CARE HOME ADULTS 18-65
Wessex Autistic - 13-15 Barnes Lane 13-15 Barnes Lane Beaminster Dorset DT8 3LS Lead Inspector
Marion Hurley Key Announced Inspection 11th October 2006 10:00 DS0000026741.V306372.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 DS0000026741.V306372.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. DS0000026741.V306372.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wessex Autistic - 13-15 Barnes Lane Address 13-15 Barnes Lane Beaminster Dorset DT8 3LS 01460 77033 01460 75003 as@twas.org.uk www.twas.org.uk Wessex Autistic Society 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) Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000026741.V306372.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: The Wessex Autistic Society is a regional charitable organisation, which operates a number of residential, day and support services. 13-15 Barnes Lane provides personal care and accommodation for up to six young people, who have an autistic spectrum disorder. The home comprises of three inter-linked terraced houses, each accommodating 2 service users. It is situated relatively close to the centre of Beaminster, which is a small but busy town. The staff support the residents to access the local amenities, which include GP surgery, Churches, Post office, pubs, cafes and several shops. Barnes Lane is owned by West Country Housing Association and is managed by the Wessex Autistic Society under a licence agreement. It is staffed on a 24 hour basis, with one waking and one sleep-in member of staff throughout the night. The home provides close support to the service users who live there. The organisation aims to enable service users to live as independently as possible in the community. Copies of the last Inspection Report are kept at the home or may be obtained from the Regional Administration offices in Crewkerne. Fees range from £1,391:00 according to the individual’s assessed needs and abilities. DS0000026741.V306372.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key announced inspection was carried out by Marion Hurley, Regulation Inspector, on October 11th 2006. The inspection at the home lasted four and half-hours, in addition information already held on file was used to prepare for the visit. The site visit focused on key inspection standards and regulations. The inspector met with the Manager and members of the support team. A variety of records were inspected including Individual Service / Care Plans, staff files, fire safety records and medication records. A tour of the building was undertaken and the inspector met three service users. The home benefits from the use of two vehicles. Five comment cards had been received and the manager had comprehensively completed the Pre-Inspection Questionnaire and much of this information was verified during the course of the inspection. What the service does well:
Staff at Barnes Lane continue to provide a high standard of care and support to all the service users ensuring that each person within their own abilities is assisted to maintain and develop their independence, choice and lifestyles. There are sufficient staff to provide a comprehensive level of support to service users. Despite some service users having communication difficulties, staff know their needs well. Staff use a range of methods, such as the use of pictures to make sure that service users are consulted and able to make choices. Individual Service Plans inform staff about the support each service user needs. There is detailed information about each service users’ likes and dislikes and how each person likes to live their lives. Activities and facilities are provided both in the home and in the nearby towns that enable service users to live their lives to the full within the home and in the local community. Health needs are well catered for and there was documentary evidence of good working relationships with health & social care professionals from the local community teams. The home is comfortable, with measures in place to make sure that the environment is safe, and that service users are appropriately protected. DS0000026741.V306372.R01.S.doc Version 5.2 Page 6 Staff receive a well co-ordinated programme of training and they confirmed that they were well supported and supervised by the management team and senior practitioners. Staff were observed interacting fully and enthusiastically with service users. What has improved since the last inspection? 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.
