Inspection on 02/03/06 for Tobias Centre For Autistic Support Services

This inspection was carried out on 2nd March 2006.

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 3 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... 16/07/07

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

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 Annie Foot Unannounced Inspection 2nd March 2006 09:15 Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 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) Modus Care Limited Mr Neil Roy Jones 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.V262501.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: The Tobias Centre is registered to provide care for up to 11 adults with autistic spectrum disorder and additional sensory disabilities. The home currently caters for six service users, and due to their complex need and the high staffing level required, it is unlikely that services will be provided for more than this number. Modus Care Ltd owns the home. 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 set out as a flat for one service user, 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 service users. All bedrooms are single and some are ensuite. There are other shared bathrooms and toilets. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place during the morning of 2nd March 2006. It was the second inspection for the year. The purpose of the inspection was to follow up progress within the home and to ensure Requirements and Recommendations from the previous inspection had been addressed. The senior carer on duty explained that the manager was unavailable as she was running a training day at Head Office. The deputy manager Lindsey Banks came in to assist with the inspection despite it being her day off. The Registered Manager/Operations Manager, Neil Jones, arrived later in the morning. Everyone involved with the inspection was friendly, cooperative and open. There were 7 care staff on duty. One member of staff, due to be on duty was off due to compassionate leave. The inspection involved a partial tour of the building together with examination of care and medication records, policies, procedures and other paperwork. Discussions also took place with staff. Four service users were met, but communication was very limited. Staff are all skilled in sign language, and well able to assist with the communication with service users. A pre-inspection questionnaire has been completed and returned during December, in advance of the inspection. What the service does well: What has improved since the last inspection? A number of improvements have been made to environment since the last inspection. These include: redecoration and new furnishings in two service Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 6 users’ rooms, a new cupboard fitted around the boiler, new carpets in three bedrooms. The new kitchen has been completed and is well equipped, with new fridges and freezers. The appointment of a facilities manager to the company, enable the homes maintenance issues to be addressed more promptly than in the past. A good start has been made on developing a wide and varied training programme for staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Comprehensive written information is available about the home, but it is not in a suitable format for the service user group to understand. EVIDENCE: The statements of purpose and service user guide are comprehensive documents providing useful information for prospective service users and their families. The statement of purpose is printed in large font, which makes it easier to read. There is a copy of the service user guide contained in each service users’ file. The length of the document and size of print is difficult for the people for whom it is intended to read or comprehend. There is space on the guide for service users to sign, but none of the documents were signed. The format of the service user’s guide was discussed with the Registered/Operations Manager. It was agreed that in order to make the document useful other pictorial or widget formats are needed. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 Service users benefit from a well-organised care planning system, which take account of individual needs and aspirations. EVIDENCE: All service user files contain care plans, and were seen. Files are well organised and are up to date, with evidence of six monthly reviews. Risk assessments are detailed and are reviewed at least annually. One service had expressed their interest in riding a bicycle. This had been risk assessed and as a result a tandem purchased so that the service user can safely ride on roads with the support of a staff member. The Registered/Operations Manager said that the management were conscious of the need to revise the wording of risk assessments and gave an example of how this might be improved. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 Routines within the home are flexible within a framework: Staff encourage and support service users in participating with daily tasks and chores. Service users’ privacy is respected. EVIDENCE: From interaction observed between service users and staff and from discussions with staff it appears that service users rights are respected. A number of examples were given as how individual privacy is respected. Service users have keys to their rooms. Service users are encouraged to participate with daily chores. This is recorded on file. Routines for meals are flexible. Service users get up at different times and help themselves, to breakfast. Everyone tends to eat together at lunchtime and service users are encouraged to assist with the preparation. Staff prepare the evening meal but again with the assistance of service users. Service users are encouraged to get involved in meal preparations wherever they have capacity. One service user was seen making a drink. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 11 One service user prefers to eat in a separate room and another, in their flat There is a four-week menu in place. Staff said this was checked with the hospital dietician to ensure a balanced menu was in place. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Systems for the administration of medication are clearly understood by trained staff, which ensure that service users medication needs are met. EVIDENCE: The senior carer on duty has responsibility for medications. He was able to confirm that 18 of the 21 staff that administer medication have received inhouse training within the last six months. The remaining 3 are booked on a course in March 2006. Medicines are stored in a locked cupboard within a locked room. The room is currently being redecorated and there are plans to relocate medicines to another room in the home. Receipts and records for medications were examined. These were found to be accurate and up to date. There are two signatures for each entry. The home uses in-house designed record forms. PRN medication is stored in a separate locked cabinet fixed to the wall. PRN is only given on authorisation from nursing staff at the hospital. The box files used to hold blister pack are well used and need to be replaced. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Service users can feel confident that their concerns and complaints will be listened to acted upon, although without the intervention of staff they may not be able to understand procedures. Not all staff have the knowledge on how to protect service users from abuse. EVIDENCE: There is a complaints procedure in place and this was read. Staff are aware that in its present form the procedure is of little use to service users unable to read. Producing the procedure in other formats was discussed and is recommended. There have been no complaints within the last twelve months. Staff feel confident that if anyone had a complaint it would be brought to their attention through the key working system or the IPP or “My Views” systems. Since the last inspection 12 staff have received in house adult protection training - a further 18 are yet to undergo training. Staff said that in future adult protection is to be included at induction. There is an outstanding requirement from the last 3 inspections that all staff receive training in adult protection. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Recent investments in maintenance of the home have improved the environment for service users. Service users’ views about the décor and furniture of their rooms are taken into account in a sensitive way. EVIDENCE: The building is old and requires a high level of maintenance. A maintenance staff member is employed with responsibility for redecorations and minor repairs. The appointment of a facilities manager at Head Office has improved the speed at which maintenance issues dealt with. It is evident from discussion and observation that a number of previously outstanding environmental matters, have been recently resolved. The deputy manager explained plans in hand to rearrange the layout of the home, to take the focus away from the main entrance, which is busy, and to create a side entrance for visitors. This will enable service users to be less distracted from the comings and goings at the home, which at present can Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 15 cause distress. It will also enable visitors to the home to be introduced more gently to the service users. Three service users’ rooms were seen. Two rooms had just been redecorated and new fitments purchased. Service users choose the colours for their rooms. Specialist protection and equipment is in place in one of these rooms. In the other, new furniture has been purchased. The service user has expressed a liking for a rocking chair and this is to be obtained. The third room is vacant and does need to be redecorated and refurbished before anyone moves in. This is planned. A maintenance plan was not available. The home was clean and hygienic on the day of the inspection. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 Service users benefit from an effective staff team committed to enhancing quality of life. EVIDENCE: Six of the seven staff on duty were met and spoken to. Staff are enthusiastic and committed to working with the service user good. Several said they had made a positive choice to work at this home because of the nature of the challenges presented. Staff say they work well together and support each other as part of a team. Interaction between staff and service users is relaxed and individuals were seen to be at ease communicating with staff. The behaviours of some of the service users was said to have improved over the years due to their familiarity with staff and the stability of the team. There have been a number of staff changes due to health issues over recent weeks. This appears to have been slightly unsettling for some staff. However, there is a high ratio of staff to service users at 2:1. The staff rota was supplied with pre-inspection material and showed 8 staff on duty during the day and 2 waking and 2 sleeping night staff. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 17 There is a new induction-training programme in place. This was discussed with a newly appointed member of staff who was able to explain the content. Induction is comprehensive and contributes towards NVQ Level 2. A Training Coordinator is appointed at Head Office, to plan and take responsibility for the staff training programme. Staff said they received good training and felt they received sufficient input to understand and enable them to meet service users’ needs. Staff said that some of the training offered, resulted in positive proactive work with service users, rather than a traditional reactive response. Staff meetings are in place and are said to be valuable. Notes of meetings are made but were not seen. Staff files were not seen on this occasion. Staff were not aware of GCSC codes of conduct. These should be provided to all staff. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 The home is well organised with good management systems in place, despite the lack of the day-to-day support of the registered manager. Quality assurance systems for systematically monitoring and reviewing the quality of the service are not yet implemented. EVIDENCE: The formal management arrangements for the home are confusing. There is a Registered Manager for the home who is also Operations Manager for the company and has responsibility for overseeing management for other residential homes in Devon and Surrey. The manager has an office at the home, but is only able to spend limited time with service users and staff. There is a proposal to register the Home’s Manager as Registered Manager for Tobias. The process for doing this has been ongoing now for over six months and must be progressed and concluded. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 19 Staff said management is improving but more open communication with staff is needed. Other staff said that managers’ are accessible. The management encourage staff to progress with the company and as such they are opportunities for growth and promotion. The Quality Assurance system continues to be developed but has not yet been implemented. A lot of work has already been done and when complete the system will be fully comprehensive and provide a valuable quality assurance. The Operations Managers anticipates that work on the system will be completed by the end of March. Quality surveys involving service users their families and other interested parties have not taken place for over a year and need to be reintroduced. The development of an appropriate quality assurance system has been a requirement for the passed 3 inspections. The Facilities Manager conducts regulation 26 visits. Reports have not yet been sent to the Commission. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 20 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 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 3 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 x 2 x 2 x x x x Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 21 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 YA23 Regulation 13 (6) Requirement Timescale for action 31/05/06 2 YA37 9 3 YA39 24 To ensure that all care staff receive Adult protection training. (Previous requirement – 01/12/04,16/03/05, 5/11/05 – not met) The proposed manager’s 30/03/06 application to become the Registered Manager must be progressed and completed. There must be appropriate 30/04/06 quality assurance and monitoring systems in place, which include views of service users, their representatives and stakeholders. An annual development plan must be completed and a report made available for the Commission and other interested people. (Previous requirement, 30/12/04, 16/03/05, 5/12/05 – not met) Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA1 YA20 YA22 YA34 YA35 Good Practice Recommendations To consider other suitable and accessible formats for the statement of purpose and service user guide. To replace the box files which hold service users’ medications. To develop the complaints procedure into a format that is understandable to service users living at the home To provide all staff with a copy of the GCSG Code of Practice. To provide disability equality and equal opportunities training for staff. Tobias Centre For Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 Austistic Support Services DS0000018443.V262501.R02.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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