Inspection on 25/05/05 for St Edwards (6).

This inspection was carried out on 25th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Edwards (6). 16/07/07

St Edwards (6). 04/07/06

St Edwards (6). 23/09/05

St Edwards (6). 22/11/04

St Edwards (6). 21/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 St Edwards (6) 6 St Edwards Close New Addington Croydon CR0 0EL Lead Inspector Peter Stanley Announced Inspection 25 May 2005 9:30am 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. St Edwards (6) Version 1.10 Page 3 SERVICE INFORMATION Name of service St Edwards (6) Address 6 St Edwards Close, New Addington, Croydon, Surrey, CR0 0EL 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) 01689 800 960 01689 800 861 croydon@nas.org.uk The National Autistic Society Robert Torrance Care Home 12 Category(ies) of Learning disability (12) registration, with number of places St Edwards (6) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 22 November 2004 Brief Description of the Service: St Edwards is situated in a quiet close in New Addington near to local shops and trams. The National Autistic Society leases the building from Croydon Churches Housing Association. All service users have been identified as having an autistic disorder. The service provides residential care for twelve residents in two houses, which are separated by an attractive garden area. One of the houses is for male residents only, the other is shared between male and female service users. All residents have a single room; all contain a wash hand basin although some are not in use. This is due to the particular needs of the person occupying those rooms and has been agreed with the registration authority as being in their best interests. The furniture in some bedrooms has also been specially adapted where necessary. In addition to the bedrooms there is a communal lounge, dining room, a kitchen, toilets and bathroom in each house. Each house has its own staff team, with one waking member of staff allocated to each and one member of staff sleeping in. Residents attend Coney Hall Day Centre in West Wickham from Monday to Friday. This is housed in the same building as many of the National Autistic Society’s regional administrative functions such as personnel, and was seen during the course of this announced inspection. St Edwards (6) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. St Edwards is a purpose-built home for adults who have autism or aspergers syndrome. There are two houses within the home with a gender divide, each accommodating six residents. Female residents are accommodated in The Willows while male residents are accommodated in The Conifers. This announced inspection was conducted over one day with the registered manager. This involved visiting the home and the NAS (National Autistic Society) Day Centre at Coney Hall where staff records are kept. The inspector spoke to a number of service users during the course of this inspection, to the parents of a service user, and to members of staff on duty. Service users spoken to by the inspector responded favourably regarding the home and the care provided by staff, and presented as settled and well supported. As a result of this inspection there are six new requirements with one requirement from the previous inspection, which has been partially met. There is also one recommendation. The inspector would like to thank the manager and staff for their cooperation throughout the inspection. What the service does well: The inspector found St Edwards to be a pleasant, relaxed and well managed home, with a high level of management and staff commitment The staff members on duty at the time of the inspection were observed to be interacting with the service users in a caring, respectful and professional manner. Service users commented favourably about the care and support they receive at the home and the caring attitude of the manager and staff team. Staff are provided with the training, support and knowledge base required with which to meet the needs of this service user group. Prospective service users are provided with the information they require, and the opportunity to visit and stay overnight, before deciding whether the home is likely to meet their needs. St Edwards (6) Version 1.10 Page 6 The home is able to demonstrate that the range of needs presented by service users are being fully assessed, and appropriately met. The home has a thorough and ongoing process of assessment and review in place. This includes social and health care professionals, and focuses comprehensively on the range of support and care needs presented. Service users’ health, personal and social care needs are set out in an individual plan of care, and service users and their relatives/ representatives are fully involved in the care planning process. Service users are assisted to participate fully in the day-to-day life and routines of the home, and are supported in making decisions for themselves in their daily activities. Staff work with service users in an enabling and clientcentred way, with service users being consulted regarding matters which affect them and their lives within the home. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to participate in activities and develop independent living skills through the development of responsible risk management strategies. Service users are provided with opportunities for participating in a varied range of day care activities and for developing their interests and abilities. Service users are also assisted to develop daily living skills through guidance/support with participating in daily routines within and outside of the home. Service users are encouraged to access shopping, leisure and educational facilities in the local community, within a risk management framework. The home actively encourages service users to maintain family links and friendships, to visit relatives/friends, and to receive visitors. The home provides guidance and support in enabling service users to develop appropriate peer relationships. Service users are provided with a healthy and nutritious diet in pleasant and homely surroundings. Individuals are consulted and enabled to make an informed choice regarding the available menu options. Mealtimes