Inspection on 16/07/08 for Tobias Centre For Autistic Support Services

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

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

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2 Perhaver Park

The Vicarage

St George`s

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Credence House

Radfords

Trevaylor Manor

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 Tobias Centre For Autistic Support Services 8 St. Margarets Road Torquay Devon TQ1 4NW Lead Inspector Antonia Reynolds Unannounced Inspection 16th July 2008 9:55 Tobias Centre For Autistic Support Services DS0000018443.V364810.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 Autistic Support Services DS0000018443.V364810.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 Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tobias Centre For Autistic 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 Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th July 2007 Brief Description of the Service: The Tobias Centre is a care home providing personal care and accommodation for up to eleven people, aged over 18, who have autistic spectrum disorders and may have additional sensory impairments. The home presently caters for six people with complex needs who require high staffing levels. The home is owned by Modus Care Limited, which owns other care homes and hospitals in Devon and Surrey. Fee levels vary depending on the individual needs of service users but presently range from £1876 to £4317 per week. The Tobias Centre has been a care home for several years and is comprised of a large detached three-storey house in a residential area of Torquay. The home is within walking distance of local shops, the centre of Torquay is accessible by public transport, and the home has its own vehicles. All the bedrooms are single and are located on each floor. Three of the bedrooms have en suite toilets with showers and one bedroom has an en suite toilet. There are also showers, baths and toilets on each floor, close to bedrooms and communal rooms. The basement has been converted into two one-bedroom flats, each of which has its own bathroom, and they each have an enclosed part of the garden for the personal use of the people in the flats. There is a lounge and dining/activity room on the ground floor as well as quiet rooms used by specified people who live in the home. The home has an enclosed garden at the front and side of the premises. The home has its own car park and on-street parking is also available nearby. Information about the home and copies of inspection reports can be obtained from the Registered Manager, Marion Grogan, or from the organisation’s head office. The address is ‘Penhayes’, Kenton, Exeter, Devon EX6 8JB; Telephone 01626 899930. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection consisted of one unannounced visit between 9.55am and 3.45pm on Wednesday, 16th July 2008. The Deputy Manager was present throughout most of the visit and the home’s Behavioural Specialist was present for the latter part of the inspection. The Registered Manager, Marion Grogan, was spoken with on the telephone on 6th August 2008 as she was not available on the day of inspection. A tour of the premises took place and records/documents relating to the care of the service users, staff and the home were inspected. An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Five people who live in the home were spoken with or observed during the inspection. Five staff members were spoken with and others were observed in the course of their normal duties. Survey forms were received from one person who lives in the home and one staff member. What the service does well: The home is comfortable, the atmosphere is welcoming and the people who live there are encouraged and enabled to participate in a range of leisure and community activities, with independence being promoted. Good communication was observed between people who live in the home and staff who used total communication methods, including finger spelling and makaton, as well as words. Various pictures and symbols are also used in the home to facilitate communication. The home is continually looking and developing new activities for each person to maintain their presence in the community and to enhance their quality of life. 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. The staff training programme, which includes working towards nationally recognised qualifications as well as providing 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 people correctly. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 6 The Registered Manager is qualified and experienced and has put a comprehensive quality assurance system in place, which has enabled any shortfalls in the care provided to be identified and addressed. What has improved since the last inspection? What they could do better: The Statement of Purpose should be amended to include the qualifications of the Registered Manager and the new contact details for the Commission for Social Care Inspection. This is so that prospective and existing residents, as well as relatives/representatives, have all the information they need to make an informed choice about where to live. The Service User Guide should be amended to include: Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 7 • • • the support, services and facilities of this home rather than the organisation generally the fees charged including the cost of ‘extras’ such as charging people to use the home’s transport the new contact details for the Commission for Social Care Inspection This is so that prospective residents, as well as relatives/representatives, have all the information they need to make an informed choice about where to live. This is also to ensure that existing residents, relatives and representatives know what facilities and services the home should be offering. The practice of the organisation retaining the mobility component of Disability Living Allowance should be reviewed. Any agreements made with the people who live in the home, and/or relatives/representatives, about the use of this money, should be documented and kept under review. This is to ensure that the system is fair and equitable for all the people living in the home. The organisation should ensure that at least 50 of care staff in the home achieve a care qualification equivalent to, or higher than, a level 2 National Vocational Qualification. This is to ensure that competent and qualified staff supports people who live in the home. The Registered Manager should keep the following records in the home: • • a copy of each staff member’s employment history to confirm that any gaps have been explored and explained and that references have been obtained from previous social care employers the date on which Criminal Record Bureau checks have been issued. This is to ensure that robust recruitment processes are in place to protect people who live in the home from risk of harm. 