. Any incident of a resident causing physical injury to another resident must be reported to the placing authority and to Wirral Social Services. The registered persons must ensure that the practices for managing residents’ finances sufficiently safeguard the residents. The registered persons must ensure that staff are appropriately formally supervised and that this is recorded. 02/05/07 7. YA23 13 02/05/07 8. YA23 13 02/05/07 9. YA36 18 02/08/07 Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 29 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 YA1 Good Practice Recommendations It is recommended that the service users guide be made available in formats suitable for the people for whom the home is intended. Discontinued care plans and risks assessments should be clearly marked or archived to avoid confusion. Records should show the choices that residents can make. It is recommended that residents have access to an independent advocacy service. Residents should always have access to a homely setting when having their meals. The manager or senior manager should sign incident reports as this provides evidence of managerial overview. Consideration should be given to replacing the doors that open in two halves with alternative doors that are not institutional in appearance. The communal areas of the home should not be accessible to people who use day services and are not resident at the home as this does not provide a homely atmosphere. Adequate arrangements need to be in place for the storage of confidential information relating to staff supervision. The management arrangements at the home should be reviewed to ensure that there are clearer lines of accountability. 2. 3. 4. 5. 6. 7. YA6 YA7 YA7 YA17 YA23 YA24 8. YA24 9. 10. YA36 YA37 Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Raby Hall DS0000018929.V331986.R01.S.doc Version 5.2 Page 31 - 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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