Inspection on 01/11/06 for Upper Ford Lodge

This inspection was carried out on 1st November 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Upper Ford Lodge 20/10/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Upper Ford Lodge Ford Lane Droitwich Spa Worcestershire WR9 0BQ Lead Inspector S Davies Unannounced Inspection 1st November 2006 13.45 Upper Ford Lodge DS0000067675.V322104.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 Upper Ford Lodge DS0000067675.V322104.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. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Upper Ford Lodge Address Ford Lane Droitwich Spa Worcestershire WR9 0BQ 01905 779949 01905 779245 kevinh@autismwestmidlands.org.uk 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) autism.westmidlands Mr Kevin Joseph Hayes Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: Upper Ford Lodge is in a rural area on the outskirts of Droitwich. It consists of two properties, one house providing the residential accommodation and one offering linked day centre facilities for these service users, set in a large secure garden area. The service is currently registered to provide for 8 people accommodated in 8 single bedrooms on 3 floors, with a kitchen, dining room and two communal rooms, plus staff offices. Weekly fee levels range from £1706 to £2077. The service provides residential and day care for up to 8 younger adults with autistic spectrum disorder. There is a high ratio of staff to service users, including day centre staff, to provide all with opportunities for 1:1 support for personal and social skills development and to ensure access to a range of social and leisure opportunities in both the home and community. The registered providers are autism.westmidlands. The Chief Executive Officer, Ms Carolyn Bailey, is the Responsible Individual. The registered manager is Mr Kevin Hayes. Mr Allan White provides professional line management support and supervision to the registered manager on behalf of the providers. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the care home was made as part of a key inspection. The focus of the inspection was to follow up previous requirements and recommendations, and to assess the extent to which management and staffing arrangements and care provision at the home achieved good outcomes for the service users. Preparation for the inspection included looking at previous reports, information about the home’s recent history, the pre inspection questionnaire and monthly visit reports completed by the provider, together with responses to survey questionnaires sent to service users, their families and supporters, and professional social and health care agencies. The inspection was undertaken over two days at different times of the day, from midday to late afternoon. Time was spent talking with the manager and members of staff and in meeting with service users according to their level of communication. The care records of 2 service users were looked at as well as the way they were being supported, and discussed with staff members. Records kept in respect of staffing, medication, food provision and a sample of the home’s written policies and procedures were also checked. Survey cards were sent out to family carers and health and social care professionals, of whom four relatives and four professionals replied. All the relatives were very pleased with the care at Upper Ford Lodge, saying for example ‘.. seems very content and happier each time we visit’ ‘ in the last couple of years the care has improved tremendously’ . One response referred to the lack of a complaints procedure although they had felt able to raise concerns anyway. Professional responses included ‘Upper Ford Lodge staff ..very professional in their approach and very honest and open’ ‘ staff approachable and dedicated…highly resourceful and cooperative’ ‘happy for one of my relatives to live in the home’. The time and assistance everyone made available for the inspection were appreciated. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Service users are benefiting from better records and communication between staff about their needs and preferences. Some service users are able to help put together their service user plan. Service users records are now more coordinated and much clearer, including health action plans and risk assessments, although staff must still take care they are kept up to date so that they can take all this information into account properly day to day. Staff now need to use information about what is risky for service users to help them learn how to manage better Service users are getting to know staff better now that they stay longer and there are fewer changes. This stability is better for everyone as it gives them Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 7 all more confidence and trust in one another. This is helping staff improve their understanding and support service users in a much more consistent way. Consistent support is very important for people with autistic spectrum disorder, who cannot cope well with a lot of changes and need to trust their carers to know what suits and reassures them. This is working well so that there is now a calmer atmosphere in the home, with service users able to relax and spend time as and where they choose. 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. Upper Ford Lodge DS0000067675.V322104.