Care Home: AALPS Midlands

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What the care home does well New people are supported to visit and try out the service before moving in. People are treated as individuals and their needs and wishes are written in their care plans. People are supported with their health and physical care in the way they prefer. People are supported to take part in activities they like at home and in the community. People also go on holiday. People are supported to stay in touch with their families and friends. People have a comfortable, clean and safe home that meets their needs.Each person has their own bedroom and bathroom and their own things. People have a choice about food and enjoy their mealtimes. People are being supported to develop and manage their feeling. Medication is being safely managed and people are supported to come off tablets when possible. People are asked their views and feel these are listened to. What the care home could do better: Each person`s health action plan could be more fully completed. People could be supported to keep their money in their bedrooms. The rest of the planned facilities need to be finished and used. The manager needs to deal with any fire safety problems quickly. More of the staff need to become qualified. CARE HOME ADULTS 18-65 AALPS College (Midlands) The Rhydd Hanley Castle Worcestershire WR8 0AD Lead Inspector Jean Littler Unannounced Inspection 21st February 2008 11:30 AALPS College (Midlands) DS0000066276.V356615.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 AALPS College (Midlands) DS0000066276.V356615.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. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service AALPS College (Midlands) Address The Rhydd Hanley Castle Worcestershire WR8 0AD 01684 312610 01684 312612 office@aalpsmids.co.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) Wider Options (3) Ltd Mr Alexander Niven Care Home 29 Category(ies) of Learning disability (29) registration, with number of places AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Residents must be at least 16 years of age when admitted and must be discharged before their 26th birthday. Residents must have Autism Spectrum Disorder or other learning disabilities that are compatible with this condition. Arrangements to meet the continuing health care needs of any resident must form part of the contractual arrangements with their funding authority prior to their admission. The service must provide the residents with a significant amount of structured life skills coaching with the aim of the residents moving on to a more independent and normal living environment. At all times a suitably qualified and experienced member of staff must be identified as the person in charge. 27th July 2006 Date of last inspection Brief Description of the Service: AALPS College Midlands (Adolescent to Adult Life Preparation Service), is situated on a thirty acre site in a rural area between Worcester and Malvern. The service is for young people with Autism and complex needs. The service is owned and managed by Wider Options (3) Ltd. who already operate a similar service as well as services for children with learning disabilities elsewhere in the country. There are eight units accommodating either three or four young people. Some units are not yet occupied but the final maximum capacity is twenty-nine people aged between sixteen and twenty-five years of age. The service aims to provide a clear educational focus and the communal buildings and grounds are due to be equipped accordingly e.g. five teaching rooms, a hydro pool, gymnasium, I.T. suite, cafeteria and a rural studies centre. Some of these are still under construction. Detailed information about the service is available from the Home. Details of the range of fees are not included in the information provided to interested parties. The young people are expected to pay for their personal items such as toiletries and clothes. They can use their personal allowance to buy things they choose while shopping or on an outing, but all normal costs of food, transport and activities will be covered as part of the service. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out over 7 hours. The manager helped with the process. We spoke with staff and looked around the house. One young person showed us their bedroom. Nine representatives of people who live in the Home filled out surveys to give us their views. We looked at some records such as care plans and medication. The manager sent information to us, the commission, before the visit. What the service does well: New people are supported to visit and try out the service before moving in. People are treated as individuals and their needs and wishes are written in their care plans. People are supported with their health and physical care in the way they prefer. People are supported to take part in activities they like at home and in the community. People also go on holiday. People are supported to stay in touch with their families and friends. People have a comfortable, clean and safe home that meets their needs. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 6 Each person has their own bedroom and bathroom and their own things. People have a choice about food and enjoy their mealtimes. People are being supported to develop and manage their feeling. Medication is being safely managed and people are supported to come off tablets when possible. People are asked their views and feel these are listened to. 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. The summary of this inspection report can AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. AALPS College (Midlands) DS0000066276.V356615.