CARE HOME ADULTS 18-65
The Autistic Society 1 Mainwaring Terrace Northern Moor Manchester M23 0EW Lead Inspector
Steve OConnor Unannounced 2 August 2005
nd 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. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Autistic Society Address 1 Mainwaring Terrace Northern Moor Manchester M23 0EW 0161 945 0040 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) The National Autistic Society Ms Helen Slack Care home only (PC) 14 Category(ies) of Learning disability (LD) (14) registration, with number of places The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 All service users accommodated have a diagnosis of Autism/Asperger`s syndrome. Date of last inspection 23 November 2004 Brief Description of the Service: Mainwaring Terrace is a care home providing 24 hour care and accommodation operated by the National Autistic Society for 12 adults diagnosed within the autistic spectrum of disorders. The service comprises of three modern semi-detached houses located on a quiet residential housing estate. Each house has four single bedrooms, communal lounge, bathroom, kitchen and a dining area. There is a shared rear private garden that has a portacabin for service users to receive visitors in private and spend quiet time.The home is in keeping with other homes in the area. Local community facilities include shops, pubs, a post office and public transport. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 2nd August 2005. The care home supports people with a diagnosis within the autistic spectrum of disorders and associated learning disabilities. As a result being in a person’s immediate environment or talking to them could cause them stress and anxiety so it was agreed that only limited time be spent with those people who maybe affected. Some time was spent with two people who use the service, staff and the registered manager. In addition people’s files, records and other relevant documentation were examined. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. The Commission for Social Care Inspection (CSCI) had not received any complaints about the service. At the previous inspection in November 2004 the home needed to carry out some changes and improvements. This included working with the CSCI Pharmacist Inspector to improve the medication administration system. The home had made the changes and improvements asked for by the CSCI. What the service does well:
The home supports people with a diagnosis within the autistic spectrum of disorders. The impact and effect of a person’s autism is varied and can mean that a person needs a high level of support to provide a stable and safe place to live. As a result of this, the introduction of any new person coming to live at the home has to take into account the impact this may have and be carefully planned. The home does this well through the way they take referrals and assess a person’s needs before taking any decision to offer a place at the home. The home often knows the person referred through their contact with other National Autistic Society (NAS) services. This allows them to look closely at the issue of compatibility, which is a major factor in deciding whether a placement should take place. The home has a clear commitment to supporting people to become part of, and to keep their presence in the local community. A high level of staffing and transport options are available to support people, on their own and in small groups, to take part in a range of community social, leisure and educational activities. The types of activities offered to people are based on what the individual person wants to try and includes such things as attending local
The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 6 colleges, attending a local team’s football matches, visits to the snooker hall, cinemas, meals out, the local gym, going to music gigs and visiting local attractions. During the inspection people were getting ready to go out for a picnic and a trip out over to the coast. The home was commended for its commitment to supporting people in the community. The home is also committed to supporting people to maintain and increase their own personal independent living skills within the home. People were offered opportunities to try new activities and skills in a safe way and their responses to those activities showed the home how the person felt. This is designed to reduce and manage the stress some people experience when presented with change. It has already been mentioned that the home supports people who need a lot of support to provide the safe and stable atmosphere and routines needed to help them cope. At times people react to what is going on around them through behaviour that can seem noisy and a little frightening to those people who do not know them. The home is committed to trying to break down these barriers of misunderstanding and responded to a complaint from some local neighbours by asking the people who live in the home their permission to invite some of the neighbours into the home to meet them. This has resulted in the neighbours being asked to come to tea and spent some time together. What has improved since the last inspection?