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 Upper Ford Lodge DS0000067675.V322104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The service is well prepared to consider prospective new service users, with a thorough and well thought out procedure to help future service users and their supporters make the right decision about whether the home would be right for them. EVIDENCE: Prospective service users benefit from the specialist understanding and skills this service offers, to make a thorough assessment of their needs. They can be confident that even though they may have difficulty expressing themselves, and would find it hard to follow a process of trial visits to help them get to know the service and the people there, the assessment process takes this fully into account. The manager and experienced staff from the service will spend a lot of time visiting them where they are living. They will talk to them and all the people who care for and know them well, about all the details of their everyday life. The people from the service will build a picture of the person they are and decide whether the service can offer them the home and the help they need. If so they will be asked to move in so that staff can get to know them better. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 10 The service will only offer them a permanent place once everyone is satisfied they and the other people living there feel comfortable with each other, and that it can meet their needs. Service users have a lot of time and support from experienced staff at this time to reassure them and help them settle in. Careful records are kept and there is a lot of discussion, about how they are getting on. The final decision about moving in will be shared between all the key people in their life to make sure everyone agrees it is the right decision for them, and when everyone feels they are ready. Records for people who have moved into the home recently show this. They are detailed and show this is a very careful process that takes time to get right, which the manager is careful not to rush. He has a great deal of expertise in this area and uses the same skills to make sure people who are moving out are given the same time, attention and respect to get their next move right, too. Surveys of supporters’ views say they found this was a good approach to assessment and introduction for their relative, it was the best way to get the right information about them and so was very reassuring. Upper Ford Lodge DS0000067675.V322104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users’ plans are becoming more person centred and help them to play more of a part in the decisions about their own lives. EVIDENCE: Service users know their needs are carefully assessed before they come into the home and this assessment is used as the basis for putting together a service user plan as staff get to know them better. People with autistic spectrum disorder are all very different from one another, but share characteristic difficulties with understanding and communication, referred to as the Triad of Impairment, so that it can be difficult to talk with them about their needs, progress and personal goals. To help them, each service user has a named member of staff who works closely with them as their key worker, who gets to know them very well and is responsible for coordinating and communicating information on their behalf so that other staff can understand them as unique individuals. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 12 Service users can now be more confident that staff here will support them properly, because their service user plans present their information much more clearly. Their plans not only have detailed descriptions of who they are and the help they need, but they have been better organised so staff can see how all the things work together that affect their daily lives. This means they can be sure staff understand who they are and what is important to them, and are on the lookout for things that may need extra attention. This is still improving but a good start has been made. To help staff see the whole person rather than a set of needs, they are being trained in person centred planning. This helps them make sure service user plans show what it is really like to be the individual they are written about. Each plan shows in detail how that person communicates, their specific likes and interests, abilities, anxieties, health needs and the things they find difficult that can trigger upset behaviours. As they get better trained, staff are getting much better at including in the plan all the things that matter about being that person. So it is very important to make sure the person centred approach is used all through the record. The service users plans seen also describe very well the things their carers need to be aware of about their behaviour or the way they understand the world, that might cause them harm, so as to help them manage safely and to live fulfilling lives. These assessments of risk need to be completed for all aspects of their daily lives so they can be used to plan the help and support each person needs to manage themself more safely. For example one person who moved in a few months ago still needs more information written down about what is risky for her. The service user plans are regularly reviewed with the service user and their family carers and placing bodies, and other professional supporters if this is appropriate. This is usually every six months, and helps make sure everyone agrees how things are going for that person and whether they need any changes to be made in their support plan. The regular reviews are important because they bring everyone together, but because someone with ASD relies on sound communication between everyone who cares for them, they do need to be confident this information is kept right up to date. So, one thing key workers do here is keep monthly summaries showing progress, highlighting important information and making sure all staff are careful about following the service users plan in the same way. But some of the summaries in records seen during the inspection were months out of date. To get the best out of life and to be supported towards making their own choices and decisions, service users need to be sure staff have up to date information about how they are doing, so it is very important these summaries are properly maintained. Upper Ford Lodge DS0000067675.V322104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16, and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users