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 AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Clear and helpful information about the service is being given to the young people and their representatives who are interested in the service. The young people admitted have had their needs carefully assessed and the manager has confirmed these can be met. All those admitted to date are appropriately placed and they have personalised contracts. The young people have been given the opportunity to visit the Home and then to move in on a trial basis. EVIDENCE: A comprehensive Statement of Purpose was developed for the Home prior to it opening. This has been kept under review and updated several times by the manager, Mr Niven. A welcome pack is given to families who are interested in the service. Part of this is a guide for the young person that contains photographs and information about the service in simple text and Widget symbols. There are plans to improve this to make it more accessible. The care plan files samples showed the young people had a copy of this information. A detailed assessment process is carried out to see if the service can meet any prospective young person’s needs. The funding authority is asked to provide a needs assessment. Information is also obtained from relatives, care and health professionals and staff at any current service. The assessment form used by AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 10 the service does not cover all the areas detailed under standard 2 e.g. foot and oral care. Mr Niven agreed to look into revising the layout. In one example seen staff had visited the young person at his residential school several times and observed him following his normal programme and having meals. The staff had taken photographs of his current bedroom and living area and asked about how his new environment should be set up to suit him. He had been supported to visit AALPS more than once and his new keyworker helped him through a staged transition. His primary needs and details of how these would be met had been set out for his representatives in the offer pack. This type of information would be improved if it showed when it was written and by whom. All placements start on a trial basis for eight weeks. For this young person a review meeting had been held after three months. The detailed report prepared for this meeting concluded that the placement to date had been a success. One person under eighteen has been admitted. Mr Niven had worked with the placing social work department to meet the requirements of the Children’s Act in regards to the assessment and admission process. Supplementary information is included in the Statement of Purpose about how the needs of under 18s will be met. Surveys received indicated that relatives were very positive about the assessment and transition process. A social worker reported that the service has responded very well to her client’s needs and have provided an excellent service. Compatibility between the young people who share living space has been prioritised and in some cases after full consultation people have moved units so they will be more content. The service has been managed carefully with admissions being paced to give time for the staff team and management systems to be established, and for each young person to be focused on during their transition. Although the service has been operational for nearly two years only twelve young people have been admitted so far. All placements to date have been successful. Contracts are agreed between the funding authority and the providers. These are personalised as each young person requires different staffing levels. A Term and Conditions agreement is also in place. Mr Niven reported in the AQAA (the Annual Quality Assurance Assessment, which registered people have to submit to us, the commission), that these agreements have been revised recently and all families have now received copies. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The young people can be confident that their changing needs are reflected in their care plans and their support and wellbeing are being regularly reviewed. They are being assisted to make decisions in their daily lives and to take reasonable risks that enhance their quality of life. EVIDENCE: The personal records of two young people were sampled. These contained detailed information including daily routines, behaviour strategies and risk assessments. The plans showed people are being supported to make decisions at a suitable level e.g. what clothes to wear, what food to eat, how to spend their weekly allowance. The risk assessments promote independence and community presence but also include risk reduction strategies. For one man twenty-seven of these assessments had been completed. They covered many areas such as horse riding, swimming, going to the shops and being aggressive in a vehicle. Some care plan information was not dated and did not show who had written it. For the person who is under 18 yrs the recommended transition pathway plan (into adulthood) had not been fully completed even through he moved in three months ago. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 12 Each person had some short, medium or long-term development targets that staff focus on. These included using plates and cutlery appropriately, increasing social engagement with peers, attending a college course and lowing anxiety levels when accessing the community. Daily reports are being completed reporting on areas such as activities, health, behaviour and general wellbeing. Incidents are recorded separately and these and the behaviour strategies are being monitored with the support of the behaviour therapist. Person centred planning training has been provided and the plans show that the support is very individualised. There are plans to make more of the information accessible to the young people. Review meetings have been held regularly for both young men. A review report contained pictorial headings and photographs of the person doing activities to help him understand what the report was about. The report was very detailed and included