are flexible and take account of service users’ activity schedules. Service users’ personal support and health care needs are evidenced to be well met in this home, with support being planned and tailored according to the individual needs presented. There was evidence of a clear commitment by the manager and staff to enabling service users to develop their communication and living skills. Service users’ personal and health care needs are being appropriately monitored and addressed, with detailed records being maintained. St Edwards (6) Version 1.10 Page 7 The home’s adult protection policies, procedures and practice evidence that service users are being well protected from abuse and are living in a safe environment. The home has an ongoing programme for staff to undertake adult protection training, and the manager has recently become an accredited trainer with the London Borough of Croydon. Six of the twenty-three staff have not yet had adult protection training, but are scheduled to receive this on dates arranged in June and July 2005. The home has a clear policy and procedures in place for the receipt, recording, storage, handling, administration and disposal of medicines. Accredited medication training is provided for all staff who administer medication. Service users are evidenced to live in an environment that is safe, wellmaintained and adapted for people with disabilities. Service users have access to safe and comfortable facilities, which includes sufficient bathrooms and toilets. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. A recently completed audit of service users’ rooms must, however, be evidenced. The home has the necessary adaptations in place with which to safely meet the needs of the service users and maximise their independence. The home presents as being clean, pleasant and hygienic, with appropriate policies, procedures and training being in place. There is clarity of staff roles and responsibilities with service users receiving one-to-one support from their key workers. There is an effective staff team with sufficient numbers being on duty at all times. Service users are evidenced to have their needs well met by an appropriately trained and qualified staff group. Sufficient numbers of staff are on duty. All staff have appropriate induction, supervision and appraisal arrangements, and there is a comprehensive training programme in place. Staff are being appropriately supported and supervised. An annual system of appraisal has recently been put in place. The home is evidenced to be well-run and managed in the best interests of the home’s service users. There was positive feedback from staff, service users and relatives regarding the open and inclusive management style and the friendly atmosphere in the home. St Edwards (6) Version 1.10 Page 8 The health, safety and welfare of service users and staff are being appropriately promoted and protected. Safety checks and certification are in place. There is an ongoing programme of training for staff. What has improved since the last inspection? St Edwards (6) Version 1.10 Page 9 The home maintains very high standards and has received very positive inspection reports from recent inspections. What they could do better: While care plan reviews are scheduled to take place on an annual basis, these need to be evidenced for two service users. The home has an appropriate and well-publicised complaints policy and procedure in place. Clear information for raising complaints is made available in an appropriate format for service users. The complaints procedure gives contact details for the CSCI, but needs to make clear that a complainant can contact the CSCI at any time. The home has appropriate recruitment policy and practices in place, which are generally providing the required level of protection for service users. There was, however, one concern regarding the need for the home to obtain a new CRB certificate for a recently recruited staff member. Policies and procedures are in place and in good order. The home’s policies and procedures have, however, recently become overdue for review, and must be reviewed forthwith. St Edwards (6) Version 1.10 Page 10 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Edwards (6) Version 1.10 Page 11 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 St Edwards (6) Version 1.10 Page 12 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) 1, 2, 3, 4 and 5 Prospective service users are provided with the information they require, and the opportunity to visit and stay overnight, before deciding whether the home is likely to meet their needs. The home is able to demonstrate that the range of needs presented by service users are being properly assessed. The home has a thorough and ongoing process of assessment and review in place. This involves social and health care professionals, and focuses comprehensively on the range of care and support needs presented. Staff are provided with the training, support and knowledge base required with which to meet the needs of this service user group. Each service user is provided with a service agreement. This is written in a format which is appropriate to the communication needs of the service user. EVIDENCE: The home has compiled a statement of purpose. This outlines the aims and objectives of the home, and the facilities and services it provides. The Statement of Purpose includes all the information detailed in Schedule 1 of the Care Homes Regulations (2001). The home has developed a service user’s guide which is called a ‘Welcome Pack’, and is written in a format/language suitable for the service users. This contains all the elements of regulation 5(1)(2)(3). St Edwards (6) Version 1.10 Page 13 The inspector looked at a number of service users’ files, and discussed the referral and assessment process with the manager. Referrals include recent assessments from referring agencies. Decisions about admissions are taken by a panel from St Edwards. This includes senior staff and a range of other professionals who know the service user. Staff from St Edwards carry out thorough and detailed assessments, with assessment visits being made to the service user and family. A comprehensive history is obtained. This includes a history of behaviours