generally have good contact with their families, and enjoy a variety of individual and group activities both within and outside the home, which are appropriate to their age and interests and offer the chance to try new experiences EVIDENCE: Service users follow a variety of activities they are interested in. Some examples are college, trampolining, horse riding, swimming, football, bowling and they are doing more things like this that bring them in touch with their local community. They also enjoy walks, and visiting places such as the sea life centre, car races and cinema, and many enjoy a drive out through the countryside, which can be relaxing for them. At home there are many things for them to do both in the day centre and the residential area, such as art and craft, music, light therapy, television and videos or DVDs, jigsaws and games indoors and out, helping staff with cooking and caring for their rooms. One service user attends church. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 14 They particularly enjoy individual time with key workers such as personal shopping trips, but also attend social activities together such as the local Gateway club, going to the local pub and meals out. They are doing more of these things now that as a group they get along better with each other and can go out together more. However, their records do not show how information about triggers and unacceptable behaviours is coordinated with likely scenarios in the community, to help plan outside activities, anticipate and prepare for potential behaviour problems. Service users need to know they can continue to benefit from and build on their community links, so they need staff to be aware, anticipate and be able to help them respond appropriately to potential difficulties. Experiences when out need to be recorded and monitored as part of the steps towards supporting the learning of new skills. Service users all have some family contact and key workers help them keep in touch with their families through visits and telephone calls. Key workers and other staff also make sure families stay involved and up to date about the care of their relative so that service users get the best help and support from everyone whether they are in their own home at Upper Ford Lodge or at the family home. To help with this, service users take home communication diaries, where staff and their families write important information that needs to be shared. Staff know that this helps too when service users go away on holiday, if planned properly to take account of what matters to them. Their records show most of them enjoy holidays with either their families or Upper Ford Lodge staff. Where some people feel more comfortable coming back to the place they know well, and prefer to have days out rather than go away on holiday, this is understood too, and planned with them to make sure they enjoy themselves in the way they like best. These service users have limited awareness of the needs of others or the responsibilities of group living, but their own rights are respected and upheld and staff aim to remind them gently of the need to respect each others space and privacy. For example one service user who regularly takes other service users drink is gently but clearly discouraged from this and offered her own drink, according to guidance in her plan which the daily record shows staff follow consistently. Staff really want to help them make their own wishes felt and develop new skills and interests. Service users are already able to enjoy a wider range of activities, and this is expanding because staff are happy to introduce and share their own interests with them too. This is helping build a better understanding of personal preferences, while pictures, symbols and photos are being used more to guide and help service users express choices. Although it can be hard for people with autistic spectrum disorder to understand about making decisions, staff need to keep in mind ways they Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 15 could have more chance to show how they would like things done. For example, as work needs to be done around the house to make it fresher and brighter and more homely, it would be good practice as part of the planning to record observations about what service users like around them or respond well to. Mealtimes might be another area where a change in approach to planning may be valuable. Some service users help with aspects of food choice and preparation, but this is not recorded as a regular part of planned daily activities and more consideration could be given to this. At the moment the cook is primarily responsible for planning the menu, and the menus seen show the range of choices has narrowed to a regular ‘common denominator’ of easy meals most people will eat. Current food provision is simple with a limited range of vegetables, much tinned food in evidence, and regular use of ‘value’ products, although fresh fruit is readily available. This approach does not always offer the most interesting or nutritious diet, so keeping alert to possible ways of introducing change is important. However if service users do not accept more change, choose only small portions and a narrow range of meals, they need to have confidence their nutritional needs are met in what they do eat with only the best quality ingredients being used. The value ranges, tinned foods and processed ingredients seen in storage during the inspection, tend to have a higher proportion of fat and sugars and may be neither as appealing, tasty nor nutritionally sufficient for active young adults. The emphasis needs to be on freshly prepared meals using fresh high quality ingredients. Dietary advice has previously been sought for a service user with a very restricted diet. In view of these service users special needs particularly where they significantly restrict the range of foods they will eat, it would be good practice to seek ongoing support from a dietician, so that service users