sections on protection from harassment and discrimination, quality of life, economic wellbeing, choice and control and dignity and privacy. People are admitted because they have complex behaviour patterns that can be challenging. It is very positive that physical intervention is being used as a last resort and clear guidance and risk assessments are in place to set a framework for this. Positive intervention strategies have been developed in consultation with representatives and the organisation’s psychologist and onsite behavioural therapist. One young man has said jogging outside helps him calm down when anxious. He has a flashcard to prompt him to do this when he becomes upset. If the incident progresses he is at times held in an approved restraint until calm and then taken for a jog. A review report showed that another young man had forty incidents in his first month but this number had reduced significantly two months later. Staff and the young person involved in any restraint are debriefed afterwards and ways to help prevent the situation recurring are explored. One man’s plan made staff aware of his sensory difficulties and limited understanding of his behaviours and feelings and those of others. He uses his emotions book to help him express himself. Sanctions are not used but sometimes planned activities and outings do not take place, as the risk would be too high if a young person is already unsettled. One family said they had seen positive changes in their son since he moved in. They had not been able to take him out before but recently spent a nice day out together. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The young people are successfully being supported to develop their potential, life skills and self-confidence. They are being given the opportunity to take part in activities and outings that suit their preferences and needs. Links with their families are prioritised and they are being encouraged to interact with each other and go into the community. People enjoy their food and mealtimes and they are encouraged to be involved and eat a healthy diet. EVIDENCE: Each unit is different and the young people are being encouraged to make their units their own homes. Daily routines are built into the activity plans, which start from when the person rises. It is recognised that routine creates a sense of order and for some people free time causes anxiety. Choices and independence are being offered where possible within the routine e.g. making their bed and own breakfast. A rota in Avon showed that everyone is encouraged to help wash up etc. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 14 Each person has a personal activity and life skills programme. The four seen were very detailed and they showed a person centred approach e.g. one young man loves animals and will rush up to unknown dogs when in the community. He now enjoys walking dogs at the rescue centre and is learning that different dogs behave differently. He also participates in woodwork, horticulture and communication sessions at college, swimming at Pershore, going to a local social club, listening to music, internet sessions, gardening and shopping. Some young people have high anxiety levels and stay on site more than others, however goals and strategies are in place to help them overcome their fears. Others go out regularly and one man is now attending college four days a week and no longer needs staff to stay with him. He had evening activities such as the pub, gym and swimming. He also helps prepare the evening meal and on Fridays he cleans his room and accesses the community. There are four vehicles currently to enable community access. Most community activities are non-segregated to give people the opportunity to mix regularly with local people. One young man talked about enjoying his holiday at Butlins where he hired a trike to ride through the forest. He also has a trike on site that he enjoys using. Another was seen in the activities area and another played ball with a worker in the courtyard. Existing hobbies and interests are being supported and young people have their chosen games, videos and music collections in their bedrooms. The young person under 18 yrs had educational sessions included in his programme such as: - recognition of food labels and everyday signs; names of people, objects and places; coins and their uses; bed making; laundry; recognition of emotions and the use of phases in right context. The teaching facilities are due to be opened in 2008. Mr Niven reported that the ASDAN (Award Scheme Development and Accreditation Network) curriculum is currently being developed for individuals. Input from a speech and language therapist is available through the organisation’s institute, and visual communication systems are being used such as communication strips and social stories. Because of their condition the young people can have difficulty developing friendships, however interaction is being encouraged and some relationships are developing. All young people are being supported to stay in regular contact with and visit their families. Their keyworkers have responsibility for ensuring this happens and for consulting relative about care issues. Relatives have been involved in supporting young people to personalise their bedrooms and are being invited to review meetings. Survey feedback was positive except for one mother who said she was not getting calls from her son and keyworker that had been promised so she called each week to keep herself informed. Mr Niven said this related to one unit and the criticism was justified. Others reported:-‘We receive weekly emails which is our preferred method of communication. The emailed photographs of him enjoying his activities are invaluable given his communication difficulties’. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 15 -‘When our son moved in they took great care as he had not been away from home before. They purchased a web cam specifically to use so he could communicate with us. They often help with weekends at home by bringing him to us. He has a very fulfilled life’. -‘Our daughter has developed choice and independence since being at AALPS and the self harming has reduced. Has offered more support than expected at times e.g. staff staying at college with her and holidays being arranged. She has a large number of activities in the week. She is brought or collected from fortnightly visits and she calls twice a week’. -‘There is a lovely calm atmosphere at the college. We feel we can call anytime, we get weekly calls from the keyworker. The staff are approachable and professional. The programme of activities is excellent and we are pleased with the strategies and support for addressing challenging behaviours’. Food is being purchased locally and prepared by staff on each unit with some involvement from the young people. The group in Avon unit was joined for the lunchtime meal. This was relaxed and staff engaged positively with the young people. They were encouraged to come into the kitchen to choose food and clear away afterwards. Pictures of what is in each cupboard are used to help people remember. The sample of menus seen showed healthy food is being provided. People’s likes and dislikes are recorded. The kitchen door is locked when not in use as one young person will over eat. A positive strategy is in place to help him manage this. He has five snacks a day, a bag of crisps, piece of fruit etc. and he removes the PECS symbol for each snack as he has these. One Stour unit the kitchen is only locked when hot things are on the hob or if staff are called away while preparing a meal. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The young people are being supported with their personal and health care needs met in a flexible and personalised manner. Medication is being safely managed and there is a positive approach to reducing the use of medication to control behaviour. EVIDENCE: A ratio of at least one to one staffing is provided, which allows the young people to be supported with their personal and health care needs in a very personalised manner at a speed that suits them. Routines are being kept as flexible as possible but there is a need for structure due to people’s Autism. Some positive examples of personal development were given such as one young person becoming more continent and several young people having their medication levels reduced. The care records seen showed health issues such as weight are being monitored. One young man enjoyed a large portion of salad with his lunch, which staff said he would not eat when he first arrived. A healthy diet and regular exercise are identified as goals for another person and his care plan showed he has lost 3 kgs in three months. Mr Niven reported that the local GP AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 17 was very interested in the young people and has provided an excellent service including health checks. All are registered with a GP and dental clinic when they move in. Some retain links with health professionals such as psychiatrists. Health Action plans have been developed but not yet completed. The format would benefit from being further developed so it covers all areas of preventative health care that should be considered such as breast checks. The organisation has a team of specialists based at their institute whose support is being accessed when needed. The on site behavioural therapist supports the care planning process. Forms are used for any health concerns and accidents and the outcomes from appointments clearly recorded by the staff who supported them. The person who is under 18 yrs had attended a Looked After Child health check two weeks earlier in line with childcare procedures. Mr Niven had not yet completed the specific paperwork, as some medical history was not known. Currently seven staff have completed the full four day First Aid Qualification. Other staff attend one days’ training. Mr Niven agreed to make it clear on the first aider lists in the units who is trained to the higher level so they can be called if a more serious incident occurs on site. The medication systems were sampled on Avon unit. The storage was appropriate including that for controlled medication. The keys are held by the person in change on the unit. The cabinet was well organised and the records seen showed medication doses had been given as prescribed. The records showed a clear audit trail from coming into the building to any unused or spoiled doses being returned to the pharmacist. The balance in the controlled medicines register was checked and found to be correct. To reduce the risk of any errors photographs are in with the records and two staff are involved in administration. Where hand written entries are added to the administration charts two staff have signed the charts. The GP has been consulted about homely medications and protocols are in place for the use of any ‘as required’ medication. Medication has been kept under review with the GP, consultants and families and reductions are implemented where possible. All staff go through an in-house training and competency check but usually team leaders and unit managers administer medicines. More in-depth accredited training is being provided and the aim is for this to be repeated every two years. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People feel their views are welcomed and listened to. They have confidence that any complaints will be taken seriously. Arrangements are in place to help protect the young people from any form of abuse or self-harm. EVIDENCE: A complaints procedure is in place and visual information was seen on display to help inform the young people about this. Mr Niven reported that no formal complaints have been received by the service since the last inspection. A discussion was held about how less formal concerns, or issues raised by staff, could be recorded to demonstrate how these are responded to. The commission has received one complaint, which related to how physical intervention training was being taught during the staff induction. This was passed to the providers to investigate. A senior member of the organisation carried out a thorough review and reported in an open manner to the complainant and us. Changes to training arrangements were made as a result of his recommendations. The young people are supported to join in unit meetings and have one to one time with their keyworkers to help them talk about any issues. Advocates are being sought but there is a shortage locally of people willing to take on this role. One of the administrative staff has taken on this role with one young man. A system is in place to record any concerns or complaints that are received and these are monitored by Mr Niven and by the provider’s representative during their monthly visits. Survey feedback indicated that people know how to AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 19 raise concerns and have confidence that these will be listened to and acted upon. One family said, ‘Mr Niven has on many occasions made it clear how to complain and has encouraged us to raise anything we are unhappy about. We have never had any grounds to complain nor do we ever expect to’. The staff spoken with said they would report any concerns promptly. Internal and external courses are provided for staff on both safeguarding adults and children. Mr Niven reported that more external training is being arranged in 2008 as some staff have not attended this yet. Abuse and Whistle Blowing policies are in place and staff sign that they have read these. Protection is also being covered in the induction and during supervision sessions. Mr Niven is aware of the need to report any concerns in line with the local multi-agency protocol and child protection procedures, when appropriate. No protection issues have arisen since the service opened. Clear guidance is in place about how to respond positively to the young people’s complex behaviours and physical restraint is used as a last resort. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The young people have a comfortable home that is clean, modern and well maintained. Their bedrooms provide them with private bathroom facilities and with enough space to relax in and keep their personal possessions. There are large grounds and additional activity and therapeutic facilities. EVIDENCE: The location of the service is not within a community, however facilities are close by and the grounds are of great benefit to the young people for whom the service is designed. As twenty-nine people can be accommodated the service is not based on ordinary living principles. However, the small units are fully self-contained and the service has been designed to have an educational focus. It is planned that people will to develop and move into community based supported living by the time they reach twenty-six years of age. Brook House was the first unit to be opened in the complex in April 06. This is a detached house in the grounds of the main building. In August 06 four units in the main house were registered, Severn A and B and Avon A and B, followed by the remaining units Teme A and B and Stour A and B in December 06. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 21 Currently four units are occupied but the others are fitted out ready for future admissions. Building work on the grounds continues in phases. Currently the teaching rooms and cafeteria are being completed and Mr Niven reported that these will become fully operational during 2008. A rural studies centre is also planned. The main building and Brook House were completely refurbished and redecorated prior to the service opening. Fire Safety and Environmental Health inspections were carried out prior to registration. The large grounds are fenced to protect the young people as the site is next to the river Severn. In the grounds there is seating and an activity area that includes a trampoline. The buildings have been well maintained and maintenance and gardening staff are based on the site so they can respond quickly to any requests for work. A three year rolling redecoration programme has been put in place. Currently Brook House is empty as it was felt that due to the behavioural needs of the young people accommodated they would benefit from the larger sized rooms in the main building. Consideration is being given to using Brook House as a transition unit for when young people are getting ready to move on. The bedrooms in the main house exceed the minimum standards and some are very spacious. The windows are large and the ceilings high so there is a good sense of space and light. All have en-suite bathrooms and there are communal toilet facilities as well. The bedrooms seen had been nicely personalised. One young man explained that he had chosen his quilt cover and other furnishings as he is a Simpson’s fan. Furniture with lockable sections has been provided and the young people can lock their rooms if they want to. Door locks have been upgraded in the rooms that are occupied so the young person can unlock and open the doors from the inside with one turn of the handle. Staff can override the locks in an emergency. A sensor locking system is used so that access to certain areas can be restricted. Instead of carrying keys the staff use electronic fobs, which are effective and discreet. The house is comfortably furnished, bright and modern throughout. Some of the pictures the young people’s art is displayed. In each unit there is suitably equipped staff office space, a kitchen, dining room, lounge and laundry room. There are two sensory rooms available with interactive equipment, a music room, a gym, a computer room with a web cam and an arts and crafts room. The hydro pool is built but is currently not in working order. The support staff do the cleaning but they have access to suitable equipment and the windows are being cleaned professionally. The units seen were clean and systems to manage infection control are in place e.g. cleaning schedules, protective clothing and colour-coding of kitchen and toilet cleaning equipment. The Environmental Health department visited in 2007 and gave the service a four start rating. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The staff team is growing as the service develops and more people move in. The young people are benefiting from the support of sufficient, welltrained and supervised unit teams. They have active keyworkers and are being supported to develop. They are being protected by the recruitment procedures. EVIDENCE: The staff team is being increased as each new unit is opened. When Mr Niven completed the AQAA in January 08 there were 25 female and 26 male staff. The team is also balanced in terms of age ranges. Each unit has separate teams to keep the number of staff who directly support the young people to a minimum. Each unit has a manager and then team leaders who run shifts. There are always two managers on site to support staff. At night a waking night worker is based in each unit and sleep-in staff are on call. A manager is also on call in case of emergency. Each young person has the staffing level they need agreed as part of their placement agreement. People usually need one to one staff support for specific activities and tasks. Some need two to one support when accessing the community. The rota seen on one unit showed that suitable staffing levels have been maintained. Some units have been stretched at times due to vacancies and sickness, however workers are being flexible and covering gaps so agency staff have not been needed. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 23 A training co-ordinator is employed and he provided a copy of the training plan for 2008. He was open about the areas that need more development such as the Mental Capacity Act. A briefing on this has been provided with a DVD but more training is needed. All new staff are working through a comprehensive induction programme that includes the Common Induction Standards, core safety and protection courses. Specialist training includes positive approaches to challenging behaviour, Autism, Augmentative communication skills and communication system (PECS) and person centred planning. The new Learning Disability Qualification is due to be introduced by March 08. Staff then go on to gain an NVQ 3 in Health and Social Care and the target is for staff to achieve this within a year. The numbers of staff employed is continually increasing as more people are admitted so the percentage of qualified staff will vary. Currently less that 50 of the support staff hold a relevant qualification but several are working towards one. It is reported in the Statement of Purpose that the staff working directly with people under the age of 18 will be over 21 years of age and they will be given the opportunity to gain an NVQ level 3 in Caring for Children and Young People. These points were not mentioned in the AQAA or in the training plan. The National Minimum Standards for 16 and 17 year olds recommends that at least 80 of staff hold this NVQ award. Two staff recruitment files were sampled. These showed that the process is well organised and clear records are being maintained. Job descriptions and contracts are in place. Staff are having to complete application forms and be interviewed by the manager and one other. Two written references and telephone references had been obtained prior to both staff starting work. Enhanced CRBs had been obtained that include POVA and POCA checks. Gaps in employment history had been explored and ID obtained. One unit managers and one life skills instructors were interviewed. Both reported that the staffing levels are suitable and that the training provided has been regular and relevant to their role. They attend regular supervision sessions and staff meetings, which they find supportive. Both seemed capable workers who are positive about their work with the young people and their relatives. Team morale was reported to be high and the staff felt that their ideas are valued. Both felt staff work in a consistent way with the young people and gave examples of how people have progressed. It is positive that the unit manager is being supported to gain an NVQ 4. One felt when the classrooms were opened the focus on formal education could be increased. Survey comments were very positive and included:-‘Staff are sympathetic to my daughter’s needs and difficulties and they give lots of opportunities for choice in lifestyle. Staff are always on training and have the right skills’. ‘This is a superb college. Facilities and the standard of care and staff recruited are first class. They exceed expectations and if there are problems due to our son’s autism then they will try everything until they find something that will work’. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The young people are benefiting from a well run service that is focused on their best interests. EVIDENCE: Mr Niven is leaving at the end of March 08. He has been working alongside his replacement, Mr Darren Goodwin, for several weeks so there is a smooth handover. Mr Goodwin holds relevant qualifications and has relevant experience. He has applied to become registered with the commission. Mr Niven has set up the service with an open and transparent ethos. The AQAA was returned to us on time and contained useful and accurate information, however this was quite brief considering the service is so complex. In future more evidence should be included, as the information may not always be supplemented by evidence seen on an inspection. Feedback received about the management of the service was unanimously positive. Some examples are below:AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 25 -‘My