and medical diagnosis. Prospective service users visit the home, usually with family members, when a placement is being considered. The initial visit takes place when other users are not present. The prospective service user is then invited to an evening meal with other service users. Overnight stays may be arranged but this depends on the needs of the individual. Service users are offered a six-month trial period with a review after three months. This is to allow for a full assessment and is normal professional practice within the National Autistic Society. The home aims to meet the specialist needs of people diagnosed with autism and Asperger Syndrome. All service users have communication difficulties, and some present challenging behaviour. Individuals’ cultural and religious needs are met in consultation with family members. Staff were observed using various means to engage with service users, and to interact in a patient, caring and skilled way. While some users possess varying degrees of verbal understanding and ability to communicate, others are unable to do so and use Makaton or other systems for communicating. Staff are provided with autism awareness training and specialist teaching techniques. Training in how to manage challenging behaviour is also provided. The home’s approach is to try and identify triggers and take preventative action if possible, using the least intrusive method of control if this is required. The inspector spent some time with a small number of service users. Through discussion with three users and observation of others, he felt assured that that users were generally settled in the home, and appreciative of the support provided. From the feedback given by staff, service users and relatives, and the information provided regarding staff support and training (standards 31 to 36), the specialist needs of this group are evidenced as being well met. The National Autistic Society has recently developed an individual service user agreement. This is written in an appropriate and user-friendly format, and is designed to provide each service user with an understanding of the services that are being provided, the obligations on the home and on the service user, and the basis on which the placement is being agreed. All service users are also subject to a local authority contract. The Registered Provider has inserted key contract terms into the Service User’s Guide; each is signed by the service user and/or representative, the local authority and the NAS. St Edwards (6) Version 1.10 Page 14 St Edwards (6) Version 1.10 Page 15 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7,8, 9 and 10 Service users have their health, personal and social care needs set out in an individual plan of care, and are fully involved in the care planning process. Service users are assisted to participate fully in the day-to-day life and routines of the home, and are supported in making decisions for themselves in their daily activities. Staff work with service users in an enabling and clientcentred way, with service users being consulted regarding matters which affect them and their lives within the home. Service users are thoroughly assessed regarding potential risks to their health and safety, and are positively enabled to take responsible risks wherever possible. St Edwards (6) Version 1.10 Page 16 EVIDENCE: The inspector examined a number of service users’ files. These detail a range of individualised health and social needs with guidelines on necessary interventions for each user. The home’s approach is to try and identify triggers and take preventative action if possible and use the least intrusive method of control if this is required. There is a detailed care plan and individual learning plan for each service user, together with individual risk assessments, a health check and medication profile. Service users’ care plans are reviewed on an annual basis, and provide information relating to users’ support needs and short term goals throughout the year. These are signed and dated. The reviews of two service users, which the inspector was informed had been completed, did not appear on the service users files. These must be evidenced and a requirement applies. Service users are assisted to make decisions about admission to the home and which activities interest them. Each service user has a key worker who provides individualised support, assists day-to-day decision-making, and provides support at reviews. Independent advocates are used, whenever possible, in drawing up and reviewing the individual care plan. The inspector spoke to a number of service users. This indicated that service users feel involved in making choices and decisions regarding their day to day activity and that their views and feelings are respected. The finance officer of Croydon NAS (National Autistic Society) acts as appointee for some service users, while others are represented by their families. Financial records are appropriately maintained. Service users are actively encouraged to manage small amounts of money where possible. Where support is needed, the reason for, and manner, of support is documented in care plans and regularly reviewed. All the homes service users have Bank accounts. Service user meetings are held and service users are also involved in a committee at the ‘Transitions Project’. Service user questionnaires, written in an appropriate format, cover all aspects of day to day living and activities, also provide a means for ascertaining service users’ wishes and choices. The Welcome Pack includes information that service users are expected to be involved in. This includes the upkeep of their room, their laundry and to contribute to the communal household tasks. It also gives general information in reasonably simple statements about the running of the service. Service users are also involved in staff recruitment. Short listed candidates are invited to the home prior to the final offer of appointment and service user reactions taken into account. St Edwards (6) Version 1.10 Page 17 The home has a policy of encouraging positive risk taking. Each activity undertaken is risk assessed. Service users’ files inspected included a range of risk assessments covering a range of identifiable