Inspection on 16/07/07 for Tobias Centre For Autistic Support Services

This inspection was carried out on 16th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tobias Centre For Autistic... 16/07/08

Tobias Centre For Autistic... 17/07/06

Tobias Centre For Autistic... 02/03/06

Tobias Centre For Autistic... 31/08/05

Tobias Centre For Autistic... 03/02/05

Tobias Centre For Autistic... 23/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

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

CARE HOME ADULTS 18-65 Tobias Centre For Austistic Support Services 8 St. Margarets Road Torquay Devon TQ1 4NW Lead Inspector Judy Cooper Unannounced Inspection 16th July 2007 10:30 Tobias Centre For Austistic Support Services DS0000018443.V343866.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 Tobias Centre For Austistic Support Services DS0000018443.V343866.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. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tobias Centre For Austistic Support Services Address 8 St. Margarets Road Torquay Devon TQ1 4NW 01803 312867 01803 323891 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) www.moduscare.com Modus Care Limited Mrs Marion Louise Grogan Care Home 11 Category(ies) of Learning disability (11), Mental disorder, registration, with number excluding learning disability or dementia (11) of places Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th July 2006 Brief Description of the Service: The Tobias Centre is owned by Modus Care Ltd and is registered to provide care for up to 11 adults with autistic spectrum disorder and additional sensory disabilities. The home currently caters for five people, with complex needs, which consequently require high staffing levels. The property is a large detached house situated in a residential area of Torquay close to amenities. There is an enclosed garden to the front and rear of the premises. The basement is currently set out as a flat for one person, with a lounge, quiet room, kitchen and bathroom. There is also an office in the basement. The main house comprises a shared kitchen, lounge and dining/activity room, with quiet rooms used by specified people that live at the home. All bedrooms are single and some are en suite. There are other shared bathrooms and toilets. The weekly fee at the home currently ranges from £1836.70 to £3776.08 with fees dependent on the type of facility, care package and needs of the individual person. The home’s inspection report is made available on request, with a notice to this effect on the notice board in the entrance hallway. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a Monday between 10.30 a.m. and 5.30 p.m. During the visit the opportunity was taken to tour the home, examine appropriate records and policies and talk with the manager, deputy manager and several staff members whilst observing the people that use the service noting such things as staff communication and opportunities made available to them. Other information about the home was also obtained, including the telephoning and speaking with three relatives/carers out of the five people that use the service as well as receiving feedback from two visiting professionals. Several staff members were spoken with in a group setting during the inspection to obtain their views. Additionally two people’s care was inspected in detail to ensure that their needs were being fully met whilst the care of the other three people at the home was also discussed. All of this collated information has been used in the writing of this report. All required core standards as well as some additional ones were inspected during the course of this inspection. What the service does well: The home provides good care to the people who live at the home. This is achieved by providing an experienced staff team and an individual activities programme to assist the people that use the service to lead a fulfilled life. Staff try hard to enable the people at the home to lead interesting and active lives. They genuinely care for the people who live at the home and were very understanding and aware of their individual needs. The staff training programme which includes working towards nationally recognised qualifications as well as providing statutory and relevant in-house and external training courses, continues to be made freely available to all staff. This helps ensure that the staff are appropriately trained and experienced to be able to care for the people correctly. The home has a thorough assessment and care planning system in place to ensure that the needs of the people are understood and met, including personal and healthcare needs. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 6 The organisation is now working towards introducing a more person centred approach to care planning to ensure that the peoples’ views are always taken into account when planning to meet their needs. The views of their relatives/carers have been sought out and used to enable the management of the home to ensure that the services provided in the home are those which would be of most benefit to the people living at the home. The newly registered manager is performing her duties to a high standard and has, or is in the process, of addressing any identified shortfalls within the home in an efficient and professional manner which evidences the clear understanding she has regarding the need to ensure that the care provision made available is the best it can be for the people who live at the home. What has improved since the last inspection? The organisation has appointed an experienced and well trained manager who was successful in the registration process with the Commission last year. Therefore the staff group are supported and managed appropriately by this manager who is based solely in the home and therefore able to concentrate on the management of the Tobias Centre only. This means that appropriate care should be given to the people in the home at all times and that both the people who live at the home and the staff will have a continuity of management. The newly registered manager has begun to review the home’s records, policies and procedures. This is to ensure that they are easily understood and accessible to the staff members