Care Home: Autism Initiatives - Lilford Court

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Autism Initiatives - Lilford Court 1-2 Lilford Court Havisham Close Birchwood Warrington Cheshire WA3 7JZ two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Jones Date: 2 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Autism Initiatives - Lilford Court 1-2 Lilford Court Havisham Close Birchwood Warrington Cheshire WA3 7JZ 01925817103 01925840256 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Autism Initiatives Name of registered manager (if applicable) Christopher Richard Rowles Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 8 0 0 care home 8 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The home is registered for a maximum of 8 service users to include: * Up to 8 service usrs in the category LD (learning disability under the age of 65 years. * Up to 8 service users in the category MD (mental disorder, excluding learning disability or dementia, under the age of 65 years). * Up to 8 service users may be in both categories LD (learning disability under the age of 65 years) and MD (mental disorder, excluding learning disability and dementia). Date of last inspection A bit about the care home 1-2 Lilford Court is located at the head of a cul-de-sac in a residential part of Warrington town. The home is established to provide care for younger adults with Autistic Spectrum Disorder. Accommodation is provided in two adjoining, four bedded houses, which share the same staff team. Each house is set within spacious gardens and provides separate entrance, entrance hall, a lounge, kitchen, dining room, multi sensory room, four bedrooms, office space and bathing and showering facilities. The premises are not adapted to accommodate the needs of people who have a physical disability. Access to local amenities and public transport is good and the service is provided with two minibuses, which are used on a daily basis. Information about 1-2 Lilford Court including copies of the most recent inspection report is made available to each resident and their representatives and can be acquired by contacting Autism Initiatives on 0151 9500 330. Fees range according to the needs of the individual and are negotiated with the placing authority. There are no additional charges other than transport costs shared between the two groups of people. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This inspection was unannounced. The visit to the home took place over one day and took 5 hours in total, starting at 13:15 on the first day. Before the visit we (the Commission for Social Care Inspection) asked the manager to complete a questionnaire to give us up to date information about the home. We ask all services to complete this document, which we call an Annual Quality Assurance Assessment (AQAA), once a year. It gives us information about how the home is meeting the needs of the people who live there. We sent questionnaires to the people who live at the home to ask them what they think about the care and services provided and we have taken their views into account in writing this report. As part of the inspection, we spoke with some of the people who live in the home and to a relative of a person who lives there. We looked at some of the policies and procedures that the staff use to help them provide care in the right way. We looked at care plans for two of the people who live at the home to see how their care and support was provided. What the care home does well Lilford Court is home to eight people who have special needs within the Autistic spectrum. Most of the people who lived at the home were unable to respond to our survey questionnaire because of communication difficulties. However, we received one response from a person who had been helped by their mother. They told us that they were always treated well and staff listened and acted on what they said. Another persons relatives wrote and told us their son was content with the level of care and leisure activities provided. Earlier in the year we received comments from other relatives who also made positive comments about the way the home supported people to develop their skills and enjoy stimulating activities. For example one of the relatives told us: The home stimulates our son into activities that help him occupy his time. They spend a great deal of time talking with him and make use positively of his sense of humour. They take care of his style of clothes and diet. They are extremely kind and patient. Another relative told us that the manager and staff endeavour to give varied quality of life to suit all tastes and needs and would appear to budget well to achieve this. This showed us that the service has a strong commitment to helping people to develop their skills including social, emotional, communication and independent living skills. There are good procedures at the home for introducing new people. Significant time and effort is spent making sure that people are familiar with the home before they move in. They have their needs assessed so they know the home is suitable for them. Staff at the home are good at involving people in the planning of their care so they can have say in how that care is provided. Individual needs and personal preferences are recognised so people receive the care and support they need in the way they prefer. The principles of privacy and dignity are promoted so people are respected and valued. The way the home is decorated, furnished and run reflects the personalities, needs and preferences of the people who live there. The gardens are well maintained and are put to good use. The home is managed by an experienced manager so staff receive the support and guidance they need to operate as an effective team. The staff are experienced, skilled and well trained so the people who live at the home are in safe hands. What has got better from the last inspection We could see that a lot of work had been done since our last big inspection of the home to improve the presentation and content of each persons care file. The unnecessary duplication of information we had seen on our last visit to the home had been removed so the information was more accessible. Most of the care and support plans had been rewritten in plain language so they were easier to understand. Risk assessment had improved so people were safe. The management of risk took into account the specialist needs of people who used the service, balanced with their wishes for independence and choice so they were helped to live a more fulfilling lifestyle. For example, people were supported to do activities that had an element of risk such as horse