CARE HOME ADULTS 18-65
The Autistic Society 1 Mainwaring Terrace Northern Moor Manchester M23 0EW Lead Inspector
Steve O’Connor Unannounced Inspection 9 March 2006 1:45
th The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 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 Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 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 Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 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 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) National Autistic Society Ms Helen Slack Care Home 14 Category(ies) of Learning disability (14) registration, with number of places The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. All service users accommodated have a diagnosis of Autism/Asperser’s syndrome. 2nd August 2005 Date of last inspection 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 semidetached 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 porta-cabin 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 DS0000021603.V279243.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 9th March 2006. 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 and staff. In addition people’s files, records and other relevant documentation were examined and a tour of the home was made. At the previous inspection in August 2005 the home needed to carry out some changes to the medication administration system. There were still some issues with the system that required attention and this will be addressed in the report. The Commission for Social Care Inspection (CSCI) had not received any complaints about the service. 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. What the service does well:
Of the core standards that were assessed during this inspection, the home does the following 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 and routine to provide a stable and safe place to live. This can mean that to provide people with a safe environment, some restrictions of movement, choice and decision-making have to be put in place. This is only done after the home has completed a detailed risk assessment and consulted with the person and/or their representative. The home is also committed to providing people with opportunities to make choices, take up new opportunities and activities. The same risk assessment process is used to make sure that all potential hazards are looked at and support provided to minimise those hazards to allow people to participate in their local communities. Having a clean, homely and well-maintained place to live is important to everyone. It has a positive affect on the people who live there and the staff
The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 6 who work with them. The home provides a good environment that is comfortable and well decorated and suits peoples’ needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgement was made. EVIDENCE: The core standard was assessed at the previous inspection. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 The home has the systems and practice in place to allow people to make decisions in their lives and to take meaningful risks. EVIDENCE: The home has a clear and comprehensive risk assessment process that identifies situations, hazards and people’s behaviours that could cause them, or others, harm. This process begins at the pre-admission stage when a persons needs are fully assessed and continues through on-going assessment and review of the way people are supported to cope with stressful or new situations. Due to the needs of people within the autistic spectrum of disorders, the home does have to place certain restrictions of choice and control in some areas of their lives. This is only carried out to provide a person with clear boundaries and to create a safe environment in which people can still participate in valued activities. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 People were provided with a choice of healthy meals based on their own preferences. EVIDENCE: People’s nutritional needs would be identified through the assessment process and their personal likes and dislikes would influence the menu and meal choices. People were encouraged to be involved in shopping for and preparing meals where this was identified as an agreed goal for that person. Mealtime routines were based on the individual person’s needs and could be taken either communally or in private. The menu choices were based on a set menu that aimed to provide a healthy and balanced diet. Sufficient stores of food were maintained. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The home does not have all the systems and practices in place to ensure peoples’ safety. EVIDENCE: The previous inspection highlighted the need for the home to improve the recording of PRN administered medication. The recording was now clear and accurate, however, it was found that not all PRN medication had clear written administering guidance. It was also found that some signatures were missing from the MAR sheets. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgement was made. EVIDENCE: The core standards were assessed during the previous inspection. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People live in a homely and safe environment. However, not all the systems and training is in place to ensure peoples’ health and safety. EVIDENCE: The home consists of three adjacent houses. Each house is a normal residential domestic property set in a quiet cul-de-sac. All three houses were clean and well maintained and decorated. Each has both private and communal space that people use and suits their needs. Each house has a washing machine that is used for all laundry items. Staff have access to protective equipment and alcohol wash for when providing intimate personal care and handling soiled items. One house has particular needs around continence issues and an industrial washing machine is used and the home are considering using a private washing service. Although issues of general health and safety are covered in staff induction there is no specific infection control training. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 The home provides a vocational training programme that provides a qualified staff team. The recruitment policies, procedures and systems are in place to protect vulnerable people. EVIDENCE: The home has a programme of vocational training whereby staff are required to undertake the NVQ Level 3 in Care. This is above the minimum standards of NVQ 2. At the time of inspection, from a staff team of 40 people 6 have attained the NVQ 3 whilst 10 are awaiting their certificate of qualification. The home is part of the National Autistic Society (NAS) and follow the recruitment policy and procedures set down by the main organisation. All preemployment checks are made and staff do not start working at the home without a current Criminal Records Bureau disclosure certificate. The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 The management team have the skills and knowledge to run the home and the systems in place to maintain people’s welfare. EVIDENCE: At the time of the inspection the home had put forward a proposal, agreed by the CSCI, that the registered manager could spend up to two days a week at another NAS residential service for a period of three months. During this time the Acting Residential Manager would take on overall day-to-day responsibility for the home. To support them the area manager and the NAS Human Resource team could provide additional support and guidance if required. Each of the three houses also has a team manager with their own specific roles and responsibilities for the provision of support. The registered manager had achieved the Certificate in Management Studies and had completed the NVQ Level 4 in Care. She had attended regular update training to maintain her skills, knowledge and competence. The home had in place the fire monitoring checks and regular servicing of fire, gas and electric equipment.
The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 16 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 X 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 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X X X X 3 X The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? NO 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 YA20 Regulation 13 Requirement 1. The recording of administering medication on the MAR chart must be accurate at all times. 2. All medication prescribed as PRN must have clear and detailed administering guidance. All staff must participate in Infection Control training. Timescale for action 30/05/06 2 YA30 12 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Autistic Society DS0000021603.V279243.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection CSCI, Local office 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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