risks, together with risk management strategies. These indicated that service users potential for developing independence is encouraged and enabled wherever possible, subject to safe strategies for managing risks being in place. Files contain service user details and photos. Service users are supported to use local shops independently and to undertake small monetary transactions. There is training with view to enabling individuals to access public transport and travel independently. All service users are given ID cards to carry with them when going to places they are not familiar with. Staff have mobile phones when supporting service users in the community. A Missing Persons Policy is in place. The home has a confidentiality policy in respect of personal information held in relation to service users. The policy states that service users have the right to access personal information held about them by the home. The NAS is a registered organization under the Data Protection Act. St Edwards (6) Version 1.10 Page 18 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) 11, 12, 13, 14 15 and 17 Service users are provided with opportunities for participating in a varied range of day care activities and for developing their interests and abilities. Service users are also assisted to develop daily living skills through guidance/support with participating in daily routines within the home. Service users are encouraged to access shopping, leisure and educational facilities in the local community, within a risk management framework. The home actively encourages service users to maintain family links and friendships, to visit relatives/friends, and to receive visitors. The home provides guidance and support in enabling service users to develop appropriate peer relationships. Service users are provided with a healthy and nutritious diet in pleasant and homely surroundings. Individuals are consulted and enabled to make an informed choice regarding the available menu options. Mealtimes are flexible and take account of service users’ activity schedules. St Edwards (6) Version 1.10 Page 19 EVIDENCE: St Edwards (6) Version 1.10 Page 20 Documentation such as the ‘Welcome Pack’ sets out the aims of the home, which include providing individuals with opportunities for development. The large majority of service users regularly attend the NAS day centres, one of which, ‘Transitions’, in Croydon, is primarily for those who have higher functioning Aspergers Syndrome and Autism. The other day centre, which a larger group of service users from the home attend, was visited by the inspector. The day centre, based in Coney Hall, provides a structured programme of activities which is tailored according to the needs of each service user. Activities include art, woodwork, drama, computer use, writing skills, and communication sessions. A sensory room is also available. Some staff from St Edward’s accompany and support service users to each of the two day centres where there are also trained day centre staff. While no service users were present when visiting Coney Hall, those service users spoken to at the home indicated that they derive considerable satisfaction from their day centre attendance and have been able to develop new skills and interests. The manager advised that activity programmes are reviewed at six-monthly intervals with both service users and relatives being consulted regarding any changes which they would like to see introduced or altered. Service users are assisted to develop daily living skills through participation in daily routines at the home. Close working relationships with the day service staff enables service users to benefit from continuity of care and behavioural management. There are Behavioural Management guidelines for individual residents, with staff having access to specialist advice from psychiatrists and psychologists. The philosophy of the home is a positive one, encouraging and assisting service users to realise their full potential and to participate as fully as possible in the wider community. Care Plans and Activity timetable boards inspected in the home, confirm that service users are offered choices regarding daily activities. All service users have a yearly holiday, which is taken in small groups, the cost of this being included in the basic contract price. The manager advised that service users are encouraged to access the local community. This includes visiting shops, recreational facilities, pubs and places of entertainment. This involves the use of public transport, with training for travel being provided. The service has three unmarked ‘people’ carriers. Also, as part of the day service programmes service users visit libraries, cinemas, restaurants and leisure centres. Several local shops display ‘Makaton’ signs. These enable service users to shop more independently. A wide and varied range of community based activities is available. These include canoeing, trampolining, horse riding, ten-pin bowling, cycling, pottery and swimming. Service users are able to attend Further Education classes at Sandown F.E College where subjects offered include English, mathematics, cookery, assertiveness and crafts. Some service users have been able to train St Edwards (6) Version 1.10 Page 21 for accredited qualifications while others have been able to gain work experience through taking part in employment projects. Many service users have extensive contact with relatives and visit them at weekends. Telephone contact is maintained with some relatives who live abroad. The relatives of one service user spoke very favourably of St Edwards, indicating that the home provides a very homely and welcoming environment, and enables relatives to be fully involved and to maintain close contact with service users. Relatives are able to visit at any reasonable time. The NAS has a corporate food policy. This states a commitment to healthy eating. A rotating menu, developed by the University of Sunderland, aims to ensure a nutritious and well balanced diet. The menu for the week includes pictures of the meal options for which service users take it in turn to make a choice for the main option each day. A random sample of menus indicates that a wide variety of different food options are available in