Inspection on 14/02/07 for The Hermitage

This inspection was carried out on 14th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hermitage 11/12/08

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 Hermitage The Hermitage Ravine Terrace Roker Sunderland SR6 9LZ Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 14th February 2007 10:00 The Hermitage DS0000066162.V330076.R02.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 Hermitage DS0000066162.V330076.R02.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 Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hermitage Address The Hermitage Ravine Terrace Roker Sunderland SR6 9LZ 0191 5677958 F/P 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) European Services for People with Autism Limited Debra Rodenby Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (3) registration, with number of places The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: The Hermitage is a large, detached house close to the seafront at Roker beach and next to Roker Park. It is set on a short private road and has secure parking on a gated driveway. The house has a large, sheltered back garden. It is close to many local amenities including shops, supermarket, restaurants, parks, and local transport. The Hermitage provides 6 spacious bedrooms for the people who live here. All the bedrooms have en-suite bathrooms with bath, shower and toilet. The accommodation is over 3 floors. Two bedrooms (and staff sleep-in room) are on the second floor and the remaining 4 bedrooms are on the first floor. On the ground floor the house provides 2 spacious lounge/dining rooms, a large lobby lounge and a sunroom at the rear. There is large, family kitchen with annex dining room and separate utility room. The home is not intended to accommodate people with mobility needs and this is outlined in the Statement of Purpose. There is good access into and around the ground floor and there is a WC that is suitable for any visitors who use a wheelchair. Most of the residents previously lived in another care home operated by ESPA, which had become too small for their needs. ESPA purchased The Hermitage to provide more spacious and improved accommodation for the people who live here. The manager and staff team also transferred to the new service and this supported the smooth transition of residents to their new home. The weekly fee is between £1114.69 and £1973.85. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. Much of the time was spent talking with staff and residents, looking at the new house and bedrooms. The inspector also joined residents and staff for a lunch-time meal. Time was also spent with the manager discussing the new service, looking at care records and health and safety records. As this is the first inspection of a new service, the home was inspected against all the national minimum standards. 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. A few weeks before the inspection a pre-inspection questionnaire was received from the home. Also 6 comment cards were received from residents and 4 comment cards were received from their relatives with their views about the home. Their comments are included in this report. There have been no complaints about this service since it opened. What the service does well: The home always looks at new service users’ needs to make sure it can support them in the right way. New residents can visit or stay at the house as many times as they want before they choose if they are going to move here. People have information about the service in easy read and pictures to help them understand their rights. Some of the people who live here are deaf or find it hard to talk, so they use speech and sign language and gestures. It is good that staff understand all the different ways that people use to talk. Staff also understand how to support people with Autism, and how to help them to learn new skills. People here find it difficult to say what they feel about the home, but there is a very friendly feeling in the house. Staff and residents get on well and spend lots of time in activities and or doing household things together. Many of the staff have worked for the residents for a few years so they know them very well. Staff said that they work well together as a team. Relatives said that they were made welcome in the house, that they are told about important things, and that they are satisfied with the service the people get here. There are lots of staff on duty so that everyone has the chance to go out to different places and activities everyday. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 6 The house is very well-decorated, comfortable, warm and safe. Everyone has their own big bedroom with their own bathroom. There are flashing lights so that deaf people know if there is someone at their door, and red flashing lights to tell them if there is a fire. Staff cannot start work here until they have been checked to make sure that they are the right people to help the residents. There have been only two changes to staff in over a year. The manager and most of the staff have worked for the residents. This has helped residents and staff get to know each other. Staff said that they get good training to help them support the people who live here in the right way. The manager and ESPA make sure that the home is run in the right way and that it is a good, safe place to live. What has improved since the last inspection? What they could do better: Some of the people who live here use British Sign Language as their first language. It might be better if they had information about their home and their rights in sign language on a DVD. The home should show why a sound monitor is used for one person when they are alone in their bedroom. The record should also show how that person’s right to privacy is met. There should be records about the new safety risks for each person since they moved to this new house. For example using their own bathroom without staff support. It would help people understand the menu choices better if they were in photographs or packets. Staff still need to have training, from the right sort of trainer, in how to support people when they are upset or angry. All the people who live here should have a key to their own bedroom door so that they can lock it when they go out or when they are away on holiday. Staff should think about the best way to help people use the kitchen without burning themselves on the kitchen hot water tap. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 7 The people who live here should have help from independent advocates when they are filling in comments about the service they get at the home. People’s daily notes should not be kept where other residents could read them. 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 Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has comprehensive assessment and admission processes so it makes sure that it can meet the needs of people who come to live here. People have good information about the service although it does not always meet some people’s specific communication needs. EVIDENCE: The Hermitage has a Statement of Purpose and Service Users Guide that clearly outlines the service. These include good details of the new accommodation for the people who have moved here. Much of the Service Users Guide information is in easy-read and pictorial format to assist some of the communication needs of the people who live here. For two people BSL (British Sign Language) is their main language, and most of the other people also use sign-supported language to support their communication skills. However there is no information about the service available on video or DVD in sign language. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 10 ESPA has a comprehensive assessment process that includes the input of the prospective resident, their relatives, social worker, care manager and, where appropriate, psychology, education and psychiatry services. In this way ESPA ensures that the needs of each prospective service user are fully assessed before a decision is made about whether the service can meet their individual needs. Following an assessment, one person moved to The Hermitage from a different service. She was supported by a BSL interpreter and picture information so that she could make her own informed decision as to whether she wanted to move here. The pre-assessment information in the home gives very clear details of her specific needs. The remaining five people moved here from another home. They had chances to visit the house as it was being refurbished for them. The manager and staff team who all transferred to this new home supported their transition. All new residents are offered several chances to visit a home through the day, and then overnight stays, before making a decision about their placement. This is clearly outlined in ESPAs policies. All the people who live here have contracts (licence agreements) that outline their rights and responsibilities whilst living here. These are written in easyread and pictorial format, and are kept in their care files (which they can access with support). There is a record that shows the agreements have been verbally explained to each resident and whether or not they were responsive to this information. The contracts also include details of the individual fees for each residents and their contribution. The Hermitage DS0000066162.V330076.R02.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, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Support plans are very detailed so that staff can support each person individual needs in the right way. People have good opportunities for making their own choices and decision so that they can lead their own lifestyle. However risks are not fully set out so residents safety or dignity may be compromised. EVIDENCE: There are individual support plans in place for each of the people who live here. These provide very detailed information about each person’s support The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 12 needs for staff. The plans are reviewed annually with residents and their representatives when any achieved goals are removed or new goals are added. The written support plans would be very difficult for residents to comprehend, but staff stated that they do try to encourage and support residents to identify their own goals and aspirations at monthly reviews with their key workers. All of the people who live here have the ability to make their own decisions about their daily lifestyle such as what to wear, what to eat, and what activities they want to do. People are also invited to join the weekly signed House Meeting, which is led by a signer from ESPA who is not part of the staff team. Here residents and staff discuss suggestions for activities menus and house rules. The manager stated that people are much more involved in these meetings since they began being led by the signer rather than by staff. The people who live here are supported to take acceptable risks as part of an independent lifestyle, wherever this appropriate and manageable. These activities include preparing food in the kitchen, and being out in the community. There are some risk assessment records in place about such activities, however the manager stated that not all risks identified within this new house have been recorded within a risk assessment framework. For example, all the people who live here have their own en-suite bathroom. The potential risks have been discussed by the staff team but not yet set out within a risk assessment. It is the manager’s intention to address these gaps within individual residents’ reviews in the near future. The use of a sound monitor has been re-introduced for one person who may need urgent staff support when using their bedroom independently. However the risk assessment record was last reviewed 2 years ago and no new risk assessment has been put into place since the move to this house. The receiver is in the main lounge so some other residents can hear this as well as staff. This compromises the person’s dignity and privacy. People who live here have had information about their rights to confidentiality and to access their own records. This has been provided in pictorial format and verbally explained to each person. However due to the nature of Autism Spectrum Disorder (ASD) the people who live here find such concepts very difficult to understand. ESPA have clear policies about confidentiality, access to information and data protection. In discussions staff are very respectful and supportive about the people who live here. The Hermitage DS0000066162.V330076.R02.