to assist them in the provision of the required care to the people at the home. For example the shopping routines for the home have been changed and now involve purchasing some items from local suppliers. This better enables the people at the home to be able to participate in this activity as previously some of the people found it difficult to cope with going to a large supermarket and were therefore denied this normal daily living skill. The home’s medication polices have been reviewed and revised to ensure that the people are protected through the correct storage and administration of their medication. A staff link team now supports people who live at the home. This is a group of staff comprising of a team coordinator, senior carer and three support workers whose role it is to liaise together and ensure that all agreed aspects of care for each person is provided for. This ensures that all people have various, specific, identified staff members who know their care needs well. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 7 Some of the staff at the home have also now been identified to undertake specific responsibilities for example, ensuring the safety of the home’s two vehicles used to transport the people and ensuring the safe storage and use of any chemicals within the home. This means that the people are further protected by the strict adherence to the necessary procedures and polices that are in place to protect them. The new manager has also undertaken an audit of activities and as such has re-commenced swimming session for any person that would enjoy this with one person already taking advantage of this. There is now a maintenance plan in place where routine maintenance, noted as being needed can be recorded to ensure that the organisation is made aware of the shortfall and can take steps to address it. This means that the organisation is now working towards ensuring that the environment of the home is both pleasant and safe for the people at the home. Since the last inspection, some redecoration and refurbishment has taken place including the redecoration of the home’s lounge and hallways and the replacement of carpets in both these areas whilst new settees and dining room furniture has also been provided. Additionally the home’s laundry area has been upgraded and provided with new equipment to facilitate the efficient laundering of the people’s clothes etc. What they could do better: A new statement of purpose and service user guide must be made available which details the changes made to the internal managment and staffing within the home, as well as detailing the organisation’s new reponsible person, so that all those involved with the service are able to have up to date information about the home. The communication methods used within the home need to be further explored/increased so that the people who use the service are empowered, as far as able, to be able to express their own views and choices in how they wish to receive care and live their lives generally. The registered manager and staff should also explore ways of ensuring that any individual religious and/or cultural needs are known, understood and met so that the people at the home and/or their relatives/carers can be assured that these very individual needs will be provided for. The registered manager should ensure that all relatives and/or carers are aware of the home’s complaint policy so that they are aware of how to complain if they should need to. Staff should receive training on equality and diversity issues to ensure that they are fully aware and confident of how to promote and maintain these Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 8 within the home and therefore further ensure that all appropriate care is provided. The responsible person must ensure that the major proposed changes to one person’s accomodation is fully discussed and agreed with the person to ensure they are happy and agree with these planned changes. The registered provider should also continue with the general upgrading of the home to ensure that the environment is maintained to a good level at all times and consequently provides an attractive environment for the people living at the home. All staff must attend training on the protection of vulnerable adults to ensure that they are aware of and recognise any form of abuse and feel confident in how to address this sensitive area. This will ensure that all people at the home remain protected from harm. The organisation should also ensure that the staff members currently undertaking a recognised qualification in care continue to do so, to allow the home to have the required fifty percent of qualified staff on duty. The registered manager must ensure that there are window restrictors in place on all windows above ground floor that have wide openings. This is to ensure that the people at the home are proteccted from the risk of falling from a high window. The registered manager should have sight of the two references obtained prior to appointment of any newly appointed staff. This is to ensure that the manager is nade fully aware of the new staff member’s background and can ensure that if there are any areas of weakness noted appropriate action can be put in place to meet these. This will ultimately benefit the people at the home by ensuring that the staff working with them are suitable. The required monthly visits by the reponsible individual should re-commnece and there should be a record of their visit available for inspection. This is so that the manager is supported in her role and there is a reference of what monitoring the responsible person undertakes to ensure that standards within the home remain high and meet the needs of the people who live at the home. The home’s annual development plan should be presented in such a way as to show timescales of when intended/agreed actions/ works are due to take place. This is to ensure that the organisiation meets any targets set within the agreed timescales and so does not allow slippage of any identified projects that will benefit the lives of the people who live at the home. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 9 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. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 10 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 Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 11 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): Standard 1 and 2 Quality in this outcome area is adequate. A suitable admission process is available in the event of any new prospective person, which would ensure their needs are known prior to admission. However the home’s statement of purpose and service user guide had not been updated to reflect the recent organisational or internal management changes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since 2002. Should there be a new admission to the home there is a suitable admission policy and procedure in place which the manager stated would ensure that both she and the staff knew they could meet the prospective person’s needs prior to admission. Currently there is some consideratrion being given to a possible new placement later in the year and the manager was able to describe the preliminary steps already taken to ensure that the home would be the right place for the person. This had included discussions with the person’s current care team and the manager was in the process of arranging to visit the person in their own setting. However the home’s service user guide and statement of purpose has not been updated recently to reflect organisational or internal management and staff Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 12 changes within the home which means that, in its current form, this information is misleading. Although there have not been any new admissions since 2002 it was pleasing to note that the on-going care planning for the people who currently use the service was in depth and ensured that any newly presenting needs were noted and appropriate care made available to meet them. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 13 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): Standards 6,7,8 and 9. Quality in this outcome area is adequate. The manager and staff are skilled in planning for all aspects of the overall needs and personal goals of the people who live at the home, showing both sensitivity and awareness of each person’s current and changing needs. However communication is limited between the people and the staff due to a lack of varying and meaningful communication methods being in place that would be useful and relevant to each person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When care plans are put together there is as much input as possible from the person using the service as well as their relatives/carers, care management, key-workers and any other appropriate outside professional. It was pleasing to note the recently introduced social history that the deputy manager had researced for some of the people who live at the home, which allowed an instant understanding of the person’s past and current history as well as their important family/carer links. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 14 As most people who live at the home are unable to communicate this information it is really useful for staff to be able to know this allowing them to have a greater understanding of each person at the home. The manager has recently introduced a “link team” of staff for each person comprising of a team coordinator, senior carer and three support workers whose role it is to liaise together and ensure that all agreed aspects of care for each person is provided for. This ensures that all the people have various, specific, identified staff members who know their care needs well. All care plans are reviewed reguarly by the person’s link team with input invited from the person’s relative/carer, care management and key-worker. However sometimes it has proved difficult in the past to get all relevant parties to attend these reviews. To help with this the organisation is considering holding the reviews at a different location, away from the home, which they feel may encourage families etc to feel better able to concentrate on the review as there is currently very limited quiet space at the home to allow this to happen. Two care plans was inspected in detail, during the inspection, relating to the two people whose care had been looked at in detail. During the inspection the care given to these two people was also observed and it was noted that their needs were being well met. The care plans also included detailed risk assessments which identified any known or potential risk and the means to minimise these as far as possible by allowing risks to be taken safely leading to more fulfilled and varied life for the people who live at the home. For example some people who live at the home very much enjoy going out for a drive in the homes’ transport vehicles. To be able to do this a restraining harness needs to be used to protect the person, the driver and acompanying staff member. This was clearly documeted and on the day of inspection it was noted that one person who has severe behavioural problems was able to go out for a drive, by using the harness, and by observing their body language it was clear that the person was very happy to be able to do this. It was also pleasing to note that a relative of the person involved, when spoken with was very aware of the need for this type of restraint and had been involved in the decision to use it, realising that felt that using these restraint measures enhanced the person’s life by allowing them to be able togo out on regular outings safely. When any form of restraint is used within the home there are detailed accounts of the restraint used and why to ensure that the correct and agreed measures continue to be used. Additionally detailed daily records are kept of all care given which were noted as being fully detailed and up to date. Further a newly formed link team also meet monthly to discuss each person’s care needs. The management of the home are in the process of implementing a new person centred care planning system for each person. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 15 However the information contained within the existing care plans is very thorough and in-depth and reflects all peoples’ needs, progress or changes but it is currently not presented in a particularly user friendly manner. This should be alleviated with the introduction of the new care planning systems. All of this monitoring and subsequent recording both ensures and evidences that the correct care is given It was also pleasing to note that the organisation employs a designated behaviour specialist and it was noted that her input had been very much used with one of the people who live at the home whose care was inspected. This could be evidenced during the day of the inspection when staff were noted as being very confident in providing the necessary care for this person who has severe behaviour problems. The care was delivered in a calm and relaxed manner which helped diffuse the situation as soon as possible. Staff were noted as receiving support from the behaviour specialist, as she visits each establishment reguarly to ensure the care given remains appropriate and ensures the safety of both the people who live at the home and the staff who care for them. The staff at the home were clearly seen to be working hard towards ensuring that the peoples’ right to respect, individuality, freedom of choice, privacy and dignity were promoted at all times. Although there are some good examples of communication methods used for those that are able to understand these such as sign language and pictorial symbols, there is still a need to further involve those with very limited communication skills. This is a challenge but one which should be explored to allow all people at least some say (no matter how small) in how the care they receive is delivered. When this greater communication is achieved it will allow and facilitate a more person centred approach to the care provided by ensuring the peoples’ feelings towards how their care should be given is both known and taken into account. At the inspection the manager was able to show evidence of a new financial management system, which has recently been introduced by the registered provider, to ensure that peoples’ accumulated monies are held safely and can be fully accounted for. Appropriate systems were noted as in place for the handling of peoples’ monies actually held within the home and full financial details were available with receipts of monies spent and held, which protects all the people living at the home. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 16 Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 17 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): 12,13,14,15,16 & 17 The quality in this outcome area is good. Life at the home is varied with various activities made available. Visitors are encouraged and welcomed. Staff respect personal choices and the home provides nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Those living at the home all have high levels of staffing support, which enables them to go out into the community regularly. Staff interviewed understood their needs, which can sometimes put constraints on where they can go and what they can and want to do. For example although the organisation makes holidays available, it has only been possible to plan for two people who live at the home to have a holiday this year, as the others’ individual needs make it extremely difficult to source suitable holiday accommodation, however all attempts should still be made to Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 18 provide this opportunity for all people who live at the home if possible if at all possible. All people who live at the home take part in activities they value in the community. Most like going for walks, trips out and eating out and visiting local shops. New activities are explored and offered and all attempts made to provide stimulating experiences for the people who live at the home. Family links and involvement are very much promoted at the Tobias Centre. The people are regularly taken to visit family and friends, as well as being helped to keep in touch by phone and letter. Families are also facilitated and supported to visit at the home. Discussion took place regarding the need to further explore any additional religious or cultural needs a person may have that may not always be obvious due to the limited communication skills that some people have. Exploring these more fully may help a person to have an additional quality of life that they would otherwise not. The people who live at the home are encouraged to participate in household chores and do a range of activities, as they are able. One person uses a computer and it is intended to incorporate a computer suite when other building work takes place (see under environment). Another person remains very keen to obtain an external shed and some hand tools to enhance their gardening hobby and again the provision of this will be incorporated when the other building work takes place. Staff plan and prepare the meals. One staff member is a qualified chef and their expertise is utilised. Individual likes and dislikes are known and the menus, worked on a three weekly basis, are displayed in the kitchen The kitchen was recently redesigned to make it more accessible to the people who live at the home should they wish to help. Some people chose to eat lunch in the dining room, whilst others chose different places. All choices were noted as being facilitated by the staff. One person helps prepare meals in their own flat, and is involved in shopping for the ingredients required. A particularly good example of how the service is considering the future needs of the people is the planning for staff to undertake bereavement training as some of the people who live at the home have relatively elderly family members and the management and staff consider this may be a needed skill in the future. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 19 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): Standards 18,19 and 20. Quality in this outcome area is good. Staff provide sensitive, flexible personal support and care to maximise the privacy, dignity, independence and freedom of choice and rights of the people who live at the home. Staff also have a good awareness regarding of the health and emotional needs of the people that use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples’ personal and healthcare needs were clearly documented in the care plans examined. There were records of regular medical and specialist check ups and appropriate specialist input requested as needed. Staff work to a designated daily structure for each person which is complied by the senior staff at the home and which details all aspects of care each person needs on a daily basis. These were noted as being very comprehensive and provided staff with a method of ensuring that all needs are known by the staff involved in the care of the individual person. Peoples’ personal care needs were seen to be supported in respectful and dignified way by staff, and staff spoken with were able to demonstrate clearly how they respect the privacy and dignity of the people that use the service. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 20 An example was noting a person being facilitated to have their lunch in a separate area as this is what they felt most happy with. Another example was the positive way some staff communicate through signing with one person at the home. This clearly allowed the person to feel valued and have input into the home’s routines. A relative’s comment included the following: “I cannot fault the home. X’s needs are met and they understand their condition. They keep in contact with me and there is an on-going dialogue so that I am kept up to date with any plans. X had the last review of care in April and I was involved in this. I feel comfortable if I can’t get to visit as much as I would like as I know they are looking after hX well”. and others stated: “We have confidence in the home. We feel the staff understand the needs of X and meet these needs”. “I can ring at any time and I feel confident with the care X gets. X is well looked after and goes out reguarly” All the people have their own GP who will visit them at the home if required. Some comments receivedf rom visiting professionals included: “The Tobias Centre is an exceptionally well run place in the face of some very challenging people who live at the home. They have systems in place to deal with any eventaulities and are stronger for their systems”. “They seem to work with the increased needs of the person I see” A recognised monitored dosage system for the administration of medication is in place within the home. Discussion took place with the designated member of staff mostly responsible for the ordering and monitoring of medication within the home. It was clear from this discussion that she had a very good awareness of the need to be thorough and the systems reflected this being in order and up to date. Due to the needs of the people who live at the home different methods of administration are used having been risk assessed and agreed with relevant professionals etc and these are fully known and documented. A medication error occurred a little while ago, when some medication was noted as being missing from the medication cuboard when medicine numbers were counted. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 21 It could not be ascertained what had happened to the medication however all necessary steps were taken to ensure that the security of the medication stored in the home was more stringently provided for and there is now a continual monitoring of the medication held within the home. (The Commission was informed immediatly of the occurance which ensured awareness of the situation and evidenced that the management communicates with the Commission as required.) The manager also ensured that staff were made aware of their responsibilities to record medication administration as required, and to minimise any further error occuring two staff members now undertake the administration of the medication which is then also checked by the team coordinator at the end of each shift. There were full details of medications received into the home all records inspected were up to date. Medication was noted as being stored correctly in a locked fixed cuboard. The home is not holding any controlled medications at present, but is aware of the procedures necessary should this change. Any medications that are given on a “needs only” basis are kept seperatly and only a senior member of staff is allowed to make the decision as to whether the medication is required and then will oversee the giving of it. The additional security of medication and the monitoring of the medication administration by the management of the home has ensured the on going safety of the people at the home and has evidenced that the registerd manager is aware of the staffs’ responsibilites, and of hers, to ensure the staff are trained to undertake their duties as required which ultimatley protects the people who live at the home . Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 22 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): Standards 22 and 23. Quality in this outcome area is adequate. Although there is a satisfactory complaints procedure in place not everyone spoken with was aware of it and arrangements for protecting the people who use the service from abuse need to be improved by ensuring all staff attend vulnerable adult training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints procedure, which has now also been developed using pictures/symbols to make it more accessible to the people who live at the home however some carers spoken with were not are of this policy and how they could formally complain should they need to. A copy of this complaint procedure is available within the home. The Commission for Social Care Inspection has not received any complaint about the home since the last inspection. However there was a full investigation, in line with the adult protection procedures, in November last year when there was a disclosure regarding a member of staff’s approach towards the people that use the service. The organisation took immediate action to protect the people and undertook a full investigation, which resulted in the organisation activating their disciplinary procedures appropriately, and the member of staff involved now no longer works for the organisation. The carers of the person involved confirmed that the organisation’s actions had re-assured them that the organisation consider the welfare of the people who Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 23 live at the home as paramount and that it helped make them feel that their relative would always be protected. This evidences that the home will always ensure that protection for people that use the service is paramount. The home has policies and procedures in place regarding adult protection, in line with the local multi-agency code of practice and training in this area is offered. However out of the thirty staff employed at the home approximately nine have not yet received vulnerable adult abuse training, which could mean that they are not fully aware of how to identify abuse and/or deal with any concerns correctly. Incidents of an untoward nature, such as any restraint used in dealing with behavioural problems, are fully documented which helps protect all involved in living or working at the home. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 24 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): Standards 24 and 30. Quality in this outcome area is adequate. The home is comfortable, homely, clean and hygienic and does not have an institutional appearance. However some areas of the home still require upgrading to ensure that the environment remains to a good standard This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of all the communal rooms and bedrooms was made at the visit. The environment was noted as clean, homely and in fairly good repair. There is now a maintenance plan in place where routine maintenance needed can be recorded to ensure that the organisation is made aware of any shortfalls in the environment and can take steps to address them. This means that the organisation will ensure that the environment of the home is both pleasant and safe for the people who live at the home. Since the last inspection, some redecoration and refurbishment has taken place including the redecoration of the home’s lounge and hallways and the replacement of carpets in both these areas whilst new settees in the lounge area and dining room furniture has also been provided. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 25 The home’s laundry area has been upgraded and provided with new equipment to facilitate the efficient laundering of the people’s clothes etc. There are additional plans in hand to further improve/alter some areas of the home, including replacing the homes’ existing windows, repainting the outside of the building and re-adapting the lower ground floor area which currently provides accommodation for one person. This new work is then intended to allow this area to provide accommodation for two people who live at the home rather than the current one. However this planned work is still in the consultation stage and before any changes take place the management must ensure that the person, currently occupying the lower ground floor room, is fully consulted on what will be a major change to their accommodation and is in agreement to these planned changes as the person has lived in the current environment for the past four years. The management of the home are also hoping to be able to upgrade the safe, accessible but currently plain garden area to provide a more colourful and sensory experience for the people living at the home. The bedrooms reflected the personalities of the people with some having many personal items whilst others had chosen to have fewer items displayed. All were noted as clean and free from odour. The manager and staff are maintaining the home’s fire precautions as required. The home’s fire log book was inspected and seen to be in order with fire precautions and fire training undertaken as required. Automatic door guards are now also in place as required, where doors are needed to be left open. Laundry facilities were clean and hygienic having been upgraded and provided with new equipment to ensure that the staff are able to undertake the laundry needs of the people efficiently. There were sufficient procedures and training in place to ensure the control of infection and staff receive regular infection control training. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 26 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): Standards 32,34 and 35. Quality in this outcome area is adequate. The people who use the service are well supported by an experienced and enthusiastic staff group, however currently the numbers of trained staff are below the required 50 percent which means that the people are not being cared for at all times by trained staff. The registered manager of the home is not involved enough in the staff recruitment processes to allow her to have a full knowledge of any new staff members prior to employment as the full recruitment process is undertaken by the head office. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken to felt that there were enough staff to provide for the needs of the people and the staffing rota does ensure that the service has the correct number of staff on at all times with a mixed gender staff group working within the home. The ratio was discussed. The home has 8 carers on duty in the morning, 6 in the afternoon, 2 waking night staff and 2 sleep-in night staff. Additionally there is the manager and often the deputy manager on duty as well as was the case on the day of the inspection. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 27 This level of staffing allows for people to be able to do various activites at different times. Currenly there is only one female person living at the home with all others being of male gender. Therefore it was pleasing to note that there are several female staff on duty to provide for the personal care needs of the female person as needed etc. There is a core group of staff who have worked at the home for a number of yars and as such are very familiar with the peoples’ needs and all spoken with had a genuine desire to provide care taking into account the peoples’ best interests. Staff commnets stated such things as: “We work well together as a team”. “We all care very much about the people here”. The staff rota also ensures that there are senior members of staff on duty at all times. The manager also works alternate weekends. This ensures that experienced members of staff are always on duty so that the people who live at the home will be cared for by well