DS0000026741.V306372.R01.S.doc Version 5.2 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 DS0000026741.V306372.R01.S.doc Version 5.2 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home/ organisation has a good admissions procedure which clearly enables prospective service users to know what the home provides and that their needs will be met. Each new service user is thoroughly assessed before admission to ensure that their needs can be met. There are good systems in place to introduce people to the home. EVIDENCE: The home/organisation has a clear statement of purpose, which contains relevant information pertaining to the services provided. A suitable service guide is written in clear, simple English for easy reading. Any prospective service users would be introduced to the people already living in the home and assessed before they are admitted to the home to ensure that their needs could be met. DS0000026741.V306372.R01.S.doc Version 5.2 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, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual Service Plans (ISP) are comprehensive documents that involve the service user to ensure their needs, wishes and decisions are fully taken into account and that they can lead as full lives as possible within a safe environment. Information is available to enable care staff to meet the service users’ needs. The care staff encourage service users to make decisions about their lives. EVIDENCE: Individual service plans examined showed full involvement of the service user, from their creation with their key worker, to participating at the reviews, if they have the desire to be involved. DS0000026741.V306372.R01.S.doc Version 5.2 Page 10 The ISP’s are comprehensive documents that inform staff of how to care for their needs and ensure that the service users have made decisions for themselves and that their wishes and choices are taken into account. Each service user is assigned two staff as their key workers and together they plan with the service user their two weekly programme of activities. Staff stated that advice and support from healthcare professionals is accessed as necessary. The Manager stated how valuable the support was from Community based teams and there was documentary evidence as close working relationships. The ISP’s confirmed and demonstrated that service users can take risks to enable them to be as independent as possible. Staff spoken with during the inspection clearly stated how they would offer choices and all were aware of the different communication strengths and needs of the service users. Where appropriate, service users are encouraged to make choices and decisions in ways that they understand e.g. using visual techniques such as photographs or symbols. The ISP’s are written with a positive attitude and concentrate on what a person can do and goals for the future. The ISP’s contained a lot of useful information however the format that they are presented in is not very “user friendly” either for the service users or staff and the individual files need to be trimmed down to contain only current information. In addition to each service user having their own Individual Service Plan each person has their own “Passport” which summaries their ISP and contains specific information concerning the service user’s likes and dislikes and their daily routines. Service users had signed none of the records seen at the time of the inspection. However, the manager explained that this was a deliberate omission as staff considered that all the service users would find it very stressful to sign their own records. DS0000026741.V306372.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities and contact with family, friends and within the local community are in accordance with the service users’ wishes. Service users are given responsibilities within their capabilities. They are offered a balanced, nutritious diet that the service users have a choice in. EVIDENCE: Service users have busy leisure and vocational timetables, which combine educational and leisure activities. Each service user has a fortnightly programme of different activities, which include cycling, swimming, walks, pottery, music, and cookery. Staff also provide one to one time and support DS0000026741.V306372.R01.S.doc Version 5.2 Page 12 different activities, which occur within the home. The Wessex Autistic Society continues to maintain the Day Service Site in Crewkerne, which is accessed for occasional activities. However, most activities are undertaken accessing regular amenities in nearby towns. The manager stated that there appears to be enough variety in the activities to keep all the service users interested. For example on the day of the inspection three service users were going ten pin bowling and having lunch out, one was choosing and preparing their own meal in their one to one time, and the other person was going to the dentist followed by some shopping in preparation for their holiday. One service user was currently staying with their family. Contact and involvement with families and friends is encouraged where possible although some families live far away from the home. A written comment received from a relative’s feedback card said, “staff are always willing to oblige when we visit or phone”. All service users are encouraged and some are given responsibilities for activities within the home, which staff said they enjoy doing, e.g. working with staff support to manage their own laundry. It is hoped to encourage service users to become more involved in some of the daily chores round the home both inside and outside. Service users are encouraged to help with meal preparation according to their abilities. On the day of the inspection one service user was, with support cooking his own lunch and preparing the pudding for the evening meal. The service user had chosen what he wanted to cook, and then shopped locally for the ingredients and then home to cook the meal. Service users also have takeaway meals such as the occasional fish and chips and Chinese meal often as a treat at weekends or specially requested for a birthday tea. The fridge /freezer in one house has to be kept locked to prevent one service user who would want to continually access it. However, this does not prevent other service users accessing the fridge as they have been given the code and are free to access food at any time. DS0000026741.V306372.R01.S.doc Version 5.2 Page 13 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 this service. Service users are provided with a good level of support and personal care ensuring their health needs are appropriately met. The levels of support are flexible according to the individual’s needs and wishes and staff are aware of maintaining services user’s dignity and independence. There are safe procedures for the administration of medicines. EVIDENCE: Staff respect service users dignity and independence and the choices made by each person is respected. Individual service plans contain information indicating each service user’s preferences and specific details with reference to their daily routines and their likes and dislikes. For example one person really enjoys having a long time in the bathroom and ensuring they are the first person up in the household accommodates this.