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): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have good opportunities to lead a meaningful lifestyle and make their own choices so that they can develop life skills. EVIDENCE: The five men and one woman who live here have Autism Spectrum Disorder, which makes it very difficult for them to express themselves or their feelings. Some people have additional communication needs, including people who are profoundly deaf. The residents use a mix of limited verbal speech, signs, British Sign Language (BSL), and gestures to communicate. It was clear that staff are very conversant with the differing communication methods used by residents. All staff have some knowledge of BSL and signsupported English, and receive training in this from time to time. Also a BSL The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 14 signer now visits the home to provide extra support for some people, such as for weekly meetings. Each person has a structured activities programme to help them to make sense of the pattern of their day. In these ways, the home ensures that each person has opportunities for personal development. It is very good practice that four people have been supported to find ‘paid’ employment. One person has a part- time job on a farm; 2 people work on a forestry conservation project (and there are plans for them to be paid to manage the garden); and one person is paid for cleaning communal areas within the house. There is also a very good range of vocational activities at the ESPA Croft Centre that people here can choose from. One person had chosen not to be involved in structured activities for a while, although is now attending a pottery class. The manager is aware that this is an area for greater support for this young person. The other person is very new to the home and so is still settling in before choosing daytime activities. The new home is near to many local facilities that people here make good use of, for example shop, restaurants, pubs, beach, parks, supermarkets and post office. The house is a large, former family house that is similar to some of the neighbouring seafront properties. It is not distinguishable as a care home. People have good opportunities for leisure activities and with the support of staff, for example sports centres, swimming, bowling, shopping, and trips to places of local interest. Residents are supported to be as involved as they can be in the running of their home. All are involved with daily domestic tasks, with support only where necessary. All are supported to read their own mail, with staff assistance, and there are signed agreements from relatives about this. All are invited to join in at House Meetings. The home ensures that people have good opportunities to contact relatives if they wish. Some people described in sign language how they go out to visit their relatives, and staff confirmed that relatives are welcome to visit the home whenever they wish. The four comment cards received from relatives confirmed that they are welcomed into the home, can visit their relative in private and are kept informed about important matters affecting the residents. All the people who live here are involved in grocery shopping, usually at a large local supermarket. People are involved in making decisions about the menu and make their own choice of at least 2 main dishes at main meals. There are a few whiteboards in the kitchen that have written information on for residents, including the menu choices on each day. However this does not The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 15 always meet people’s communication needs. Staff said they are planning to use photographs and packet-front to help people make informed choices about their meals and menus. Staff aim to support people to have a healthy, nutritious diet and have involved a dietician to support them with this. One person has their own menu for their health needs. People also choose to have a take-away meal once a week, and also have the chance to go out to restaurants form time to time. People have one-to-one support to prepare meals to support their independent living skills. The staff are planning to introduce ‘make your own pizza’ sessions and ‘make your own sandwich’ sessions to keep people involved and motivated in this area. The Hermitage DS0000066162.V330076.R02.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, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures good support with personal and health care needs so that people’s care needs are well met. EVIDENCE: The six people who live here are generally physically fit and can manage most of their own personal care needs with staff guidance and prompts. A couple of people need some degree of supervision for bathing. None require physical assistance. The home does have a clear Intimate Care policy to guide staff. There is always at least one female member of staff on duty to provide genderappropriate support to the one female resident. The residents are registered with a local GP practice, and have access to community dental, optician and chiropody services as and when required. ESPA has access to psychiatry, psychology, Speech & Language Therapists and Dietician input if required by the people who live here. In this way the home The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 17 ensures that residents health care needs are met by appropriate health care services. At this time none of the current residents has been assessed as able to manage their own medication. At this time, all medication is managed by trained, designated staff. 