trained and experienced staff. Staff were observed during the inspection to be interacting at all times with respect towards the people, and when spoken with all showed a genuine affection, regard and understanding of those they cared for. The staff files for the last two staff members were inspected. Staff files demonstrated that correct staff recruitment processes were carried out including obtaining criminal record bureau checks however these are carried out by the head office personnel and the manager did not get to see either the returned CRB or the references before the member of staff commenced working. This practice should be reviewed, as the manager, being the registered person, must be able to see this information prior to appointment to ensure that the prospective staff member is suitable for the role to which they are to be appointed. The organisation employs a designated staff trainer who is also an NVQ assessor and who works with and ensures that staff trianing is maintained as is required/needed. Currently out of the 30 staff at the home 8 have already obtained a recognised qualification in care with 16 others working towards this. When these staff have obtained this qualification the home will then exceed the required number of trained staff, however currently they do not meet this criteria. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 28 There was a training record for each staff member which clearly showed what training had been completed and when. Regular stautory training is provided including health and saftey, food hygiene, positive behavourial management, infection control, care of medications etc. Induction training is currently provided and the organisation is in the process of introducing a new very comrehensive induction package (details of which were shown at the inspection), based on the national minimum standards, which covers all required areas, taking a new staff member about three months to complete. Also each new staff member spends their first two weeks shadowing an experienced member of staff before undertaking work on their own. Staff comments reflected that these systems allow them to feel confident before they work alone with any person at the home and that there is always support made available if required. This level of induction and support also ensures that staff are fully aware of their role and the expectations of the organisation in relation to their role. The training manager is currently sourcing training material to cover equality and diversity issues that staff need to be aware of. However it should be noted, that although this training will enhance their knowledge, staff displayed a commitment to providing care for each person at the home in a fair and non discrininatory manner which took into account the many diverse needs of the current group of people living at the home. The manager holds staff meetings and the deputy manager and senior staff provide regular supervision sessions for staff with records kept. This ensures that staff are monitored and supported in their role and that, ultimately, people who live at the home are provided with the best care. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 29 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): Standards 37,39,41 and 42. Quality in this outcome area is adequate. The management and staff endeavour to ensure that the home is run in the best interests of the people living there. However the lack of recording of formal monthly visits by the responsible person means that the required monitoring is not being undertaken, as it should be. The home provides a mostly safe, secure environment however the safety of the people who live at the home is being compromised by the absence of some window restrictors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has had a newly registered manager in post from November 2006 although she was working at the home for a short while before becoming registered. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 30 She transferred from another home within the organisation and is very experienced having twenty years of experience and being appropriately trained, holding the Registered Manager’s Award and the nationally recognised NVQ 4 award in care She also updates her training and skills knowledge by attending regular training both inhouse and externally. An experienced deputy manager supports her in the management of the home. Staff spoken to felt that the manager was approachable and supportive and understood their roles. Examples of comments received were: “New manager is excellent, most approachable, things are back on track with the team and people who live at the home more supported, there is a more positive atmosphere it’s more consistent and the systems are better and now in place”. A relative’s comment also stated: “The manger is very kind” However there were mixed feelings about how staff felt about the organisation’s current responsible person with some stating they do not feel they have much communication with this person and as a consequence do not feel valued whilst others felt more positive. The previous named responsible person left the employment of the organisation earlier this year and has since been replaced. The Commission has been informed and is in the process of amending the registration certificates accordingly. The required monthly visits (under regulation 26 of the Care Home’s Regulations) by the named reponsible person should re-commnece and a record of the visit made available for inspection. This is so that the manager is supported in her role and there is a reference of what monitoring the responsible person undertakes to ensure that standards within the home remain high and meet the needs of the people who live at the home. The manager confirmed that there were up to date policies and procedures in place to cover all areas of health and safety including fire, manual handling, first aid, COSHH, infection control etc and that she monitored and oversaw the implementation and maintainance of these. The testing of portable appliances was last undertaken in March this year (certificate seen) and the manager confirmed that all other necessary health and safety procedures were maintianed. Hot water tested had been regulated to a safe temperature to ensure the people are safeguarded from the risk of scalding and the manager stated that water regulation and the protection of hot surfaces operates throughout the home. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 31 Questionnaires were sent out to relatives/carers so that the management and staff were able to obtain their views on how the home is run from which some very good feedback was noted, for example: “We are very pleased as a family with the care and understanding that X receives at the Tobias Centre” and: “Overall we are pleased with X’s care and X indicates that X likes the centre”. One person able to verbally communicate their feelings about the service had been enabled to complete a questionnaire which they had signed. The feedback from this was noted as positive with the person stating they were very happy with their care. The management intend to work towards including the views of all the people that use the service by improving the communication methods to enable them to communicate these views. An action plan had been put together incorporating any changes that the home felt would be beneficial resulting from the current feedback obtained. This was seen at the inspection and a quality assurance system has also begun to be developed within the home. The quality assurance system is focussing on relevant areas such as the need to ensure a more person centred approach to the care provided within the home generally, however the plan did not have any timescales when developments/improvements are due to be undertaken by. The pre-inspection paperwork returned to the Commission by the manager stated that checks on the home’s electrics, central heating, water and gas installations were carried out regularly. The home’s incident/accident recording was in order within the home. All staff receive training in health and safety issues which are updated annually. All of these measures ensure the overall welfare of the people who live at the home. However there is a need to ensure any windows above ground floor level have adequate restrictors in place, which limits how wide the windows can be opened, to ensure the safety of the people who live at the home can be maintained. Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 32 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 2 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 2 2 x x 2 x Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 33 yes 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 YA1 Regulation 4 (1) (a,b,c) (2) Requirement An updated and amended statement of purpose, containing details of the new management structure and any other new details regarding the way the home runs, must be made available to all interested parties including the Commission. This is so that that all those involved with the service are able to have up to date information about the home and the services it can offer. Timescale for action 16/09/07 2 YA1 5 (1) (a) (2) An updated and amended service 16/09/07 user guide, containing details of the new management structure and any other new details regarding the way the home runs, must be made available to all interested parties including the Commission. This is so that that all those involved with the service are able to have up to date information about the home and the services it can offer. The registered provider must 16/09/07 ensure that any planned changes DS0000018443.V343866.R01.S.doc Version 5.2 Page 34 3 YA16 12(3) Tobias Centre For Austistic Support Services 4 YA23 13 (6) to a specific person’s accommodation is only undertaken if the person is aware and in agreement with the changes. This is so that the person’s right to have proper provision made for their welfare is taken into account. The registered manager must 16/10/07 ensure that all care staff working at the home receive adult protection training. This is so that an aware and knowledgeable staff group will be able to protect people who live at the home. The registered provider must ensure that the required monthly visits are made in respect of the home. This is so that there is appropriate monitoring of the service by the responsible person to ensure that the people who live at the home at the home receive the required care. The home’s annual development plan must have timescales against work agreed to be undertaken. This is to allow monitoring of work done which will ensure that the service continues to improve as required. Window restrictors must be in place on all windows above ground floor that have wide openings. This is to ensure that the people at the home are proteccted from the risk of falling from a high window. 16/09/07 5 YA37 26 6 YA39 24 16/09/07 7 YA42 13(c) 16/08/07 Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 35 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 YA8 Good Practice Recommendations The communication methods used within the home between staff and the people at the home need to be further increased/improved upon. A shed should be provided to allow a person living at the home to be better able to undertake their hobbies and interests by having this space. The registered manager and staff should explore ways of ensuring that any individual religious and/or cultural needs are understood and met by the staff at the home. The registered manager should ensure that all relatives and/or carers are aware of the home’s complaint policy. The registered provider should continue with the upgrading of the home to ensure that the environment is maintained to a good level. The organisation should ensure that there is the required number of qualified staff on duty. Staff should also receive training on equality and diversity issues. The registered manager should have sight of the two references of newly appointed staff before the commencement of their employment at the home. The registered manager should also be made aware of any issues, or not, arising from the potential staff member’s Criminal Record Bureau check. 2 3 YA12 YA13 4 5 6 YA22 YA24 YA33 7 YA34 Tobias Centre For Austistic Support Services DS0000018443.V343866.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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