Inspection on 10/05/07 for The Court

This inspection was carried out on 10th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Court 16/12/08

The Court 07/02/06

The Court 18/07/05

The Court 20/01/05

The Court 13/07/04

The Court 03/02/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 The Court 22 Thornholme Road Sunderland SR2 7QG Lead Inspector Miss Andrea Goodall Unannounced Inspection 10th May 2007 10:00 The Court DS0000015782.V334708.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 Court DS0000015782.V334708.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 Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Court Address 22 Thornholme Road Sunderland SR2 7QG 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) 0191 5675264 Tyne and Wear Autistic Society Ms Christine Graham Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: The Court is a care home for 3 younger adults with Autistic Spectrum Disorder. It is owned and managed by the Tyne & Wear Autistic Society (TWAS), which operates several care and educational services for children and adults in Sunderland. The Court is a family-sized detached property in a quiet area near the City centre of Sunderland. It is indistinguishable from similar surrounding family houses, including the neighbouring 2 houses which are also small care homes operated by TWAS and managed by the same registered manager. The house has a short driveway and a car porch for the home vehicle. There is a small front garden and an enclosed, private back garden. The house has an open hallway, off which there are a comfortable main lounge, dining room and well-equipped kitchen. There is another smaller lounge leading off from the kitchen. On the first floor there are 3 generously-sized bedrooms, a bathroom, toilet, and the small staff sleep-in room. The quality of furnishings and decoration are of a very good standard throughout the house. The house does not offer accommodation for people with mobility needs, though arrangements can be made for visitors with such needs to access the ground floor. The weekly fee is £1,340 - £1,477. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit took place over one day and evening. The home was only told about the visit a couple of days before, and this was to make sure that the people who live here were going to be at home. A couple of months before the inspection the manager sent back some information about the home. The three people who live here filled in picture comment cards about their home with help from staff. Three relatives also sent in comment cards. During the visit the inspector talked with the manager about staff, records, and how the home supports the people who live here. Most parts of the house were looked at, and some people showed the inspector their bedroom. The people who live here have Autism Spectrum Disorder. This makes it very hard for them to say what they think of the service they get at this home. The inspector spent time talking with residents and staff, and joined them for an evening meal. There have been no complaints or concerns about the home since the last inspection. What the service does well: There is some information about the home in pictures and photographs to help the residents. Staff keep good records about how residents are learning to do things for themselves, such as cooking and looking after their own money. People here go out to lots of different activities that they choose. Staff help residents to join in chats about what they would like to do. Residents and staff spend lots of time talking to each other. Staff know how to help resident to learn to do things for themselves. One person said, “I am very happy.” One relative also said, “The staff at The Court have managed to make this a ‘real home’ for the adults in their care. It is always a joy to visit.” There are good choices of meals. People are helped to shop for and make the meals that they like. All of the house is nicely decorated. People said that they “like” their bedrooms and said that they can choose their own colours for their room. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 6 One resident said, “I like the staff”. The staff have lots of training to make sure that they know how to help people in the right way. The manager has lots of experience and the home is very well-run. 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 summary of this inspection report can be made available in other formats on request. The Court DS0000015782.V334708.R01.S.doc Version 5.2 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 Court DS0000015782.V334708.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides clear information so prospective residents can make an informed choice about whether to move here. Comprehensive assessment procedures ensure that only those residents whose needs can be met are offered a placement at The Court. EVIDENCE: The Service Users Guide includes a brief brochure that is written in plain English, which gives specific information about the house, the service, and the activities. It includes photographs of residents taking part in the daily domestic tasks and relaxing in the house. In this way any prospective new residents have clear information about the house before they visit to see if it would suit them. Since the last inspection one resident has moved to another TWAS home, and a new resident has come to live at The Court. TWAS has clear written guidelines about referrals and assessments. Before they move here, the needs of a prospective resident are assessed by social and The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 9 health care professionals. The prospective resident, their relatives and TWAS staff are also fully included in making a decision about whether the home could meet people’s needs. Two of the young people have lived here since it opened a few years ago. The new resident previously lived in a specialist service for people with autism in America. TWAS managers visited her in that placement and received in-depth transitional information about her needs in order to support her potential move to The Court. People who are new to TWAS services have at least a one-week trial stay at a TWAS home as part of the assessment process. From the one week assessment, the transitional information and the input of care managers, it was determined that the new resident’s needs could be met at The Court. A review of her placement will be carried out in the near future. The Court DS0000015782.V334708.