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 Hermitage DS0000066162.V330076.R02.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 good. This judgement has been made using available evidence including a visit to this service. The home supports people to understand the complaints procedure so that they can express their views about the service they receive. Staff are better trained in safeguarding adults so that people who live here can be protected from abuse. EVIDENCE: Each resident has been given a copy of the Service Users Guide, which also includes the homes complaints procedure. This information is in pictorial symbols to support the communication needs of the people who live here. (It is not currently available as signed information on a video or DVD that people could refer to whenever they wished.) Due to the nature of Autism some people find the complaints information very difficult to comprehend. However residents are asked at signed house meetings if they have concerns. All residents have good contact with relatives who can advocate on their behalf if they indicate any dissatisfaction with the home. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 19 The residents do use signs, gestures and noises to express their dissatisfaction about immediate situations, and staff are very knowledgeable about the individual communication skills of each resident. There have been no complaints from residents or relatives about this new service. There have been two minor concerns from neighbours about litter on a roof, and the gardener making noise too early in the morning. The home addressed both these matters immediately. As with all adult care services in the City of Sunderland, the home endorses the MAPPVA (Multi Agency Panel for the Protection of Vulnerable Adults) procedures. These are robust procedures for dealing with suspected abuse. It is good practice that the manager is now a trained Trainer in MAPPVA protocols and has delivered this training to all the staff. Due to the nature of their Autism, the people who live here need occasional staff intervention during episodes of behavioural needs to prevent them from harming themselves or others. There are behavioural guidelines in place for each of the residents and these are shared with parents. There are also Intervention Records in place that record any occasions where intervention techniques have been used. Some staff have had brief restraint training sessions. None of the staff have had training in physical intervention techniques from a BILD-accredited trainer (British Institute of Learning Disabilities). In this way staff may not be following current best practice guidance, as outlined by the Department of Health and BILD, in this area of care. This matter has been the subject of previous requirements. Since then ESPA have appointed a Behaviour Training Co-ordinator who is to support ESPA to adopt the BILD Code of Practice, and to arrange BILD accredited training for all staff in physical intervention. Although this is not yet in place this is clearly planned for the near future. Residents are supported to keep their own personal allowances wherever capabilities allow. Two people keep their own monies, and the other people are supported to take their own wallets out with them. Everyone is supported with their own bank accounts, and bank statements are included in the good management of people’s monies. There have been a couple of changes to the way that residents are supported with monies that have not yet been included within the home’s financial procedures. The Hermitage DS0000066162.V330076.R02.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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People here live in good quality, safe, comfortable, spacious accommodation so that their needs and independent lifestyle are met. EVIDENCE: Most of the people who live here previously lived in a smaller terraced house that had become too cramped to accommodate them and the number of staff involved in their care. The Hermitage was identified as a more spacious home that would better suit the needs of the residents. Five of the residents moved here last autumn, and a new resident moved in more recently. The Hermitage provides a large, comfortable, and well-maintained house. It is decorated and furnished to a good standard (although curtains that have been The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 21 ordered are still awaited and these will make the home seem more cosy and homely). The benefits of the new house for residents include a large, family style kitchen so there is plenty of room for people to be supported when preparing meals. A choice of spacious lounges so residents can spend time together, or in different sitting areas, without feeling cramped. All sitting areas are on the ground floor so staff can be around and available without seeming intrusive. The house currently provides 6 spacious single bedrooms, each with its own en-suite facility of toilet, sink and bath with overhead shower. (There is a seventh bedroom that is currently unused.) The bedrooms are decorated and furnished in light, bright, modern way that suits the age and lifestyle of the people who live here. Residents have individualised and personalised their own bedrooms to suit their own styles. It was clear during this visit that people spend time in the privacy of their own room whenever they wish. All bedrooms are lockable by residents, if they wish, from the inside. Residents used to have a key to their own bedroom at their previous house, but not all have been given a key to their bedroom at The Hermitage. This means that they cannot lock their own bedroom doors when they are out of the house. This does not support their continued independence and right to privacy. Everyone