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 Autistic Support Services DS0000018443.V364810.R01.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 Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.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): Standards 1, 2 and 4 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s admissions procedure ensures that prospective residents and their relatives/representatives know that the home will meet their needs. The home’s Statement of Purpose and Service User Guide do not contain all the information required to help people make an informed choice about where to live. EVIDENCE: The home has a Statement of Purpose and Service User Guide available for prospective and existing residents and their relatives/representatives. These documents have recently been reviewed and updated. However the Statement of Purpose did not include the qualifications of the Registered Manager or the new contact address for the Commission for Social Care Inspection. The Service User Guide contained general information relating to the organisation, rather than specifically to this home, therefore needs to be amended to reflect the support, services and facilities of the home. Neither of these documents contained information about people having to pay for the use of the home’s transport. When admitting new people to the home there is an admission procedure and assessment process to ensure that the person’s needs and aspirations are Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 10 identified before they come to live in the home. The Deputy Manager described this process that includes members of the staff and management team meeting the person concerned, their relatives and/or representatives, as well as any other professionals involved in the person’s care. Wherever possible staff from The Tobias Centre will work alongside staff who already know the prospective resident so they are familiar with that person’s needs and how staff respond to these. Prospective residents and their relatives/representatives are welcome to visit the home prior to admission to meet the other people who live there, the staff and have a look around the home. This may include day visits and overnight stays if appropriate. Guidelines and an interim care/support plan are put in place before the person moves in so that staff are aware of their needs and how to meet them. The home does not accept emergency admissions. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.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): Standards 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be confident that they will be encouraged and supported to make choices and decisions about their lifestyles. Care/support plans and risk assessments reflect the complex needs of the people in the home. EVIDENCE: Discussions with a person who lives in the home and the staff team, as well as information contained in personal files, confirmed that personal care is maintained, people can bathe/shower when they choose to and are encouraged to be as independent and make as many choices as possible. Wherever possible people who live in the home are involved in the day-to-day running of the home and independence is promoted. Two personal files of people who live in the home were inspected and these contained care plans and risk assessments relating to social, health and personal care needs. The Deputy Manager confirmed that person centred Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 12 planning is being introduced into the home. The communication methods used within the home between staff and the people who live there have been improved and a competency pack has been developed for each person relating to communication needs. With regard to peoples’ money, the Deputy Manager confirmed that they are in the process of setting up personal bank accounts for everyone who lives in the home. In the meantime five of the six people living in the home have their money managed by the organisation (Modus Care Limited) and this is kept in an account specifically for this purpose. The money of the sixth person is administered by parents. If people need money, staff contact the Head Office, and money is transferred to the home. The home then administers this spending money on behalf of the people who live in the home, unless the person is able to look after it themselves. The financial records of two people who live in the home were checked and found to be generally correct, although one was a few pence out. The Deputy Manager agreed to sort this out. The Deputy Manager said that, wherever possible, people are supported and enabled to administer their own finances. The home provides transport (a car and a people carrier) for all the people who live in the home. The organisation retains the mobility component of Disability Living Allowance (DLA) from five of the residents as a contribution towards the cost of transport. This means that the organisation also meets the costs of any public transport that people use including taxis. However this system is not fair and equitable because people may be in receipt of differing amounts of DLA, people may not have equal use of the transport and one person is not contributing this money at present. Therefore some people who live in the home may be subsidising others for the use of the home’s transport. The Deputy Manager said that she believed a formal agreement had been made about the use of DLA with the people who live in the home and/or relatives/representatives but these were not in evidence on the day of inspection. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home can feel confident that they will have opportunities for personal development, various activities are available to fulfil their aspirations, and independence and choice are promoted. EVIDENCE: Discussions with staff, as well as information contained in personal files and various activity charts, showed that all the people who live in the home are encouraged and supported to participate in a range of leisure and community activities. People’s individual interests and hobbies are accommodated and supported by staff at the home. For example, people have computers, one person has a driving simulation machine and another person has been provided with a workshop and tools. People who live in the home use the local amenities, such as shops, cafes, pubs, discos, the church, swimming pool, gym and any other places they may wish to visit. Information from a staff member suggested that a sensory room would be useful for people and the Registered Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 14 Manager confirmed that this is part of the long term plan for the home. In the meantime, people are supported to use sensory rooms in local day care centres and schools. Wherever possible the people who live in the home are involved in daily routines and domestic activities, including cleaning and tidying their own rooms, preparing and cooking meals/snacks and doing their own laundry. Discussion with staff confirmed that relatives are welcome to visit the home, telephone contact is encouraged and supported, and some people visit their families on a regular basis. Observation and discussions with staff showed that the staff team were knowledgeable about the personalities of each person in the home and the activities that they enjoy. Good communication was observed between the people who live in the home and staff who used total communication methods, including finger spelling and makaton, as well as words. Various pictures and symbols are also used in the home to facilitate communication between people who live there and staff. Each person in the home participates in individual activities supported by the staff team. The home is continually looking for and developing new activities for each person to maintain their presence in the community and to enhance their quality of life. The Deputy Manager confirmed that holidays are arranged for some people but going away from a familiar environment is sometimes difficult for people due to their complex needs. However the home is taking one person away on holiday this year for the first time as a new venture, thereby demonstrating that staff are willing to support people to have different experiences. The home owns a people carrier and a car to transport people to appointments and social events. People who live in the home are also supported to use public transport, including taxis, if they are able to. The organisation retains the mobility component of Disability Living Allowance from five of the residents as a contribution towards the cost of transport (see Standards 1 and 7). A written menu was available, which showed that the people who live in the home are offered a varied selection of meals. Discussions with the staff team indicated that they are well aware of the likes and dislikes of each person and are always willing to offer alternatives to the menu. People who live in the home have a choice of where to eat their meals and, if possible, people are supported to prepare and cook their own drinks, meals and snacks. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 15 Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be confident that personal support is provided in the way, and at the time, that they want and need. Health care needs are monitored and external professional advice is sought when necessary. EVIDENCE: Care/support plans for two people who live in the home were inspected. These provided information about personal, emotional and health care needs and how these should be met/supported by the staff team. The home keeps daily records to monitor an individual’s progress. External professional advice and guidance is sought when necessary from local health care professionals, the learning disability service or social services and visits to the doctor, dentist and other health appointments are recorded in individual files. Specialist assessments and guidance are sought if required, for example, speech and language therapy and reflexology. Through observation it is clear that timings are flexible and the choice of the people who live in the home. Medication was stored securely in new metal cupboards obtained since the last inspection. Records pertaining to its administration were up-to-date, audited Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 17 weekly, and the administration practices described by a staff member were satisfactory. All the staff have received training in the administration of medication and new staff are supervised until they are deemed to be competent. 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, and these are fully known and documented. Procedures are in place for medication that is prescribed on a “needs only” basis where its use can only be authorised by a senior member of staff. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home, and their relatives/representatives, can be confident that they will be protected from any risk of harm and any concerns or complaints will be listened to and addressed. EVIDENCE: The home has a complaints procedure and discussion with one of the people who lives in the home confirmed that they know what to do if they have a problem or complaint. Discussions with the staff and management team showed that the open culture of the home and the recognition of people’s rights ensure that they are protected from harm. The Deputy Manager confirmed that all staff are expected to attend in-house and external training courses related to the safeguarding and protection of vulnerable adults. The home has a procedure for staff and management to follow should an incident occur and has copies of useful publications such as the Department of Health’s document ‘No Secrets’. Incidents of an untoward nature such as physical restraint of any kind, used by staff when managing someone’s behaviour, are fully documented and monitored by senior staff to look for any patterns which may help to reduce the behaviour in future. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a clean, safe and comfortable home that is constantly being refurbished and redecorated so that the environment remains at a good standard. EVIDENCE: The home is comfortable, safe and clean with a good standard of décor and furnishings. The home has a maintenance plan to record jobs that need to be done and when they are completed. The Deputy Manager confirmed that repairs, maintenance and redecoration are ongoing projects. There are lounge, dining and quiet rooms on the ground floor and this is where the people who live in the home spend most of their time with staff support. Rooms that are not being used at any particular time are usually kept locked, for example the kitchen, so that the people who live in the home cannot enter those rooms as they may be at risk of harm if they go in on their own. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 20 Each person who lives in the home has a single bedroom with space for individual needs and lifestyles. There are two one-bedroom flats in the basement with their own lounge, kitchen and bathroom; one bedroom is on the ground floor and the person in that room has the exclusive use of a bathroom; and the other bedrooms are on the 1st floor. All of the bedroom doors are fitted with appropriate locks that can be locked from the inside by the residents and locked from the outside by using a key. The people who live in the home can have a key to their bedroom door subject to risk assessment. For example, the key to one person’s door hangs on a hook outside it because that is their choice. Bedrooms are always kept locked when people are not in them to prevent unwanted entry by other residents. The Deputy Manager said that the people in the home may have unrestricted access to their own bedrooms whenever they want. All the bedrooms contained wash hand basins and four of them have en suite toilets, with three of these also having showers. However these en suite rooms are not all occupied by the people who currently live in the home. Bedrooms are individually furnished and personalised by or for the people who live in the home, depending on their wishes. The Deputy Manager confirmed that, wherever possible, people are enabled and supported to choose the colour and décor of their bedrooms. The type and quantity of furniture varies dependant on the wishes and needs of individual people. The bathrooms and toilets are in good condition and discussion with the Deputy Manager, as well as observation, indicated that there are enough facilities to meet the needs of the residents and staff. All of the bathrooms, except the one for a person’s exclusive use on the ground floor, and toilet doors are fitted with locks that can be opened from the outside by staff in an emergency. The Deputy Manager confirmed that people use their own en suite facilities for personal care tasks. At the front and sides of the building there is a garden that may be used by everyone. Two areas in the garden have been fenced off to provide private gardens for the people living in the two flats in the basement. There is a parking area for cars at the back of the house. Laundry and kitchen facilities are satisfactory and discussions with the Deputy Manager and staff confirmed that infection control procedures are in place. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 21 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, 33, 34, 35 and 36 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are robust and the people who live in the home benefit from a competent, experienced, well-supported and motivated staff team. EVIDENCE: Throughout the inspection staff were observed responding sensitively and respectfully to the people they support and were able to use their knowledge of each individual to encourage choice and independence whenever possible. Staff were friendly, good-natured, courteous and respectful at all times. They interacted well with the people in the home and used various methods of communication with people. Discussions with the staff on duty and the Deputy Manager confirmed that there are always enough staff on duty to meet the needs of the people who live in the home. Everyone who lives in the home needs a staffing ratio of at least 1:1 during the day and sometimes a higher ratio when they go out. On the day of inspection there were nine staff on duty as well as the Deputy Manager. At night there are usually three waking night staff and one member of staff who sleeps in the home. The home has an on-call system for staff to Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 22 either seek advice/support on the telephone or for an additional person to come to the home should assistance be needed. There is also a senior Manager on call at all times. The files of two newly recruited staff members were inspected and showed that the organisation has a robust recruitment procedure managed through the Head Office. Information in these files, as well as discussion with the Deputy Manager, confirmed that all the required checks and references are obtained before new staff start work. Copies of relevant documents are usually kept on the premises so that they are available for inspection however one file did not contain a copy of the person’s application form. This meant that their employment history could not be checked to ensure that any gaps had been explored and explained. Neither was it possible to check that the references on file had been obtained from previous social care employers. There was documentation confirming that checks had been obtained from the Criminal Records Bureau but the dates of these checks had not been recorded, therefore it could not be confirmed that these were obtained before the staff started work. Discussions with staff and the Deputy Manager, as well as documentation, showed that all staff are expected to participate in various courses or training sessions and receive regular supervision. The home has a designated training co-ordinator and all staff are expected to complete an induction programme as well as ongoing training covering topics such as health and safety, manual handling, food hygiene, infection control, first aid, fire safety, positive behavourial management, breakaway techniques, infection control, medication, safeguarding vulnerable adults, equality and diversity, epilepsy, autism and Asperger’s syndrome, the Mental Health Act and total communication skills as well as National Vocational Qualifications. The training officer confirmed that a new induction pack, specifically designed for staff working with people with learning disabilities, is being introduced in September 2008. He also confirmed that, due to problems with a previous training provider, only nine members of the staff team have a qualification eqivalent or higher than a level 2 National Vocational Qualification (NVQ) although three staff members are working towards it. The Deputy Manager confirmed that most staff will receive training related to the introduction of the new Mental Capacity Act in due course. The Deputy Manager said that staff, team and link worker meetings are held regularly so that everyone is kept up to date with the changing needs of the people they support. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 23 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 and 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from a well run home, where the quality of care provided is regularly reviewed through a process of self-review and consultation. EVIDENCE: The Registered Manager, Marion Grogan, has been managing this home for approximately two years but has many years of management and care experience. She confirmed that she has relevant care and management qualifications in that she has completed a level 4 National Vocational Qualification (NVQ) in Care and the Registered Manager’s Award. She has recently attended training relating to the new Mental Capacity Act thereby demonstrating that she keeps herself up to date with current good practice in Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 24 social care. A Deputy Manager supports the Registered Manager and the organisation’s senior management team visit the home on a regular basis. Discussions with the Deputy Manager, the home’s training officer, as well as training records, confirmed that all staff are expected to attend training in health and safety, first aid, food hygiene and fire safety. The fire logbook showed that the tests and checks of the fire safety equipment were carried out regularly and there was a fire risk assessment in place. There are flashing lights in bedrooms connected to the fire alarm system so that people with a hearing impairment know the alarm has been activated. Documentation in the home showed that health and safety checks and tests have taken place such as servicing and checks/tests of the gas and electrical supply, as well as the plumbing. Portable electrical appliances have been checked for safety. The Deputy Manager confirmed that all the hot water for baths/showers is regulated and checked by staff to ensure that the temperature control valves are working so that the people who live in the home are protected from scalding. She also confirmed that all the radiators are guarded to prevent people from burning themselves and that window restrictors are fitted to all windows above the ground floor. However a window was found that did not have a restrictor fitted. This was in the staff bedroom and the door to the room was locked at the time of inspection and the Deputy Manager confirmed that this door is always kept locked. The quality of care provided is continually being monitored and reviewed by the Registered Manager as well as through the monthly visits carried out by a senior representative from the organisation. This process includes obtaining feedback from the people who live in the home, their relatives/representatives and any other professionals involved in the person’s care. The Registered Manager has also carried out an internal audit and, from all this information, has produced a report with an annual development plan of issues that need to be addressed with timescales. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 25 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 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 X 3 X X 3 X Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 The Statement of Purpose should be amended to include the qualifications of the Registered Manager and the new contact details for the Commission for Social Care Inspection. This is so that prospective and existing residents, as well as relatives and representatives, have all the information they need to make an informed choice about where to live. The Service User Guide should be amended to include the following information. • • • The support, services and facilities of this home rather than the organisation generally. The fees charged including the cost of ‘extras’ such as charging people to use the home’s transport. The new contact details for the Commission for Social Care Inspection 2. YA1 This is so that prospective residents, as well as relatives Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 27 3. YA7 4. YA32 5. YA34 and representatives, have all the information they need to make an informed choice about where to live. This is also to ensure that existing residents, relatives and representatives know what facilities and services the home should be offering. The practice of the organisation retaining the mobility component of Disability Living Allowance should be reviewed. Any agreements made with the people who live in the home, or relatives and representatives, about the use of this money, should be documented and kept under review. This is to ensure that the system is fair and equitable for all the people living in the home. The organisation should ensure that at least 50 of care staff in the home achieve a care qualification equivalent to, or higher than, a level 2 National Vocational Qualification. This is to ensure that competent and qualified staff supports people who live in the home. The Registered Manager should keep the following records in the home. • A copy of each staff member’s employment history to confirm that any gaps have been explored and explained and that references have been obtained from previous social care employers. The date on which Criminal Record Bureau checks have been issued. • This is to ensure that robust recruitment processes are in place to protect people who live in the home from risk of harm. Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Tobias Centre For Autistic Support Services DS0000018443.V364810.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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