Inspection on 20/06/07 for The Alton Centre

This inspection was carried out on 20th June 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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Alton Centre 04/11/08

The Alton Centre 08/10/08

The Alton Centre 08/10/07

The Alton Centre 07/06/06

The Alton Centre 12/12/05

The Alton Centre 05/05/05

The Alton Centre 16/11/04

The Alton Centre 14/07/04

The Alton Centre 25/05/04

The Alton Centre 13/02/04

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

CARE HOME ADULTS 18-65 The Alton Centre Irchester Road Knuston Spinney Wellingborough Northants NN29 7EY Lead Inspector Sarah Jenkins Unannounced Inspection 20th June 2007 07:50a The Alton Centre DS0000055888.V339520.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 The Alton Centre DS0000055888.V339520.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. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Alton Centre Address Irchester Road Knuston Spinney Wellingborough Northants NN29 7EY 01933 413646 01933 413664 altoncentre@activecarepartnerships.co.uk Not available Active Care Partnerships Ltd 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) Vacant Care Home 55 Category(ies) of Learning disability (24), Physical disability (31) registration, with number of places The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Care Home with nursing A total of 31 residents in the category of PD (Physical Disability) between the ages of 18 and 65 years may be accommodated in the home. Four named residents in the category of PD over the age of 65 years may be accommodated in the home. A total of 31 residents in the category of PD (Physically Disabled) A total of 24 residents in the category of LD (Learning Disability) between the ages of 18 and 65 years requiring personal care only may be accommodated ed in the home. No more residents in the category of PD may be admitted to the home when there are already 31 residents in this category accommodated. No more residents may be admitted to the home when 24 residents in the category of LD (Learning Disabilities) are already accommodated in the home. 7th June 2006 6. 7. Date of last inspection Brief Description of the Service: The home provides care for 31 physically disabled adults and 24 residents with learning difficulties between the ages of 18 and 65 years. The home is situated in a small village, close to two local towns and their amenities. Transport is provided in the form of two mini-busses. Accommodation for the client group with Physical Disabilities is mainly provided over three floors and is in single rooms with ensuite facilities. Six residents have their own self- contained bungalows in the grounds but attend the main house for meals and activities. Adaptations such as ceiling hoists and mobility aids are provided according to assessed needs. This part of the home is known as The Alton centre. Residents with Learning difficulties are accommodated in a separate unit with separate staff and management. They also have single rooms and ensuite facilities. The Unit is known as Thorpe Life Skills Centre. Fees range from £564 to £3034 per week according to residents assessed level The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 5 of care need. Additional charges are made for hairdressing, chiropody, toiletries, newspapers and extra activities. This information was provided by the home in April 2007. Statements of Purpose and Service Users Guide for each of the two areas are available from the Acting Managers at the home. Inspection reports are available from the home or from the Commission for Social Care Inspection website. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting 3 service users and tracking the care they receive through meeting with the service users, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited Thorpe Life Skills Centre during the morning (6.5 hours) to observe practices by staff and to meet with service users. Service users have Learning Disabilities and in some cases autistic spectrum disorders or other diagnoses and thereby communication for some is difficult. Establishing Service Users choices and informed decisions is dependant to some extent upon the consistency of staff, service users relationships with staff, and the quality of communication. Feedback obtained from Service Users in this report was in part through observations of their relationships with staff, and also through interpretations of their general levels of happiness with their routines. The Inspector spent a further 3 hours in the Alton Centre where one service user was case tracked and the inspector sample checked the other aspects of care through discussion with staff and a sample check of some records. There were no indicators from this process of any serious problems in provision on this side of the home. Staff at Alton Centre (Main House), expressed disappointment to the Inspector that the hard work they had undertaken since the last inspection and the improvements that they felt had been made could not be fully verified through the inspection process due to the impact of the time restraints. The issues identified at Thorpe Life Skills Centre restricted the time the Inspector was able to spend in the Alton Centre (Main House). The inspector has recommended to the Responsible Individual that the registration of the home/s be reconsidered as the Registered Home is currently functioning as two separate homes. The inspection process included a review of the history of the home since the last inspection, analysis of the two pre-inspection questionnaires returned by the Acting Managers in each area, and analysing and summarizing the content of a number of feedback forms from service users and relatives. The inspector also spoke to a sample of relatives on the telephone, and had a telephone discussion with the Acting Manager for Thorpe Life Skills Centre, after the site visit, as she was not on duty on the day of the inspection. Feedback from the visit was given to the Responsible Individual for the organization on the day of the site visit. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 7 The Responsible Individual telephoned the Inspector within 24 hours of the inspection to update her on the immediate and urgent action that had been taken at the home to safeguard the medication administration at Thorpe Life Skills Centre and to establish a means of addressing and resolving the other issues identified there and detailed on this report. The inspector viewed the action he reported to have been taken as being effective and appropriate. What the service does well: What has improved since the last inspection? What they could do better: Thorpe Life Skills Centre is not functioning effectively to provide the positive outcomes for service users that it should, or to fulfil the Statement of Purpose. There appears to be a lack of clarity about the function of the unit and what is intended that it should provide, and a lack of leadership in terms of its direction and future. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 8 The overall management of the unit is of limited effectiveness, and this has led to unfulfilled contracts, and some unacceptable risk factors and poor outcomes for service users (as detailed in the main report). Thorpe Life Skills Centre is not properly protecting vulnerable service users, and this outcome area is judged to be poor. Service users needs are not being consistently met and the unit is failing to provide the structure and routine that has been assessed as being required for the service users with Autistic Spectrum Disorders. 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. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 9 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 The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are properly assessed prior to admission, which should lead to appropriate placement, and good outcomes. EVIDENCE: The Inspector reviewed records and discussed with staff the process for the admission of new service users, and found that detailed information of needs was collected and transferred onto an initial care plan prior to service users admission to the home. The process for admission was flexible according to service users needs and wishes, and service users and their relatives appear to have been well supported through the period through introductory visits, meetings and other communication. The Alton Centre DS0000055888.V339520.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the Thorpe Life Skills Centre, programmes of activity need to be fuller, and care plans more detailed in order to ensure the necessary level of input and consistency of care from staff, and to thereby achieve give good outcomes for service users. EVIDENCE: Care plans are available in both parts of the home and meet general standards. There is a lack of the necessary detail of information in Care plans for service users at Thorpe Life Skills Centre leaving them vulnerable to inconsistencies in staff practices. The necessary structure and cycle of activity and relaxation, needed to give security to service users with Autistic Spectrum Disorders is lacking. Service users changing needs are not always responded to sufficiently promptly. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 12 Care plans in the Alton Centre (Main House) were sufficiently full and detailed to provide good care/nursing care. Service users in the Alton Centre expressed satisfaction with the delivery of care although there was a lack of evidence that they, or their advocates had been fully involved in drawing up the care plan. Service users at Alton Centre (Main House) generally feel properly involved in decision making about their lives, including the right to take reasonable risks, and there was evidence from discussions with these service users, that staff properly consider service users rights and wishes in this respect. Observations and records at Thorpe Life Skills Centre showed that staff were willing and anxious to safeguard service users rights and establish their wishes, but that sometimes the balance of the relationship between service users rights and independence, and the duty of care and protection, is an uneasy one. Advice was given to the Acting Manager at Thorpe Life Skills Centre of the need to undertake and evidence proper procedures and where needed multidisciplinary reviews in relation to any restriction of service users rights, in line with good practice and the coming implementation of the Mental Capacity Act. This advice was given in relation to an alarm that had been installed on a service users bedroom door to alert staff to movement. It was the Inspector’s understanding from staff there was an intention to implement this system on all bedroom doors. The Acting Manager assured the Inspector that this issue was under review, and that no such alarms were currently functional. A staff member also expressed some anxiety that the balance of protecting service users rights against the necessary restrictions to safeguard them at Thorpe Life Skills Centre was not always right, and that unnecessary risk to service users may be caused. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 13 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): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lifestyles are fully satisfying for some, but outcomes for others are not so good. The needs of Service users in Thorpe Life Skills Centre for routine and structure in their lives are not always sufficiently met. EVIDENCE: There is evidence at the Alton Centre (Main House) that most service users are satisfied with their activities and the activities programme and records show that many service users enjoy a variety of satisfying activities. Service users who were able to speak with the inspector in this part of the home expressed full satisfaction with their lifestyles and said they enjoyed their access and involvement in the local community. Two feedback cards indicated service users wish to be able to go out more often. Leisure activities, outings and work placements at Thorpe Life Skills Centre are also evident, but service users have different needs. Their need for structure The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 14 and routine, and full programmes of routines were not available and had not been implemented sufficiently to give satisfactory outcomes. Records and discussions with staff advocating on behalf of service users at Thorpe Life Skills Centre confirmed this. Admission details for some service users showed their need for the TEACCH programme (Treatment and Education of Autistic and Related Communication Handicapped Children) to be continued at the home. However not all staff had received the relevant training and TEACCH had not been sufficiently implemented to provide good outcomes. Service users are encouraged to retain contact with friends and relatives, and staff at the home understood that good relationships producing positive outcomes for service users were important, and did their best to support positive contact. The home has implemented staff training in the area of relationships and sexuality in order that service users may be properly supported to make informed choices and maintain appropriate relationships. Service users and staff spoke positively about food provision and there was evidence of service users being enabled to make choices, have alternatives and enjoy general flexibility in relation to food provision. A service user in The Alton Centre side of the home spoke in particular of the helpfulness of one of the chefs at the home in meeting individual needs. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Outcomes for service users are generally good however the management of medication in Thorpe Life Skills Centre is failing and potentially putting service users at risk. EVIDENCE: Heath care in both areas appeared to meet the Standard although this was difficult for the Inspector to verify in Thorpe Life Skills Centre due to inconsistencies in records quality and continuity. However staff advocating on behalf of service users they worked with, told the Inspector that there were no shortfalls in general health and personal care delivery. Medication was not reviewed at the Alton Centre (Main House), but was found to be poorly managed at Thorpe Life Skills Centre. Problems at Thorpe Life Skills Centre included service users not receiving prescribed medication; a The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 16 failure by staff to advocate on behalf of a service user by failing to pursue the prompt dispensing of necessary medication; poor recording and a failure by staff to follow the homes procedures. These shortfalls are judged to be putting the welfare of service users at risk and the cause of the failure must be addressed. The Responsible Individual confirmed within 24 hours of the inspection that appropriate action had been taken to safeguard good practice and that follow up work with staff, (supervision and training) was being undertaken. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The welfare of the service users in Thorpe Life Skills Centre is not being adequately protected to the Standard expected. EVIDENCE: Some staff have not yet received the necessary safeguarding (Protection of Vulnerable Adults) training to ensure that they fully understand their roles and responsibilities in respect of vulnerable service users. There was evidence that an issue has arisen at the Thorpe Life Skills Centre and that although the action taken in response to this incident has been appropriate and has addressed the issue, the incident may have been avoided by a more proactive approach. Privacy issues prevent the disclosure on this report of more detail. The inspector is satisfied that the necessary staff training is now to be prioritized. There was evidence at Thorpe Life Skills Centre that contracted one to one care for a service user had not been provided on at least one occasion since the last inspection. The Inspector was assured that this matter had been rectified and that all one to one contracts were now being fully met and that records demonstrated this. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 18 Thorpe Life Skills Centre has received 4 complaints since the last inspection and the Commission for Social Care Inspection has received one. Complaints were properly investigated by the home following the correct procedures within timescales. Aspects of the complaints that were founded include concerns about structure in supporting service users and one to one cover. The anonymous complaint received by Commission for Social Care Inspection related to the care and protection of service users and was recently passed back for investigation by the home. The findings of this report confirm that some degree of concern about care and protection was justified. At Thorpe Life Skills Centre an emergency situation may arise in relation to the need to accompany a service user to their room safely; the process is described and detailed as part of the care plan. The Acting Manager has been asked to forward the full details of the process by which this procedure was agreed, implemented and how the appropriateness is reviewed, as it amounts to restraint. There are insufficient staff trained in the procedure, which requires two trained staff on duty at all times, in order for it to be implemented safely. The Inspector considers this failure to have sufficient staff on duty who are properly trained to deal with this situation to be a failure to properly protect the service user and those around them. The lack of prompt implementation of professional advice relating to a service users routine, and including a change in medication potentially put a service user at Thorpe Life Skills Centre, at risk. There was a lack of confidence expressed by two relatives in relation to their confidence to raise concerns. Where concerns had been formally raised, the response by the home was appropriate, but it was worrying that relatives did not always feel that they were being listened to. This lack of confidence needs to be addressed by the management of the home. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is pleasant and spacious and conducive to service users being able to enjoy a good lifestyle within the home. EVIDENCE: Both areas of the home (Alton Centre (Main House) and Thorpe Life Skills Centre) were sample checked and found to meet Standards. Service users expressed or showed general content with the environment. Redecoration and refurbishment work were in process at the time of the inspection at the Alton Centre (Main House). There has been considerable recent damage to a bedroom and the bathroom area at Thorpe Life Skills Centre, and neither was therefore available for use at the time of the inspection. The service user concerned had been moved into The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 20 another room, which was seen and found to be comfortable, whilst repairs were in process. The Inspector was assured that service users were happy to use their ensuite facilities whilst repair was being undertaken. The garden area is now available for service users use and they were seen to be enjoying it at the time of the inspection. The home was clean and tidy throughout at the time of the inspection. The Inspector met with the staff member responsible for maintenance at Thorpe Life Skills Centre and judged that repairs required were generally addressed promptly. Advice was given that staff may not be adequately trained in Health and Safety as it was noted that a door guard that was poorly fitted presenting a potential hazard, had not been reported or apparently noticed by staff. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 21 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): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall staffing on the day of the inspection was sufficient to meet service users needs. Outcomes for service users in Thorpe Life Skills Centre were potentially compromised by lack of adequate training. EVIDENCE: Staffing at Alton Centre (Main House) appeared to be sufficient for the needs of service users at the time that the Inspector undertook sampling of the general Quality of life in that part of the home. At the time of the inspector’s arrival at Thorpe Life Skills Centre there were only three service users there, as the other three service users who are currently resident were out. There were three and later more staff on duty in this area and this therefore was the equivalent of more than one to one staffing. However the training of the staff team on duty was not sufficient to safeguard service users (see under complaints and protection). There was no first aider in this part of the home and there may have been some delay in the attendance of a first aider from the Alton Centre (Main House). The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 22 Although the rota showed shift leaders and individual shift leaders were showing some leadership skills, there appeared to be an overall lack of effective leadership in relation to staff generally in Thorpe Life Skills Centre. Staff there, reported that they didn’t always feel confident in what they were doing, or sometimes felt unclear as to their specific roles in relation to working with service users. Some did not always feel as though they were sufficiently debriefed after incidents with service users. Recruitment processes were discussed with staff who had recently started working at the home and the process described was thorough and professional. Staff felt well supported by the process. Records confirmed that recruitment processes were well documented. The inspector observed that a recently recruited staff member was undertaking duties with high responsibility such as extracting relevant information from assessment details for new service users, and writing out the initial care plans. The senior on duty assured the inspector that staff were well supported in this activity by senior staff. It was not possible to undertake a full check on the quality of initial care plans on service users files and whether they included all relevant information, due to the fact that much of the paperwork was not dated or signed. Discussion with service users and general feedback showed that staff are seen to be caring and attentive, service users felt they were “kind” “good” “have good training” “mostly very understanding” and that there were generally adequate staff on duty. Previous issues relating to the language and communication skills of some staff were thought to have been resolved after the issue was discussed with the management of the home. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 23 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): 37,43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been no Registered Manager at the home since the last inspection and therefore overarching management, the responsibility of the Registered Owner, should have been stringent. Some management duties and responsibilities have been undertaken effectively and well, but some shortfalls have led to poor outcomes for service users in Thorpe Life Skills Centre. EVIDENCE: As details on outcomes for service users are reflected throughout the report and there is no Registered Manager, the judgement on the management of the home is based on the overarching management of the home by the organization. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 24 There is a previous requirement on the last inspection report on the need for the home to submit an application for a Registered Manager by July 1st 2007. It was evident at the time of the inspection that the organization were trying to meet this timescale. Given the aspects of registration discussed at this inspection with the Responsible Individual the timescale has been extended to allow consideration to be given to the registration of two separate units, with two Registered Managers. However Management issues as detailed on this report must be addressed (Staff training, Welfare and Protection of service users, and day to day management). The overall judgement on management as adequate reflects the fact that the home has evidence of some good processes in place and the main failings were found to be at Thorpe Life Skills Centre. The Acting Manager at Thorpe Life Skills Centre indicated that prior to the inspection she had raised some of her concerns verbally, with line management. The Responsible Individual has been informed of the findings of this inspection and has responded appropriately with immediate action. The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 2 x LIFESTYLES Standard No Score 11 x 12 1 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 x N/A x x x x x 2 The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 YA12 Regulation 15, 12 Requirement Service users assessed and changing needs, and the way in which staff should meet them must be detailed in care plans to ensure that service users needs are being fulfilled, and that staff are delivering appropriate care consistently. When professional advice is received from healthcare services it must be implemented promptly, to ensure service users needs are properly and promptly met. A full audit and review of the medication system must be undertaken and necessary improvements implemented to ensure proper procedures are in place, and followed by staff, to serve and protect service users. Service users must be properly protected at all times through the maintenance of a staff team on duty who are fully trained to meet all their identified needs. The overall management of the home must be secure to ensure shortfalls in management are picked up promptly in Regulation DS0000055888.V339520.R01.S.doc Timescale for action 01/08/07 2 YA19 YA20 12 13 01/08/07 3 YA20 13 14/07/07 4 YA23 YA35 13 18 24,26 01/08/07 5 YA43 01/08/07 The Alton Centre Version 5.2 Page 27 26 visits, especially when there is no Registered Manager 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 YA9 Good Practice Recommendations Risk taking in relation to service users at Thorpe Life Skills Centre needs to be properly balanced in respect of service users rights and the need to ensure that the duty of care is met. Further thought should be given to this balance. The TEACCH system (Treatment and Education of Autistic and Related Communication Handicapped Children) should be fully implemented as soon as possible for those service users whom it will benefit. There needs to be better support and leadership of staff in Thorpe Life Skills Centre to promote good outcomes for service users. Registered Manager/s should be appointed as soon as possible subject to the registration decisions to be made about the future of the two units. 2 YA12 3 4 YA32 YA37 The Alton Centre DS0000055888.V339520.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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