riding, swimming and going out to places in the community such as the local pub. Information we received before our visit and staff training records showed that more than 80 of staff had or were working toward National Vocational Qualifications at level 2 or 3 in health and social care so the people who live at the home are in safe hands. What the care home could do better A service users guide should be made available so people who use the service or those interested in using the service have the information they need to help them with their decision making. The service users guide and some other documents such as the complaints procedure should be made available in easy read formats so the people who live at the home are helped to understand the information. Care plans, support plans and All about me plans should always confirm the persons full range of abilities regarding communication so staff have the guidance they need to help the person express themselves and make their needs known. Any limitation on a persons choice or power to make decisions must be agreed with them or a person acting on their behalf, so the persons rights are always protected. Managers and staff must make sure that all medication errors are followed up and where necessary staff receive retraining on medication and have their competency assessed before they are allowed to administer medication. This will help to ensure that people always receive their medication as their doctor prescribed it. Equality and diversity should be included in the homes staff training programme and discussed at staff meetings and at supervision meetings so staff are aware and kept up to date with legislation, guidance and best practice. The home needs to improve the system for measuring quality of services provided so it is always based on seeking the views of the people who use the service and their relatives and, where appropriate, nurses and social workers. This will help to make sure that the home is always run in the best interest of the people who live there. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact David Jones Colston 33 33 Colston Avenue Bristol BS1 4UA 011 7930 7110 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service have their needs assessed so they receive the care and support they need. Evidence: Most of the people who live at the home were unable to tell us about the home because of communication difficulties. However, we could see that they had good relationships with staff and one person told us they were happy living at the home. We received information from some of their relatives and we spoke to a social worker who worked with three of the people who lived at the home. All told us they were satisfied with the home and the standard of care received. We looked at the care records of two people who lived at the home. We could see that the manager and staff had worked closely with each person and their representatives to make sure their introduction to the home was personal and well managed. This showed us that the home had good procedures for introducing new people to the home. Personal care records showed us that people who are interested in moving to the home have a full needs assessment, so they know the home is suitable place for them to live. Planning meetings are held and support plans are drawn up with the person so they receive care and support in the way they prefer. They are encouraged to visit before they move in so they can get to know about the home, staff and other people who live there. There is a statement of purpose for the home that sets out the objectives and philosophy of the home and provided detailed information about all facilities and Evidence: services provided. However, the document was so large it could not be copied and there was no service users guide. This meant that people who needed information had to ask staff or come to the home to read the statement of purpose. A service users guide must be produced and made available to all people who live at the home and all those thinking about moving in so they have all the information they need to make an informed choice about living there. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who live at the home are supported to play an active part in planning of their care and support so they receive care and support in the way they prefer. Evidence: We looked at the personal care records of two people living in the home to check on the care and support they receive. We could see that each persons care and support plans were based on their initial assessment and had been developed through working in partnership with them and their family members, social workers and health care professionals. Each persons care plan set out how their special requirements including goals, and personal preferences would be met through positive and planned interventions so they received care and support in the way they preferred. We could see that a lot of work had been done since our last big inspection of the home to improve the presentation and content of each persons care file. The unnecessary duplication of information we had seen on our last visit to the home had been removed so the information was more accessible. Most of the care and support plans had been rewritten in plain language so they were easier to understand. One of the support workers told us how the staff group used care and support plans to monitor and evaluate the way they responded to each persons needs so they could learn from experience. Most of the people who lived at the home were unable to say what they needed but staff had helped them express their needs by using photographs, signs and symbols. Documents called All About Me had been drawn up with each person. These provided detailed guidance on how to meet the persons needs including the way they communicated, and their personal routines and personal Evidence: preferences. Staff told us that the new care plans had made their work much easier. They said that the information in them helped them meet each persons individual needs in a consistent way. The manager told us that this was extremely important because unexplained changes in routines could easily upset the people who lived at the home and cause unnecessary anxiety and distress. Staff receive special training on working with Autism and we could see that a lot of effort had been put into providing staff with clear guidance on how each person communicates. However, we noted that one of the people used Makaton sign language to communicate but this was not recorded in their All about Me plan and some staff were not fully aware of the persons abilities. Care files