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear care planning means that residents are supported towards achieving their goals. People are supported so that they can make their own decisions, and take acceptable risks as part of an independent lifestyle. EVIDENCE: There are individual care plans for each of the young people living here. These include comprehensive details of each person’s abilities and strengths, as well as their background, cultural/religious beliefs, and a baseline assessment of their support needs. From the assessments, the care plans set out a small number of specific independent living goals (smart targets) for each person in 3 main areas of their lives - domestic, leisure and self- development. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 11 The plans include detailed instruction to staff about the level of support each person needs with their goals. There are clear daily records about each residents progress and how staff can further support them towards independent living. Residents are often present when staff are completing their care plan records. Due to their Autism most people find it difficult to understand the care plans, but there is a dated record to show when the care plan was verbally explained to each resident and whether the resident can understand their care plan or not. Staff stated that the care plans do not contain symbols or pictures as residents do not understand the wider concept of the care planning process. However staff do use picture schedules with one resident to show the sequence of what they will do at different times so that they can make sense of the pattern of their day. The manager also discussed the use of Speech and Language Therapists input to help find innovative way of using pictures to support the communication needs of one resident. The people who live here use either speech, gestures or pictures to communicate their likes and dislikes. They are encouraged and enabled to make their own choices and decisions, such as their appearance, menus, leisure activities, and holiday destination. For example, one person chooses not to go with other residents to the weekly disco. Also during the evening meal residents talked about their preferences for holiday destinations and where they choose to go this year. The home has a Participation of Service Users policy that supports residents’ rights to be involved and included in making decisions about the home. Residents have a meeting about every month where they are encouraged to make suggestions and reach group decisions about the house. The people who live here are supported to take acceptable risks as part of an independent lifestyle. There are risk assessment records in place about activities that people carry out that might incur an element of risk, such as using a locked bathroom, and preparing food in the kitchen. Where unacceptable risks are identified the home has put protective measures in place to minimise any risk. For example, using a sensory pad in one person’s room to detect possible epileptic seizures during the night. In this way staff are clear about the support that people need to minimise any risk to them. It is good practice that these records have been sent to parents and the relevant Social Workers, and are reviewed at least annually. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 12 Recently all TWAS small homes have been fitted with a new door security system, which is linked into the homes’ fire alarm systems. This allows the main entrance doors to be locked at all times for security, but the lock releases in the event of the fire alarm system being activated. In this way resident and staff can exit the house in the event of a fire without having to first unlock a door. However this system also means that people cannot access or exit their house without a fob (electronic swipe key). At the time of this visit none of the people who live here had their own fob, and there were no individual risk assessments in place about this restriction. The Court DS0000015782.V334708.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 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can choose from a good range of suitable activities so that they have fulfilling, purposeful occupations. Residents have good support keep in contact with family members and enjoy community facilities so that they have opportunities to meet others at social and leisure events. Residents have clear information so they understand their rights and responsibilities. Residents enjoy nutritious, healthy meals so their choices and dietary needs are met. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 14 EVIDENCE: All the residents attend day services provided by Tyne & Wear Autistic Society. These include vocational courses at the nearby Thornbeck College, such as IT, arts & crafts, and performance arts. Residents also have opportunities to gain practical skills at the TWAS Workshop where they make garden furniture, greetings cards and jewellery, which is sold in the TWAS shop (on a not-for-profit basis). This provides residents with tangible, purposeful outcomes to their daytime occupations. All the residents have their own pictorial copy of their weekly schedule so that they can refer to it at any time. One person wrote in their comment card, “I like The Court. I am very happy.” The home is a family residence and is indistinguishable from other similar properties in the area. It is a short distance from the city centre so residents have a good range of shops and leisure resources nearby. The people who live here make good use of local facilities in the community including shops, sports centres, pubs and cinema. In this way residents are included in the local community. Residents choose from a wide range of leisure activities that they enjoy in the evenings and at week-ends. These include ice-skating, saunas, sensory rooms, cycling and discos. Although people with autism often find it difficult to form social relationships, one person has made friends at a weekly disco. In this way residents do have opportunities to meet other people outside the TWAS services. Residents are supported to keep in contact with their relatives by telephone, and some residents have short breaks with their families. Three relatives sent comment cards to the CSCI indicating that they were satisfied with the service provided at The Court. One relative also wrote, “The staff at The Court have managed to make this a ‘real home’ for the adults in their care. It is always a joy to visit.” Staff encourage and promote conversations with the residents to help their language and communication skills, but also to involve and include them in discussions about their home. Staff were seen to be respectful and supportive when talking with residents. Residents can choose to use their own bedrooms for privacy when they are not involved in another activity. There are some set routines in the home because people with Autism benefit from structured programmes that helps them make sense of the pattern of their day. It is evident from observations at this and previous inspections that The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 15 residents have really improved their independent living skills over the time that they have lived here. All residents are all involved in choosing menus preferences and are all involved in grocery shopping at a large supermarket. All are involved in preparing meals, snacks and drinks with support from staff. The home has a pleasant dining room where residents and staff to dine together. Staff encourage residents to make mealtimes a social occasion where they can talk about their day and discuss their choices of activity for that evening. Meals are nutritious, healthy and suit the age, and preferences of the young people who live here. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents receive the right support to access health care services where necessary so that their health and welfare is well met. EVIDENCE: The three people who live here are young and physically fit. They need support, guidance and verbal prompts to help them to carry out their own personal care. No-one needs physical support or with intimate personal care support. All of the staff are female and this meets the need for gender-appropriate care of the three female residents. The residents are registered with a local GP practice, and have access to community dental, optician and chiropody services as and when required. Residents also have access to specialist health services, for example psychiatrist, neurologist and dietician services. In this way the home ensures The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 17 that residents health care needs are met by the appropriate health care services. One person has specialist equipment fitted to their bed that is sensitive to changes in movement that occur prior to an epileptic seizure. This equipment provides an alert for staff attention to her health care needs only at times that the person requires it, so does not compromise the privacy of her room. At this time all medication is managed by senior staff as none of the residents have been assessed as capable of managing their own medication. All staff receive training in safe handling of medication. Care records include comprehensive background information about residents’ medical history and consent forms from GPs about which over-the-counter medications would be suitable or not for each of the people who live here. Medication is delivered to the home by a local pharmacy in suitable containers. Medication is securely stored in a locked, alarmed metal medication cupboard away from residents accommodation. Records of the administration of medication are in place and up to date. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have good information so they know how to make a complaint. Staff are trained in safeguarding adults so residents are protected from abuse. EVIDENCE: The home has a Complaints Procedure, which is also in pictorial format, and is periodically explained to the people who live here. Staff ask residents for their comments at Residents’ Meetings. All of the people who live here can express their dissatisfaction with a situation, for some people this would be through behaviour. All the people who live here wrote in their comment card that they know who to speak to if they are not happy. Relatives have opportunities to contact the home if they are dissatisfied, and can also discuss any concerns at annual reviews. There have been no complaints about this service. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 19 All staff receive training in the local vulnerable adult procedures to ensure that residents are protected from abuse. As with all care services for adults in the City of Sunderland, TWAS has adopted the MAPPVA (Multi-Agency Panel for the Protection of Vulnerable Adults) policy and procedures. These are robust procedures for dealing with suspected abuse. All staff are trained in CALM (Calm Aggression-Limitation Management) and new staff will receive this training. This is a method of physical intervention that requires minimal restraint, and is used only to prevent harm to the resident or to others if residents need support to manage their behaviour. This method is approved by the BILD (British Institute of Learning Disabilities) and ensures that all staff can present a consistent, safe approach when supporting a resident in this way. Very detailed intervention guidelines for staff ensure that they work in the same way to support residents with their behaviour. For example one person can exhibit self-injurious behaviour as well as scratching others. Intervention records were seen to be kept in bound books with numbered pages and clearly detail any triggers and the intervention used to support the resident. These mainly relate to the use of diversion, and time and space for the resident to regain control of their own behaviour. Residents are supported to manage their personal allowances in their own individual savings accounts. Smaller amounts of money can be stored at the home for access by residents whenever they want. All records of residents’ personal allowances were in good order, with receipts kept for any transactions made by residents. As part of her care plan objectives one person is now working towards managing a small amount of money to take on a social activity and records how much she has spent and how much she has left. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People here live in very good quality accommodation that is homely, comfortable, safe and clean. EVIDENCE: The Court is a family house that is decorated and furnished in a modern bright style that suits the age and lifestyles of the 3 people who live here. The house is well-maintained, and provides a very comfortable and safe environment for the 3 residents. TWAS has its own maintenance team that visits the home on a weekly basis to carry out fire tests and to address any minor repairs. In this way any items can be addressed quickly so the home remains very well maintained. There have been no significant changes to the house since the last inspection. During this visit several door closures were very noisy, which could have a negative impact on residents with heightened sensory sensitivity. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 21 Two residents said that they “like” their bedrooms. One person described how they had chosen their own colour scheme for their bedroom and how the TWAS decorator will be redecorating their rooms soon. Residents’ Meeting minutes show how people are encouraged to make their suggestions about decoration and equipment for their house. Residents are supported by staff to manage the household tasks within the house. Staff support them to manage their own laundry. The washing machine is sited in the kitchen and there are clear risk assessments in place that ensure laundry is not in contact with food preparation surfaces. This is checked every month during health & safety audits of the home. All the people who live here wrote in their comment cards that the home is ‘always’ fresh and clean. One person also wrote, “Smells nice.” All staff receive training in Infection Control and support the people who live here to keep their house very clean and hygienic. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are competent and qualified so residents receive an effective service. TWAS uses robust recruitment practices to ensure that residents are safeguarded from unsuitable staff. EVIDENCE: The staff team is led by the manager and a deputy manager who are also both responsible for two other small homes next door to The Court. There are also two senior support workers and two support workers. There are at least two staff on duty (including one senior support worker) at the times that the four residents are at home. Staff carry out sleep-in duties so that there is one staff in the house overnight. During discussions about the best things about their home, one resident said, “I like the staff”. There are clearly good relations between the residents and the staff team. Staff were supportive, encouraging and respectful in their The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 23 engagement with residents. All the people who live here wrote in their comment cards that staff ‘always’ treat them well. It was clear from the staff rota that the manager has been covering a number of gaps on the staff rota due to vacant posts, holidays and sick leave across the three homes. Whilst it is acceptable for the manager to cover the occasional gap, recently there have been frequent occasions where the manager has carried out long shifts and sleep-ins. This takes her time away from the many managerial, administrative and supervisory tasks involved in running three small homes. There have been a couple of changes within the small staff team. However these were of existing staff from other homes who were already familiar with the people who live here. TWAS operates very thorough recruitment and selection procedures. Staff are only employed after satisfactory references and police checks have been received, and this ensures the protection of the people who live here. TWAS promotes a comprehensive equality and diversity policy for all those involved in its services, that includes equal opportunities protocols for its staff. The two senior staff have achieved NVQ level 3 (a care qualification) and the two support staff are currently training towards this qualification. All staff receive Autism Focus training, which is specific training to support them to understand the needs of the people with autism. There is an individual learning plan for each member of staff that identifies any training that they need and a record of all training courses that they have attended. It is evident from records and discussions with staff that TWAS is committed to staff training so that residents receive support from a welltrained, competent staff group. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from a well managed, well organised service. Systems, procedures and practices promote safety and welfare so residents are safe. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager has many years experience of working in care settings with children and younger adults with autism, and has been registered as a manager for this and 2 other small homes for the past few years. She has attained a Diploma in Care Management, NVQ level 4, and the Registered Managers Award, all of which are suitable qualifications for a manager of a care home. She is also currently undertaking a certificate in Autism Spectrum Disorder, which demonstrates her commitment to updating her skills and competence in this specialised area of care. There are clear lines of accountability and management support within the TWAS organisation. In this way the residents, and staff, benefit from a well managed service. TWAS has a quality assurance processes in place to review the service, and these includes the views of the residents (and their representatives) through their annual reviews and Residents’ Meetings. Pictorial questionnaires are also given to residents from time to time for them to indicate their likes and dislikes about various aspects of the service including staff, other residents, menus, activities, and the house. A summary of the responses to the most recent pictorial questionnaire of March 2007 is in the Service Users Guide for any future prospective residents to see. Also, there are monthly visits to The Court by an external consultant (on behalf of the Provider) who seeks the views of residents and staff, and reports back to the organisation and CSCI on their findings. Staff training records demonstrate that all staff receive statutory training in all health & safety matters, and there are up-to-date records of health & safety checks in the house. All staff receive in-house fire instruction every 3 months, and all residents take part in a monthly fire drill to help them understand what to do in the event of a fire. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 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 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 4 X X 3 X The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 27 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 YA9 Regulation 13(4) Requirement There must be risk assessment in place for each resident whose access into and exit from their house is restricted by the new security door system. This will ensure that residents are individually assessed for their capability, or otherwise, to manage their own front door fob. Timescale for action 01/09/07 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 2 Refer to Standard YA24 YA33 Good Practice Recommendations Noisy door closures should be addressed. TWAS should ensure that the manager is not responsible for covering gaps and shift on the duty rota as this could removes her from her managerial responsibilities, and this could lead to a negative impact on the 3 services that she is responsible for managing. The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Court DS0000015782.V334708.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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