Supporting people to take the medication they need to maintain their health and wellbeing is essential. At the last CSCI Pharmacist Inspector worked with the home to help them review the medication administration system to make sure that it was safe. The home had provided the CSCI with an action plan detailing how they were going to make the improvements and at the inspection it was found that the changes had all been made. The home had been chosen by the NAS to take part in a project that would change the way that the home worked with people, their families and other professions. The plan was to introduce a way of working called ‘Person Centred Planning’ (PCP). This would mean that all aspects of the home’s practices, from assessments, risk assessments, care planning, reviewing and monitoring the quality of the service provided would start from the experience of the people using the service and how it affects them. This should mean that people will be fully involved in how they are supported and what they want to achieve. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home’s referral process and own in-house assessment clearly identifies people’s individual needs prior to admission. EVIDENCE: The home’s referral process requires that the purchasing authority provide a multi-disciplinary assessment of people’s needs prior to the home deciding whether it can offer a placement. In addition the home undertakes its own inhouse pre-admission assessment. This assessment process continues in the initial stages of a persons’ stay to reflect how they are coping with their new environment. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 10 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 People’s personal goals and needs are reflected in their care plan and these goals were reviewed to reflect their changing needs. EVIDENCE: From the assessment information the home develops an individual care plan for people based on their goals and needs. The care plans set out the support the home provides to support people to achieve those goals. The care plans goals were often identified as tasks or actions and it was recommended that the home take the opportunity, during the review process, to clearly identify the goals, rather than the activities, that people wish to achieve and that these goals and activities were clearly identified and the outcomes evaluated through the Individual Plan (IP) review process. Care plans are reviewed by the home according to the complexity of the care package and people’s individual needs. This can mean a care plan is reviewed on a weekly, monthly or quarterly basis. In addition each person has an annual Care Management review by the purchasing authority. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 11 The home was part of a pilot project to introduce a new person centred planning ethos into the assessment, care planning and support they provide. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 and 16 The home provides the support and resources to allow people to fully access appropriate community social, leisure and educational activities. They support people to maintain family relationships and provide the structured routines people require in their daily lives. EVIDENCE: The home provides the staffing and resources to support people to access a wide range of appropriate and meaningful social, leisure and educational community based activities. Each person has an individually tailored programme of events based on their assessed needs and goals. The scope and level of support provided by the home to ensure people’s presence in the community was commended. People were encouraged and supported to maintain close links with their families. Family members were encouraged to take an active part in people’s lives and their input was welcomed by the home. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 13 The home’s routines were based totally around people’s needs for stability and consistency. Any restrictions of choice or movement were based on agreed risk assessments to keep people safe. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 14 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 The home provides the support and systems required to meet people’s personal and healthcare needs. The home’s medication administration systems do not fully ensure that the recording of administering medication fully protects people. EVIDENCE: The home has continued to show that it has identified people’s personal and healthcare needs and goals and provided the support required. In addition they have worked alongside and received input from specialist healthcare agencies when needed. People continued to access community healthcare services to maintain their health and wellbeing. The home has taken the advice of the CSCI Pharmacist Inspector to review and update its medication administration systems. A new medication policy has been developed and actions taken to address the issues identified by the Pharmacist Inspector. These actions met the requirement from the previous inspection. The home must ensure that the recording of medication administered ‘as required’ (PRN) is consistent across the three houses. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has the policies, procedures and systems in place to enable people to raise their concerns and to be protected. EVIDENCE: The home had received one complaint since the last inspection that has been addressed. The complaints log recorded the nature of any complaint or concern and the outcome. However, the log did not include the date that the complaints had been resolved. The home’s complaint procedure included appropriate time scales for responding to complaints. The home’s Adult Protection Policy had been updated to address the requirement raised during the previous inspection. The home continued to meet the required standards of awareness, policy, procedures and training. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 16 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) EVIDENCE: These standards were not assessed during this inspection. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 17 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) 33 and 35 The home provides staff with the required training to be able to meet people’s needs. EVIDENCE: The home had actioned the previous requirement relating to the staff rotas. The home continued to show that it provides the training that staff need to support people. Training plans and records were maintained and staff spoken to described the training that they had attended. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 18 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) 39 The home actively seeks the views of people, their representatives and others in monitoring the quality of the service it provides. EVIDENCE: The home used a variety of systems to gather people’s views of the service they receive and to monitor the quality of support they provide. This includes the use of monthly Regulation 26 inspections, residents’ meetings, feedback and input from external agencies. In addition the home is taking part in a pilot project to introduce a NAS quality assurance system based on person centred planning. These actions met the requirement raised at the previous inspection. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 4 4 x 3 3 x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Autistic Society Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x x x F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 20 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 20 Regulation 13 Requirement The recording of medication administered ‘as required’ (PRN) must be consistent at all times. Timescale for action 30th August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations It is recommended that the home take the opportunity, during the review process, to clearly identify the goals, rather than the activities, that people wish to achieve and that these goals and activities were clearly identified and the outcomes evaluated through the Individual Plan (IP) review process. The Autistic Society F55 F05 s21603 Autistic Society V242359 D020805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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