the home. Where the published menu option is not desired on the day alternatives are provided as service users wish, and a detailed record is kept of the food actually provided. Mealtimes are relaxed and flexible to suit individual work and activity schedules. Service users spoken to by the inspector indicated that they like the food provided and that their individual tastes are catered for. St Edwards (6) Version 1.10 Page 22 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users’ personal support and health care needs are evidenced to be well met in this home, with support being planned and tailored according to the individual needs presented. There is a clear commitment by the manager and staff to enabling service users to develop their communication and living skills. Service users’ personal and health care needs are being appropriately monitored and addressed, with detailed records being maintained. The home has a clear policy and procedures in place for the receipt, recording, storage, handling, administration and disposal of medicines. Accredited medication training is provided for all staff who administer medication. EVIDENCE: Each service user is allocated a key worker whose responsibility it is to provide personal support. Several service users receive 1:1 support throughout the day. This allows a flexible person centred approach to service delivery. Staff were observed to be interacting in a positive and respectful way with service users, and to be generally helpful and supportive. Service users’ wishes and St Edwards (6) Version 1.10 Page 23 preferences in terms of daily routines, and support offered were recorded in service user plans and daily records, and explored in questionnaires. The inspector spoke to a few service users and to two care staff, and observed other service users with whom it was difficult to engage. The impression gained was that service users felt reassured by the support provided, and that their needs were being appropriately addressed. Staff on duty demonstrated a receptivity and awareness in responding to individual expressions of need and the range of behaviours presented by users. Guidelines are in place to assist staff, in their interaction with residents, with objects of reference for those who require help with knowing which activity is about to take place. The healthcare needs of service users are being well monitored with detailed health records being in place together with monitoring and referral procedures. Service users are registered with one of two GP practices. Records checked indicate that GP’s and other community based medical/health care professionals are contacted as and when required. These include dentists, opticians, audiologists, chiropodists, and specialist nurses. The manager advised that service users receive regular annual health checks from a GP. Potential complications and problems are identified and dealt with through prompt referrals to the appropriate health professional. Records of all medical/health appointment/visits are recorded. There is a medication policy and training for staff through a pharmacist from Boots. A pharmacist inspects the handling of medication regularly and the last visit prior to this inspection was on 11.2.05. Medication records were inspected and found to be in good order. No service users are responsible for the administration of their own medication. The home has a ‘Homely Remedies Policy’ GPs state in writing what Home Remedies each service users can have administered, this is reviewed on a regular basis and a record of what is administered to each service user is kept on their medication chart. The medication policy also states that medicines should be retained for 7 days following the death of a service user. St Edwards (6) Version 1.10 Page 24 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) 22 and 23 The home has an appropriate and well-publicised complaints policy and procedure in place. Clear information for raising complaints is made available in an appropriate format for service users. The complaints procedure gives contact details for the CSCI, but needs to make clear that a complainant can contact the CSCI at any time. The home’s adult protection policies, procedures and practice evidence that service users are being protected from abuse and are living in a safe environment. The home has a rolling programme of training to ensure that all staff undertake adult protection training. Six of the twenty-three staff have not yet had training, but there are dates scheduled to do so within the next two to three months. EVIDENCE: The home has a complaints procedure that has been given to all the homes service users and/or carers. The home’s complaints procedure is available in an appropriate language/format for each service user and/or their carer. This includes a version in Makaton. Information about the complaints procedure is also included in the statement of purpose. A simplified copy of the complaints procedure was on display in both homes, using large print and makaton symbols for the benefit of service users. Relatives’ feedback forms received prior to this inspection indicates that relatives know how to make a complaint if they wish to. St Edwards (6) Version 1.10 Page 25 There have been no complaints since the last announced inspection. A record of complaints made about the operation of the home is appropriately maintained. This includes details of any investigation, its outcome, and action taken. All complaints are responded to within twenty-eight days after the date on which the complaint was made. Reference to the 48 hour and 28 day timescales, within which complaints are acknowledged, investigated and responded to, must be included in the complaints procedure. Whilst contact details for the CSCI are detailed, reference to the right of the complainant to refer a complaint to the CSCI at any time must also be included. The inspector recommends that the home maintains a Concerns and Compliments Log in the reception area, so as to provide a channel for both criticism/concern and positive feedback from relatives and other visitors. As discussed with the manager this could provide a useful additional tool for helping to measure the home’s performance and for identifying