has their own toilet and bathroom within their en-suite, and there is an additional (accessible) toilet that is on the ground floor off the large hallway. There is also an additional shower room on the first floor that can be used by staff. The home has 2 very spacious lounges, both of which also contain dining areas. One lounge also has a number of games and activities such as pool table, and computer games. In between the 2 lounges is a large hallway that can also be used as a sitting area, and a sun-room to the front of the house also provides another sitting area for the people who live here. There is a very large, well–kept garden that residents can enjoy in better weather. It is clear that the Provider has considered the specific needs of the people who live here when designing the adaptations to the house. For example, there are light switches outside bedroom doors for staff to use to seek the attention of people with hearing impairments without intruding in their rooms. There are also flashing lights in each bedroom that are linked to the fire alarm system. Special toughened ‘glass’ has been fitted in the bedroom of one resident who would be at risk of breaking standard glass. Overall the home offers very good accommodation. It is clean and hygienic. As the kitchen sink is used to wash food utensils the hot water is set at a high temperature. There is a laminated notice stating ‘Caution Hot Water’ pinned into the window frame in front of the sink. This does not meet residents The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 22 communication needs and looks out of place in this otherwise homely, family kitchen. Also the hot water is set at over 70°C, which is dangerously hot and unnecessarily higher than the guideline for kitchen sinks. However residents are always supervised by staff when using the kitchen. There is a well-equipped laundry area is a small room under the stairs. Residents have not yet been involved in using the laundry area until risk assessments about its location have been completed. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 23 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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who live here receive an excellent service from a competent, supportive, consistent staff team that values and responds to their individual needs. EVIDENCE: ESPA provides all staff job description, employment contract, terms and conditions and code of conduct. Most staff transferred here from the previous service at Montpelier Terrace. It was clear from discussions with staff that they are very clear about their roles and responsibilities. Staffing levels are designed to provide maximum support for residents at the times that they require it. There is always a minimum of 4 staff on duty and more on the day of the weekly house meeting. Discussions with staff demonstrated their value of the residents, and their willingness to provide a responsive service. As a result the staff rota is flexible to meet any extra needs The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 24 such as specific evening leisure events, or to support residents on holidays, or to support people with episodes of behavioural needs. It was clear that the heightening behavioural needs of one person is having an impact on the staff rota. The staff team are concerned that a long-term staffing solution is now needed if the person’s needs are to continue to be met at this service without negatively impacting on the other people who live here. The staff team is a good mix of age, gender and experience. The manager and staff stated that they work well together as a team. The only change to the staff team in the past year is the addition of two new staff. The people who live here benefit from the continuity of care from this consistent staff team, and staff have become very knowledgeable about each residents individual needs. The Provider, ESPA, operates very thorough recruitment and selection procedures. Staff are only employed after all satisfactory references and police checks have been received, and this ensures the protection of the people who live here. All staff receive training in Autism Awareness and some staff have completed an Introduction to Autism certificate. At this time 8 staff have completed NVQ 2, which is a care qualification and 8 other staff are training towards this. Individual training records of each staff are kept in their personnel files. There is also a training matrix for the staff team that would identify any training gaps. ESPA is arranging to become a training agency and so will provide all its own NVQ training in the future (though will still use external assessors and verifiers to ensure proficiency.) In discussions staff were positive and enthusiastic about the training opportunities and the plans for future training. Staff members have individual supervision sessions with their line supervisor, around 6 times a year. These are clearly recorded and set out any support needs or issues raised by staff for action. The supervision records are stored confidentially in individual personnel files. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 25 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, 38, 39, 40, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run so that best interests and welfare of the residents are safeguarded. EVIDENCE: The Registered Manager has been in post for several years. She was the manager at the previous home where the residents lived before moving to The Hermitage. She has many years experience of working in care settings for people with Autism Spectrum Disorder. She is currently working towards NVQ level 4 and the Registered Managers Award, which are appropriate qualifications for a manager. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 26 She is supported by 2 senior staff who lead the staff team in her absence. She is supervised and supported by as appropriate management representative of ESPA, who also carries out the required monthly visits to the home to report on its operations. The people who live here who live here have benefited from the consistent support of the manager and staff team, particularly during the major changes involved in moving house. Discussions with staff indicated that they work well as a team, are motivated, and are supportive of the people who live here. The manager has an open, inclusive and encouraging style. There are clearly good working relations between staff, manager and the residents. These positive practices help to give the home a friendly, welcoming and relaxing atmosphere for the people who live here. ESPA has a comprehensive quality assurance system to review the quality of The Hermitage. This includes monthly visits by a representative who reports on the progress of the service. There are weekly House Meetings for residents and staff to make their suggestions, comments or concerns about the service. Each resident has an annual review with ESPA, their relatives, and their social worker to make sure that the service is still meeting their needs. Residents, relatives and staff receive an annual questionnaire to complete in which they can give their views about the. The CSCI sent easy-read, pictorial questionnaires to the six people who live here for their views about the service they receive. However all had been supported by staff to complete the questionnaires, which may have influenced the responses that they gave, for example “do the staff treat you well?” Staff have access to all the relevant policies and procedures that are involved in the running of the home. Some procedures have been made more accessible for residents e.g. in pictorial format and staff do verbally explain these to residents where their capabilities allow. Records that were examined were up to date and clear, and most are securely and confidentially stored. It is good practice that care files are kept in residents’ own bedrooms (except where a resident could not tolerate this). Some daily plans and records were in the lounge for easy access by staff, but this also allows access by residents to each other’s records, so may compromise confidentiality. All staff receive statutory health & safety training, and new staff receive this through Induction training. In this way staff understand the practices and procedures to ensure the health and safety of the people who live here. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 27 The fire alarm system includes sprinklers throughout the building, which have been approved by the Fire Authority, and provide an excellent system of managing the potential risk of fire. The maintenance of the building is carried out by a contracted company that also ensures all health and safety measures are in place. There are extra facilities within the new building (e.g. private en-suite baths) that have been identified as potential areas of risks for some of the people who live here. Although staff are supporting people to manage these risks, some have not yet been recorded within a written risk assessment. The Provider operates a number of similar small homes, a college and a day centre. Satisfactory financial clearances were received in respect of ESPA during the registration process of The Hermitage last year that demonstrated its on-going business viability. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 28 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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 4 26 4 27 4 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 4 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 3 3 4 2 3 2 3 3 The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A first 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 12(4)(a) 13(4) Requirement Timescale for action 01/06/07 YA9 2. 13(4) 3 YA23 13(6) and 13(7) 4 YA26 12(4) 13(4) The use of a sound monitor between a person’s bedroom and the lounge must be justifiable through an up-to-date risk assessment strategy, and must also show how the person’s dignity and privacy is maintained. The risks identified for each 01/06/07 person following changes to their environment must each be set out within a risk assessment framework. This is to ensure that people’s safety is upheld. The plans to introduce BILD01/09/07 accredited training in physical intervention for all staff working at The Hermitage must continue. This is to ensure that staff are equipped to support people in a safe and appropriate way. All residents must have a key to 01/06/07 their own bedroom unless a risk assessment has identified otherwise. This is to ensure that people can exercise their rights to independence and privacy. The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 30 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 YA1 Good Practice Recommendations Consideration should be given to providing the Service Users’ Guide information in sign language on video or DVD to support the specific communication needs of some of the people who live here. Consideration should be given to improving the accessibility of information for residents, such as alternatives to menus written onto white boards. The home’s financial policy and procedures need to be amended slightly to reflect the changes to the way that resident’s monies are now banked. Consideration should be given to how residents can be safely supported to use the kitchen sink whilst still maintaining good hygiene practices. Consideration could be given to accessing advocacy services or to using independent personnel to support residents to complete any questionnaires about the service they receive as independently as possible. Consideration should be given to where daily notes about residents are kept so that these are not accessible by other residents, in order to maintain confidentiality. 2 3 4 5 YA17 YA23 YA30 YA39 YA41 6 The Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 31 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 Hermitage DS0000066162.V330076.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!