can be sure the food provided is as nourishing as possible. Upper Ford Lodge DS0000067675.V322104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is some good practice and staff show they have a good knowledge and understanding of service users personal and health care support needs. This now needs to progress beyond support to promote service users personal awareness and skills development in a systematic way, to help them develop more control over their lives. EVIDENCE: Service users can be confident staff know and understand what matters to them about the way they are supported to care for themselves. Their plans contain detailed information about their personal and healthcare needs and this information corresponds to their health action plans, which are currently being completed. Evidence from discussion, records and surveys shows good liaison with health care agencies. Staff actively promote a philosophy of supporting service users to be as independent as possible while making sure through daily records and discussion that personal and health care is consistently attended to. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 17 Service users are helped to make choices for themselves, for example going clothes shopping with staff and being encouraged to decide for themselves what they like to wear. One key worker acknowledged how staff are aware of the way their own tastes may affect the way they support service users, and are therefore careful to make sure service users have support to choose from as wide a range of options as they can cope with. Information in service users personal and health care records is better coordinated, and staff spoken to speak confidently and knowledgably about how to support them. Service users can therefore be reassured that information is now being gathered in a way that should help staff monitor and respond to their needs in a timely and consistent way. Their plans contain very detailed pictures of their needs, include detailed communication profiles, record challenging incidents and describe clear risk management strategies, and staff show a good understanding of triggers that lead service users to problematic responses. It is evident from care records and a reduction in incident reports that service users are now enjoying a much calmer life in this home, with staff communicating better and using their shared knowledge more effectively to help avoid such triggers. Service users are taking part in more things and joining in activities in the wider community, and need well planned support to continue making progress. To do this staff will need clear guidance and training to help them assess the skills service users already have, and plan how to help them learn new ones to gain more control over their own lives. To do this properly, service users need staff to communicate effectively with them, so communication profiles need to be followed up to make sure staff have the right training. For example one of the newest service users has learned Makaton, but this skill lapsed when previous carers lacked this ability and she needs staff to resume this with her. Medication policies and procedures are clear and designed to make sure service users receive the support they need in managing their medication. Records show no service user is assessed as being able to take responsibility for their own medication or understand the meaning of consent to staff administering their medication. There is regular support and oversight of the medication systems from the community pharmacist, indicated by satisfactory monitoring reports. Medication administration records and storage are in order, and a sample of medication in the home showed service users can be confident this is being managed responsibly on their behalf. Upper Ford Lodge DS0000067675.V322104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Procedures for protecting service users interests are in place, and staff receive appropriate training. Robust recruitment procedures are followed so service users can be confident they can trust staff who work with them. Information about complaints and safeguarding from abuse needs to be complete and accurate. Relatives are unaware of the complaints procedure. Although staff are aware of what constitutes abuse and of the need to promptly report any concerns, they have been provided with inaccurate information about local procedures for responding to abuse. The providers must put this right as they have been required to do. EVIDENCE: Service users seen in the home during the inspection seemed settled and relaxed, and interactions between staff and service users were good humoured. No complaints have been received about this service since the last inspection, and there has been no need for referral to safeguarding adults procedures. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 19 Documentation guiding staff about complaints and safeguarding adults procedures still contains errors. These must be corrected to make sure the right steps are taken in the event of concern. There is a corporate complaints procedure, which still awaits updating as highlighted in previous inspections. The copy of the procedure seen still refers to the National Care Standards Commission, which needs to be replaced with the name, and correct local office address and telephone number, of the Commission for Social Care Inspection so that complainants have accurate information about who to contact in the event they wish to formally voice a complaint. The procedure needs to specify the timescales for responding to the complaint. Survey respondents said they had not had information about the complaints procedure. The service needs to make sure it puts this right, so that service users can be sure their relatives and significant others know how to take up issues if necessary on their behalf. Although it is recognised not all service users will find this meaningful, service users themselves also need a version of the complaints