any immediate concerns or positives. Since the last inspection there has been one adult protection concern. This involved a service user who had been inappropriately touched by another service user. The inspector discussed the incident and the actions taken, with the manager, and is satisfied that correct procedures were followed, with appropriate strategies having been put in place. Following an adult protection strategy meeting, a full health and safety risk assessment was undertaken and preventative measures put in place to protect the service user. These included monitoring contact between the two service users, adjusting the activity programmes of the two service users, and arranging for support from a psychologist. There has been no further concern. The home has an Adult Protection procedure, which is in line with Croydon’s multi-agency vulnerable adult procedures. The home also has an appropriate whistle blowing procedure. Physical and verbal aggression by a service user is understood and dealt with appropriately, in accordance with the homes physical intervention policy. All staff have undertaken restraint and breakaway techniques training in accordance with Department of Health guidelines. The manager advised that the home has a rolling programme to ensure all staff undertakes adult protection training. 17 of the 23 staff have attended this St Edwards (6) Version 1.10 Page 26 training. A requirement applies for the six staff who have yet to attend.Three one-day courses are scheduled, the next being due on 29.6.05. Following discussion with the inspector on the previous inspection, the manager has undertaken the three day adult protection course ‘training for trainers’ course and is now an accredited trainer with the LB Croydon. This will enable him to cascade Croydon’s adult protection training to other staff at the home. The home has a policy on precluding staff benefiting from service users wills. There are trustees for 10 of the 12 service users, with accounts being externally audited. Monthly balance sheets of service user’s accounts are maintained in the home, while receipts and other records are kept at the NAS regional office. The inspector did not examine service users’ accounts on this occasion. St Edwards (6) Version 1.10 Page 27 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, 25, 26, 27, 28, 29 and 30 Service users are live in an environment which is safe, well-maintained and adapted for people with disabilities. Service users have access to safe and comfortable facilities, including sufficient bathrooms and toilets. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting their personal identities, and being suited to their individual needs. The home has the necessary adaptations in place with which to safely meet the needs of the service users and maximise their independence. The home presents as being clean, pleasant and hygienic, with appropriate policies, procedures and training being in place. EVIDENCE: St Edwards (6) Version 1.10 Page 28 St. Edwards was purpose built for people with disabilities. The home is well laid out and meets the needs of the service users. The garden is well laid out and maintained. There is a ramp to the front door but no lift. In style it blends in well with the local community. The premises were inspected and found to be homely, comfortable and safe. Fittings, adaptations and equipment are of good quality, and domestic in scale. The home was decorated to a reasonably high standard throughout and presented as being comfortable, bright and warm. The manager confirmed that there is a planned programme of maintenance for the redecoration of the home. There is a requirement from the last inspection for an audit to be undertaken of all service users’ bedrooms, so as to ensure that all are in a good state of repair. The manager advised that the audit has been completed. This needs, however, to be evidenced with a copy being forwarded to the CSCI. There are 12 single rooms. Some doors have individualised symbols indicating whose room it is. The rooms are suited to the needs of the present service users, but are not suitable for people who use wheelchairs. The inspector viewed a number of service users’ rooms and found these to be pleasantly arranged and decorated, reflecting individuals’ personalities and tastes. Furnishings and fittings are adapted to meet the needs of individual residents. All rooms have washbasins. Some of these are not in use as residents are not able to use these appropriately. This is indicated in the individuals’ care plans as not being appropriate. Service users spoken to by the inspector indicated that they liked their rooms. There is consultation with service users regarding any redecoration of rooms that takes place. There are four toilets and two bathrooms in each house. One of the toilets is on the ground floor where there is also a shower. All afford privacy to users. The two houses share a pleasant, reasonable sized garden area with covered seating. Each house has a separate lounge and domestic style kitchen and dining room. These are homely, with comfortable furniture and pictures. There is a small room in each house, which can be used as a quiet room. The medication is also stored here as is the white board with information about shift plans. St Edwards (6) Version 1.10 Page 29 The home has the necessary adaptations in place with which to safely meet the needs of the present service users. Equipment such as bedroom furniture is adapted to meet specific needs. A ramp leads into the building. Objects of reference and photographs are used to communicate with service users. Photographs of staff who are on duty at a particular time are mounted on a wall where service users can see them. The houses have separate laundry areas, which are domestic in scale. The homes laundry facilities are suitably positioned to ensure that any soiled articles/foul laundry is never carried through areas where food is stored, prepared or eaten. The homes washing machine is capable of thoroughly cleaning foul laundry at appropriate temperatures (minimum of 65 Degrees Celsius). The homes policies/procedures manual contains various policies for the prevention and control of infection including dealing with spillages, HIV and Hepatitis B. The home presents as being clean and hygienic throughout. Appropriate training is in place. 