son was the first student and the service was unproven. I took a leap of faith after much discussion with Mr Niven. I have not been disappointed. Communication has been excellent and they are very caring. They try and make everything they do Autism friendly and treat my son as an individual’. -‘For the past 18 months my son has been at the college. The care and administrative staff have given my son and the family all the support they can give. We have regular reviews and discuss how we can improve his life skills. Any problems are discussed and nothing is too much trouble for them. We are always told about any incidents’. The manager’s hours are supernumerary to the support staff and the service is supported by administration, auxiliary and maintenance staff. The unit managers meet weekly and systems are in place such as shift handovers, staff meetings and supervision sessions to enable information to be shared. The college is part of a large organisation and the managers are supported by corporate structures. There is also an internal intranet system to help staff communicate and keep informed. There is a Quality Assurance manager and formal auditing and consultation arrangements are built into the company procedures. Mr Niven has been carrying out monthly unannounced monitoring checks on the units and formally reports on the findings. This helps monitor the standards between the units and ensures the unit managers know they are accountable for implementing the company policies and providing an audit trail of actions and decisions. Some of the monitoring has been focused on a specific area such as medication. A provider’s representative also carries out monthly monitoring visits to the Home and reports on these to the directors and the commission. Mr Niven reported that feedback surveys were sent to relatives in the Autumn 08 and that feedback is also requested at each review meeting. A sample seen showed people were very satisfied with the service. A service development plan is in place for 08/09. All the required policies are in place and evidence was seen throughout the inspection that these are being implemented. Records are being stored in an office area that is secured when not in use. The sample of records seen were up to date, they contained useful and appropriate information. When gaps in recording have been identified in the monitoring visits these are followed up to improve practice. Records relating to one young person’s money were sampled in Stour unit. These showed that he was being supported to spend appropriately. Receipts are being kept and stored with a print out at the end of each month. In some cases more information could be logged on the computer record to give clarity e.g. a description of the toy purchased rather than just noting ‘toy’. A risk assessment had not been completed about his ability to be involved in money management but his money was being held in the office. Restricted access to personal possessions should only be on the basis of a risk assessment. The unit manager agreed to AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 26 completed assessments and consider if young people could keep tins in their bedrooms even if the keys were held in the office. Suitable health and safety training and management systems are in place. The risk assessments seen showed that the young people and staffs’ safety is considered a priority. Mr Niven reported that routine servicing and equipment checks have been carried out. A sample of health and safety records were seen in Stour unit. These showed that the expected checks were being carried out such as water and fridge temperature checks, weekly fire alarm tests. Fire drills are usually carried out monthly and the young people reportedly cope well and leave the building when asked. Currently waking night staff are not included in drills but take part in walk through during their induction. Consideration should be given to involving them in drills at least annually as their competence is essential as night fires are very difficult to respond to. The fire door on the laundry was propped open. Discussions highlighted that the lack of ventilation makes the room too hot when the tumble drier is on. Mr Niven agreed to take immediate action so a requirement was not made. On February 29th he reported that the ventilation system has been repaired and a device has been fitted so the door will now close automatically if the fire alarm rings. In-house systems need to identify and solve this type of issue in future. AALPS College (Midlands) DS0000066276.V356615.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 3 2 4 3 3 4 4 5 3 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 4 26 4 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 4 32 2 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 4 4 3 3 3 x AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The fee range should be included in the Service User’s Guide (reference Regulation 5). If this is not appropriate due to the Guide being specifically for people with Autism then this information should be included in the Statement of Purpose. The assessment process should include all areas that young people may need support with. Complete risk assessments and consider if young people can be more involved in the management of their money. Further develop the person centred health action plans for each young person. Ensure the training plan and record keeping arrangements reflect good practice principles for people under 18 years of age. DS0000066276.V356615.R01.S.doc Version 5.2 Page 29 2 3 4 5 YA2 YA16 YA19 YA32 YA41 AALPS College (Midlands) 6 YA32 YA42 Consider how the night staff can be included in periodic fire evacuation drills to ensure they could competently deal with a nighttime fire. AALPS College (Midlands) DS0000066276.V356615.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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