procedure, in a format which is more accessible to them for example using symbols. New staff take part in a programme of foundation learning linked to the Learning Disability Advisory Forum framework through which they are trained in the principles of safeguarding people. There is further in house and external training on this topic and on the management of behaviour which may challenge the service. It is intended all staff will receive training at foundation level and be trained to National Vocational Qualification level 2 in due course, ensuring all have the same level of training in safeguarding adults. However, the corporate policy and procedure documents contain misleading information. They still refer to the National Care Standards Commission, and to Birmingham City Council guidelines contact details and procedures for safeguarding adults, despite previous requirements to establish a policy for Upper Ford Lodge which incorporates the local Worcestershire County Council procedures. The misleading details need to be replaced with complete and accurate information about local procedures, and all staff provided with correct information and training without further delay. It was reassuring that despite this staff spoken to were aware of correct local procedures. There is a clear equal opportunities policy, and staff are committed to making sure service users have the support and encouragement they need to access community facilities. Staff records show service users can be confident they can trust staff who work with them, through the application of robust recruitment procedures. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 20 Procedures for managing service users finances are transparent with transactions signed for, checked and supported by receipts, providing clear evidence that their personal money is handled in their best interests. However the manager is appointee for four service users and one more is being transferred to his appointeeship. It would be good practice to avoid the service holding such responsibility and to make more suitable arrangements. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The premises are sufficiently spacious indoors and out for 8 people, with a separate day centre for additional daytime activities. However the furnishings and accommodation show significant signs of wear. Carpets and paintwork have not been well maintained, so that much of the communal space is bleak and unwelcoming. Bathrooms need upgrading. EVIDENCE: Service users have a right to live in comfortable, safe and homelike surroundings which are clean and well maintained. They are unable to do so at Upper Ford Lodge because the accommodation does not currently meet this standard throughout. Upper Ford Lodge consists of two large buildings, the day centre and the residential home. There is a maintenance programme and the residential home Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 22 has had some work done since it opened, with some redecoration and refurbishment including replacing carpets with laminate flooring, but while the communal sitting rooms, service users bedrooms and the dining room are airy and welcoming other areas need further upgrading work. Carpets on the stairs and landings are worn and stained, and need prompt replacement. Paintwork in this area is badly chipped and there is a general air of institution and neglect. Bathrooms have old and worn fittings some of which are cracked or broken. These areas need upgrading and refurbishment so that service users are able to enjoy these facilities in safety and comfort. A full audit of the home should be carried out, to identify all areas where work is needed, and establish a programme of upgrading and refurbishment. The accommodation was fresh without unpleasant odour on the day of inspection, but in other respects such as carpet cleaning there is room for improvement in housekeeping standards, so service users can be sure of living in clean and comfortable surroundings. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from stability in the staff group. This consists of a mixed group of younger and more mature staff providing for a good balance of experience and energy on the team. EVIDENCE: Service users are supported by staff who have been recruited following sound and robust principles, are being well trained and who are committed to helping them get the best out of life. Staff say they feel well supported and welcome the improvements in training since the central training team was established. There are sufficient male and female staff to provide a high level of one to one support, and service users benefit by being able to follow a more personal choice of activities. Service users can be more confident staff know and understand their unique and personal needs, as all new staff complete a foundation course linked to Learning Disability Advisory Forum standards, and are expected to progress to National Vocational Qualification level 2. 50 of staff have completed National Vocational Qualification programmes and it is anticipated all staff will achieve National Vocational Qualifications in due course, with the exception of those who are due to retire very soon. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 24 Training is planned according to staff training and development profiles and assessment of service user needs, and an in house training unit is now beginning to take a systematic approach to this. Staff complete their basic care practice training which includes modules on autism, and can select more specialist training from the opportunities available. For example one team leader has communication training and consideration is now being given to becoming a total communication household. This would be a sound step towards meeting the needs of people with significant communication difficulties. One service user who has learned Makaton is unable to use this to communicate as no staff are currently trained in this method, highlighting the need to make communication training for all staff a high priority. Service users with ASD are likely to have greater difficulties than most with the changes associated with agency staff. The use of agency staff is limited as far as possible but remains necessary to cover a vacancy. Past difficulties with staff recruitment and retention have led to close cooperation with one agency. This aims to ensure the provision of staff possessing the specialist knowledge and skills to work with people who have ASD, so that if agency personnel are needed service users can have confidence they understand their needs and how to support them. The agency places staff with homes in the autism.westmidlands group for an induction period so they are familiar with the company and service users before a placement. An agency worker spoken to during the inspection felt this process was working well in the service users interests, and he felt well supported by both his agency and Upper Ford Lodge. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Although there remain aspects of this service which need further improvement, the management of the home has made good progress in addressing previous concerns so that service users are experiencing a more stable, supportive and enabling service. The providers do need to take seriously their responsibility for providing sound guidance on raising complaints, concerns and allegations, but staff are aware of their responsibilities and correct procedures and confident in the support and training they receive. EVIDENCE: Service users know their experiences are sought and taken into account through observation and discussion with significant people in their lives such as family, and careful records. There is a quality assurance process carried out by the national autistic society, whose report in June 2006 was generally Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 26 favourable although it highlighted the need for a more systematic approach to supporting service users skills development. Regular monthly visits are made on behalf of the providers by other service managers in the group, and are attentive to quality and safeguarding matters. Since the establishment of a central training team, training in safe working practices has been attended to effectively and service users can now be confident they are supported by staff with up to date knowledge and skills to support them well and help them keep safe. A sample of health and safety measures in the home (including fire safety) showed a more effective programme is in place to ensure staff training in these procedures, which are well understood and being followed so that service users can be confident their well being is properly safeguarded. Service users need to be confident the providers will respond to matters they are responsible for in a timely way. For example service users need to know their rights and well being are valued, so procedures for them or their supporters to make complaints, and for safeguarding them, need to be very clear. The providers must meet the requirement to get these statements right without further delay. Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 27 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 x 2 4 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 28 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 YA6 Regulation 15 Requirement Service users plans must be kept up to date so that all staff have the information they need to understand them well, including full risk assessments, and can provide the service user with consistent support. This requirement is ongoing Food provision must take full account of service users observed preferences and provide optimum nutrition with good quality ingredients to compensate for any low intake All staff must be suitably trained in communication techniques to meet the particular needs of individual service users and the overall needs the service seeks to meet The complaints procedure must meet all the elements of Regulation 22 including the timescales for response, and be made available to service users’ families, and a version developed for service users in a more suitable format. Procedures for the protection of service users, including whistle DS0000067675.V322104.R01.S.doc Timescale for action 30/12/06 2. YA17 16 30/12/06 3. YA18 18 28/02/07 4. YA22 22 31/01/07 5. YA23 13 30/12/06 Upper Ford Lodge Version 5.2 Page 29 blowing and the reporting and investigation of allegations, must be comprehensive, explicit and robust, describe clearly the local (Worcestershire) arrangements for responding to allegations of abuse, and include information about the provision of support both to service users and to staff. (Previous timescales of 31/10/04 and 31/10/05, 30/06/06 not met) 6. YA24 23 The premises must be kept clean and reasonably decorated and in a good state of repair. An audit of the home should be carried out by the date specified, to identify all areas where work is needed, and then establish a full and ongoing programme of upgrading and refurbishment. Specifically, carpets must be replaced and walls and woodwork repainted on the stairways and upstairs landings, and bathrooms must be refurbished to a comfortable domestic standard 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA18 YA23 Good Practice Recommendations Staff should be provided with the training and support they need to work with service users beyond support towards enabling, through skills development Consideration should be given to finding alternative arrangements other than the home’s manager or other staff, for handling service users money as appointee on DS0000067675.V322104.R01.S.doc Version 5.2 Page 30 Upper Ford Lodge 3. YA33 their behalf. Staffing levels should be kept under review as occupation levels increase Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Upper Ford Lodge DS0000067675.V322104.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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