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) 31, 32, 33 34, and 36 St Edwards (6) Version 1.10 Page 30 There is clarity of staff roles and responsibilities with service users receiving one-to-one support from their key workers. There is an effective staff team with sufficient numbers being on duty at all times. Service users have their needs well met by an appropriately trained and qualified staff group. Sufficient numbers of staff are on duty. All staff have appropriate induction, supervision and appraisal arrangements, and there is a comprehensive training programme in place. The home has appropriate recruitment policy and practices in place, which are generally providing the required level of protection for service users. However this could be undermined if the appropriate checks on staff are not undertaken in a timely fashion. Staff are being appropriately supported and supervised and appraised. EVIDENCE: The inspector examined a sample of staff files at the Regional Office. Contracts and job descriptions were in place together with a detailed induction programme. All staff are issued with the General Social Care Council’s code of conduct. There is clarity of staff roles and responsibilities, with clearly defined job descriptions having been developed. A key worker system is in place, with each key worker having a clear responsibility for developing a one-to-one relationship with an allocated service user, providing both a supportive and enabling role. Staff also work at the day service with service users. This is viewed by the provider as encouraging a consistent approach to programming and care. The home does not currently work with volunteers and/or students although the home has a policy and procedure in place to cover this. Staff files and training records indicate that staff at the home are appropriately qualified and trained. No concerns regarding the competency of staff were raised or identified, and this standard would appear to be well met. The staff rota indicated that the homes staffing levels comply with those agreed with the previous Registration Authority. Staff rotas confirmed that the home has 3 staff on duty in each house at all times during the day. This gives a staffing ratio of 2:1. In addition to this several service users receive 1:1 support at key times during the day. Each house has 1 waking night staff and a sleep in member of staff is shared between the two houses. The home’s manager is on-call during weekdays from Monday to Friday, and covers alternate weekends in tandem with the deputy manager. There is also an onSt Edwards (6) Version 1.10 Page 31 call Out of Hours Service provided within the organisation for providing cover for any emergencies that may arise. The manager advised that of twenty-three care staff, the four shift leaders and one full-time support worker are NVQ Level 3 qualified, with another holds an NVQ Level 2. One member of staff, the deputy manager, has qualified social worker status. The inspector was informed that all other care staff, apart from one, are registered to do their NVQ Level 3, with four or five expecting to complete this by October/November 2005. While the home is currently on track to meet the target of 50 of all care staff to have achieved a minimum of NVQ Level 2 by 2005, this will need to be verified at the next inspection. The inspector received positive feedback from both service users and relatives regarding the care and support provided by staff. Staff present during the inspection presented as skilled and responsive to the behaviours and needs presented by service users. There was evidence of sound practice and sensitivity in the quality of interactions which were observed to take place. The home has a comprehensive programme of induction and foundation training in place which complies with TOPPS requirements. The manager advised that all new staff undertake a six-week induction programme, followed by six-months of foundation training, when they commence employment. The induction programme starts with two weeks of training which includes ‘autism awareness’ and introduces staff to the aims and objectives of the service, policy and procedures. Weeks 3 to 5 are spent observing practice and procedures while week 6 is spent shadowing an experienced staff member. The home offers a 3-day induction programme for bank staff and specialist autism training is provided for all staff who work at the home. Staff records provide documentary evidence of qualifications obtained by staff. This includes statutory training in Basic food Hygiene, First Aid, health and safety, fire safety, medication, equality, diversity and rights, person centred planning and epilepsy training. All staff receive training on autism awareness, and on how to manage challenging behaviour. The home has in place a 6 week and 6 month foundation training, which uses TOPSS induction standards. The home offers a 3-day induction programme for bank staff. The staff rota indicated that the homes staffing levels comply with those agreed with the previous Registration Authority. During the day, in each house, there are 3 care staff on duty until 10pm, with two staff members being on duty from 8pm until 12oclock. At night there is one waking staff member for each house, with a sleeping staff member shared between the two houses. In addition, the home employs one full time domestic and two cooks. St Edwards (6) Version 1.10 Page 32 Service users with whom the inspector had contact responded favourably, indicating that their needs are being met, and that staff are caring and supportive towards them. One new staff member has been employed since the last inspection. The staff file included all the relevant documentation relating to identity, references and employment checks as detailed in Schedule 2. The CRB certificate was not, however, satisfactory. While fairly up-to-date, the certificate had been obtained from a previous employer. This was addressed with the manager and it was made clear that a new CRB is required for this and all future staff appointments, portability between employers no longer being permissible. The inspector