DS0000026741.V306372.R01.S.doc Version 5.2 Page 14 Services users are registered at the local GP surgery. Each service users’ health needs are identified and specialist services such as psychology are available. Medication storage and administration records were inspected in one of the three houses and were found to be satisfactory. Staff have received training in the safe handling of medicines. There are guidelines for the administration of homely remedies, which are only given under GP guidance. DS0000026741.V306372.R01.S.doc Version 5.2 Page 15 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are clear systems in place to ensure that service users are protected, and that their complaints and concerns are taken seriously. Service users are kept safe by staff who are aware of and follow the home’s policy and procedure regarding the safeguarding of vulnerable adults. EVIDENCE: A simplified version of the complaints procedure is displayed and is available in symbols format for easy access by all the service users. There have been no concerns or complaints since the last inspection. It is important all staff receive regular refresher training to ensure their knowledge is up to date concerning vulnerable adult issues and in the management of complex behaviour. Staff support the service users’ rights and independence and where necessary will act as their advocate. DS0000026741.V306372.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Barnes Lane provides a comfortable and personalised environment in which service users feel confident, happy and well cared for. EVIDENCE: All three houses were clean and pleasant smelling except for in one area, which staff have repeatedly tried to resolve. Service users are encouraged and supported to be responsible for cleaning their own rooms. Service user’s bedrooms are very personalised and homely. Information boards in each house clearly display in symbols and words the activities planned for the day and which staff are on duty to support the service users achieve the activities. Staff said that the service users seemed to be using the boards regularly now they have been modified and present the information in a simple and clear format. Improvements to the environment are on going and since the last inspection the bathrooms in each house have been totally refurbished with new baths and
DS0000026741.V306372.R01.S.doc Version 5.2 Page 17 showers fitted in each house. Future works include the redecoration of all the communal areas. DS0000026741.V306372.R01.S.doc Version 5.2 Page 18 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): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff receiving training and are supported to undertake their roles and responsibilities. However, some staff have not completed all the regular mandatory training and this needs to be rectified as soon as possible. Current recruitment procedures are robust to protect service users. EVIDENCE: The records of both senior practitioners and support workers were inspected and all contained the documentation necessary for the protection of service users. There are good staffing levels at Barnes Lane and these reflect the needs of the service users. The staff rota indicates that there is always sufficient staff on duty and this was confirmed by the staff on duty at the visit to the home. Staff files are kept at the Administration Offices in Crewkerne and were inspected at this site. DS0000026741.V306372.R01.S.doc Version 5.2 Page 19 All new staff receive thorough induction training and are given a comprehensive book detailing all aspects of the home and the standards expected from staff. Each house has a “Daily Routine and Shift Planning file” which is a checklist for staff to complete and sign to ensure all basic duties and responsibilities are completed for the shift. There are fortnightly staff team meetings and this brings staff together to review their work with individual service users and to talk and discuss ideas. DS0000026741.V306372.R01.S.doc Version 5.2 Page 20 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 this service. The home promotes the health, safety and welfare of its residents and staff by providing a safe environment, allowing for risk-taking and independence within the service users’ capabilities and wishes and by staff training and support. EVIDENCE: The CSCI currently has an application for the registration of the newly appointed manager at Barnes Lane. The manager has within the past four months completed an internal transfer to Barnes Lane having successfully managed the Day Services for the Wessex Autistic Society at the Crewkerne site for many years. Despite the manager having only worked at Barnes Lane for a short period there was sufficient evidence to demonstrate that the home is well organised and managed. DS0000026741.V306372.R01.S.doc Version 5.2 Page 21 Staff stated they had felt well supported through the transition of the new manager and the changes in the delivery of day services, which have positively impacted on their working week. Staff stated they felt they could talk to the manager who they consider listens and supports them appropriately. The manager said that service users are regularly asked on an informal basis if they are happy and if the service provided is appropriate to their needs, tastes and wishes. Service users involvement is documented in their ISPs. Health, safety and welfare of the service users are provided within a safe environment, as seen during the tour of the home. Service users are allowed to take responsible risks, and the provider, manager and staff support independence within the service users capabilities and wishes. Servicing and maintenance information had been included in the pre inspection questionnaire in detail and was reported as being up to date. Records seen on the day showed that staff conduct regular checks to ensure the houses are safe. DS0000026741.V306372.R01.S.doc Version 5.2 Page 22 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 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 X 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 2 X DS0000026741.V306372.R01.S.doc Version 5.2 Page 23 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. 1 2 Standard YA30 YA42 Regulation 16 (2)(j)(k) 24(d)(e) Requirement The premises must be free from offensive odours throughout. All staff must receive regular training in safe working practices. Timescale for action 31/12/06 31/12/06 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 YA6 Good Practice Recommendations It is recommended that the format of the ISPs is presented in a more “user friendly way” and only current information is contained in the working files. It is recommended that staff receive up to date training to ensure all service users are cared for safely.e.g. basic food hygiene and awareness of adult protection. 2 YA42 DS0000026741.V306372.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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