confirmed that details of all CRB certificates must be recorded on a log sheet and that CRB certificates must be retained on staff files until these have been seen and signed off by the inspector. This clarification follows from a concern identified at the last inspection relating to the NAS’s policy of destroying CRB certificates after six months. The manager confirmed that all staff receive regular supervision at six to eight weekly intervals. Supervision of staff is provided by the registered manager to the deputy manager, and by the manager and deputy manager to the shift leaders. The shift leaders provide supervision for the care and support workers. The inspector examined some supervision records which confirmed that staff are being regularly supervised. The supervision format ‘Management support and Development record’ provides a structured format for recording practice, training and performance issues. Annual appraisals have now been undertaken (since March 2005), to review staff performance against job descriptions and agree career development plans. Staff receive copies of the company’s written grievance and disciplinary procedures as part of their induction pack, which are also available in the homes policies/procedures manual. St Edwards (6) Version 1.10 Page 33 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) 37, 38, 40 and 42 The home is well-run and managed in the best interests of the home’s service users. There was positive feedback from staff, service users and relatives regarding the open and inclusive management style and the friendly atmosphere in the home. Policies and procedures are in place and in good order and safeguard the interests of the service users. However this could be undermined if they are not reviewed on a regular basis. The health, safety and welfare of service users and staff are being appropriately promoted and protected. Safety checks and certification are in place. EVIDENCE: St Edwards (6) Version 1.10 Page 34 The manager presented as qualified, competent and experienced, and has been at St Edwards since its opening, having worked his way up to manager. He has attended a number of short courses to keep up to date with relevant issues and has access to the NAS in-service management training programme, which includes supervision, and Health and Safety at work training. The manager has now completed his NVQ Level 4 and is currently completing studies leading to the Registered Managers Award. From the inspectors observations and his contact with service users, relatives and staff, he found there to be a good and positive atmosphere within the home. The management approach is perceived as being open and inclusive, with staff feeling that they are well supported in their work roles. Staff and service users spoken to during the inspection indicated that they feel valued and involved in the running of the home, and that the management team are approachable and supportive. There are regular monthly staff and service user meetings and there is a support committee which involves relatives, friends and representatives of service users in the planning of services. A parents group also meets every 2 to 3 months, which is attended by staff representatives. A sample of policies and procedures were seen during the inspection. These were generally in good order and took account of the specific needs of the client group. All staff have access to the homes’ policies and procedures, which are brought to their attention during the induction period. The inspector noted that the home’s policies and procedures are overdue for review, not having been reviewed since March/April 2004. All policies and procedures must be reviewed at least annually for which a requirement applies. The inspector found that all health and safety checks have been completed and are up to date. PAT testing, gas, and electrics have all been undertaken by the home and certificated. A Legionella check is due in June 2005. A fire inspection (23/2/05) and fire awareness training for staff (23/2/05) were evidenced. The home has in place a rolling programme of training which includes manual handling, food hygiene, first aid and medication. There is also infection control training which is being extended to all staff. Hazardous substances are being appropriately stored. No health and safety concerns were identified and service users’ were evidenced as being well protected. SCORING OF OUTCOMES St Edwards (6) Version 1.10 Page 35 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x 3 x St Edwards (6) Version 1.10 Page 36 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 YA6 Regulation 15(2)(b) Requirement All care plan reviews must be evidenced on the service users’ files. Reference to the right of the complainant to refer a complaint to the CSCI at any time must be included in the complaints procedure. The home must meet the target of 50 of all care staff to have achieved a minimum of NVQ Level 2 by 2005. A new up-to-date CRB certificate must be obtained for a recently recruited staff member. All future staff appointments must have a new CRB certificate before employment commences. Portability of CRB certificates between employers is not permissible. 5. YA 40 12(1)(a) The registered manager must ensure that all policies and procedures are reviewed annually. 1.10.05 Timescale for action 1.07.05 2. YA22 22(7)(b) 1.09.05 3. YA32 18(1)(a) & (c) 1.12.05 4. YA 34 19(1)(b) (i), Sch.2, No 7 1.09.05 St Edwards (6) Version 1.10 Page 37 6. 23(2)(b) YA24 7. 13(6), 18(1)(a) & (c) YA23 The internal audit undertaken of all service users’ bedrooms must be evidenced, and a copy forwarded to the CSCI. The registered manager must ensure that all staff employed at the home receive adult protection training. 1.07.05 1.10.05 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 YA22 Good Practice Recommendations The inspector recommends that the home maintains a Concerns and Compliments Log in the reception area, so as to provide a channel for both criticism/concern and positive feedback from relatives and other visitors. St Edwards (6) Version 1.10 Page 38 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 St Edwards (6) Version 1.10 Page 39 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!