included a comprehensive risk assessment. Management of risk took into account the specialist needs of people who used the service, balanced with their wishes for independence and choice so they lived fulfilling lifestyles. For example people were supported to do activities that had an element of risk such as horse riding, swimming and going out to places in the community such as the local pub. The risks were clearly identified and guidance for staff on how to manage these had been drawn up. This meant that people could take part in these activities as safely as possible without putting unnecessary limitations on their choice or freedom to make decisions. There was no doubt that these decisions had been made in the persons best interests. However, it was not always clear whether the person had capacity to agree to the limitation or whether they had been given the support they needed to help them with their decision making. Any limitation on a persons choice or power to make decisions must be agreed with them or a person acting on their behalf. Where there is any doubt about a persons ability to make important decisions an assessment of their capacity must be made. The assessment must determine the level of support the person needs to make the decision and who should be asked to act on their behalf. This will ensure that the people who live at the home always receive the support they need to help them with their decision making. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who live at the home are supported and encouraged to take part in a range of activities so they can use local facilities, participate in new experiences and lead fulfilling lives. Evidence: The atmosphere in the home was relaxed and sociable. There was a lot of activity going on with people getting involved in the general running of the home including making and serving meals and clearing away afterwards. We could see that staff were skilled at giving the right type of support for each person. We spoke to staff about how they help people to develop their independent living skills and they showed us that they had drawn up support plans with each person to help them achieve their personal goals. This showed us that staff understand the importance of helping people to achieve their goals, follow their interests and take part in ordinary community based activities. Records showed that people take part in range of activities in the home and in the local community. Most of the people who lived at the home were unable to respond to our survey questionnaire because of communication difficulties. However, we received one response from a person who had been helped to complete it by their mother. They told us that they were always treated well and staff listened and acted on what they said. Another persons relatives wrote and told us their son was content with the level of care and leisure activities provided. Earlier in the year we received comments from other relatives who also made positive comments about the way the home supported Evidence: people to develop their skills and enjoy stimulating activities. For example one of the relatives told us: The home stimulates our son into activities that help him occupy his time. They spend a great deal of time talking with him and make use positively of his sense of humour. They take care of his style of clothes and diet. They are extremely kind and patient. Another relative told us that the manager and staff endeavour to give varied quality of life to suit all tastes and needs and would appear to budget well to achieve this. We could see that the routines of the home were as flexible or as structured as each person needed. Independent living skills, developing and maintaining family and personal relationships and interpersonal skills were promoted and supported. The routines, activities and support plans focused on the individual needs of each person and were regularly reviewed and where necessary updated. Daily records showed that people were offered a varied and nutritious diets. Support staff were aware of each persons likes, dislikes and personal preferences and were seen to help them make choices. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The health and personal care that people receive is based on their individual needs so their health care needs were met and staff make sure they provide support in a way that respects the dignity and privacy of the people living in the home. Evidence: We could see that staff provided sensitive, flexible personal support to each of the people who lived at the home. Care and support plans were person centred so people received the help they needed in the way they preferred. One of the people who was helped to complete our survey questionnaire by a relative told us that the care staff try very hard to understand them and help them and their family. Records and discussion with staff showed us that each persons health care needs are monitored and where necessary contact is maintained with their health care professionals. A social worker who was visiting the home told us that the staff work in partnership with each persons health and social care professionals so their needs are met. Staff training records showed that all staff involved in giving medication had received training from a pharmaceutical company. A medications check showed that the home has effective arrangements for the storage, administration and recording of medicines. However we noted that the medicine for one person was recorded as being given but the tablets was still in the monitored dosage system. The manager told us that he would investigate this and the staff member responsible for the error would be given further training and have their competence checked before they would be allowed to give medication again. This will make sure that the people who live at the home are always given their medication as their doctor prescribed it. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff have guidance and training to make sure the people who live at the home are safeguarded from abuse, and have their rights protected. Evidence: The home had received one complaint since our last inspection there. The complaints records showed that it was investigated and dealt with. The complaints procedure gave good clear guidance on how to make a complaint but it was not available in a format that was suitable for the people who lived at the home. We recommend that the complaints procedure is produced in a variety of formats, which may include illustrations, symbols, or photographs so all people are helped to understand the information should they need to make a complaint. There are good procedures at the home for responding to suspicion or evidence of abuse so people were safeguarded. These included the Autism Initiatives adult protection policies and procedures and those provided by the local authority. There had been one adult safeguarding referral in the last 12 months. This had been reported to the local authority and managers and staff had worked in partnership with the social services department to make sure people were safeguarded. Staff training records showed that most staff had received training on safeguarding procedures so they know what to do to make sure people living in the home are protected. The manager showed us that any further training needs were to be addressed by the homes staff training programme. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well maintained so people live in comfortable , clean surroundings that meet their needs. Evidence: Lilford Court provides a homely and comfortable environment. The home is spacious, bright, cheerful, airy and clean throughout. The premises are in keeping with the local community and have a style and atmosphere that reflects the homes purpose. The decoration and furnishings in the two houses that make up this home reflect the personalities, needs and preferences of the people who live in them. People identify with their bedrooms and have been encouraged and helped to personalise them. The gardens are well maintained and put to good use. The home is well maintained. Systems were in place for food hygiene and infection control so people were protected from infection and food contamination. Maintenance records showed that electrical and gas installations and fire prevention equipment were serviced regularly so people were safe. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who live at the home are supported by well trained, effective staff who have gone through a thorough recruitment process, so peoples needs are met and they are safe from possible harm and poor practice. Evidence: The staff work as an effective team to provide the care and support needed by the people living in the home. During our visit we observed staff staff supporting and interacting with the people who live there. We could see that there was good communication between staff and they responded sensitively and effectively to each persons needs. For example we observed staff work together to manage a situation that could have resulted in conflict if they had not intervened. They quickly redirected a group of people who were becoming agitated by another persons behaviour. This ensured that the atmosphere in the home remained relaxed and sociable. We could see that the people who lived at the home had good relationships with staff. We saw evidence of mutual respect, warmth and humour between staff and the people who live at the home. Their relatives and other representatives speak highly of the staff team showing they have confidence in their abilities. Worked rotas showed that staff are employed flexibly with higher numbers of staff on duty at busy times of the day to meet the changing needs of people. There was a minimum of six staff on duty when all people were at home and up to nine staff when group activities were planned in the community. We talked to the manager and some staff about staff training opportunities and we looked at staff records. All new staff have thorough induction training that included Skills for Care common induction standards. These set down the minimum expectations about learning needed so new care workers know how to work effectively and safely. Information we received before our visit to the home and staff training Evidence: records showed that more than 80 of staff had or were working toward National Vocational Qualifications at level 2 or 3 in health and social care. All staff have an annual appraisal, which helps them and their managers to identify further training needs. Staff training records show that most staff had training on adult safeguarding, medication, food hygiene, positive intervention 1 and 2, introduction to Autistic Spectrum Disorder, epilepsy, infection control, risk assessment and mental health awareness. Two staff had done training on communication and the Autistic Spectrum Disorder. Observation and discussion with staff showed that other staff needed this training, including Makaton sign language, so they have all the skills they need to communicate with the people who live at the home. We looked at staff personal files and found that there are good procedures used at the home for recruiting new staff. All necessary checks are carried out to make sure new staff have the right skills and qualities to work with the people who live at the home. Staff told us that they appreciated the support and guidance provided by the manager. They have regular supervision meetings and staff meetings take place every other Thursday. This helps to make sure that the people who live at the home benefit from well supported staff team. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed so this it is run in the best interests of the people who live there. Evidence: The manager is experienced in the care of people with Autism. Since our last inspection of the home he had achieved NVQ level 3 in care and had developed his skills and knowledge through a range of other training courses. He is registered to complete NVQ level 4 in care and the registered Managers Award. This shows us that the manager is continuously improving his skills so he has the ability to manage the home well. We found that the home is well managed with positive outcomes for the people who lived there. People are involved in planning of their care so they receive care and support in the way they prefer. All people who had moved into the home had settled well and their review documentation showed their needs were met. Staff told us that they appreciated the support and guidance provided by the manager. Communication is good and regular one to one supervision is provided. Autism Initiatives use a structured quality assurance monitoring system that includes monthly visits by the area manager and an annual quality assurance audit by the organisations Quality Assurance Co-coordinator. A report detailing the action taken to address quality issues is published annually. This helps to make sure the home is running well. The manager told us that the views of the people who live in the home or their advocates are not routinely sought as part of the quality checks. The most recent quality assurance report dated 10 May 2007 does not include the views of people who Evidence: live at the home or their representatives. Action should be taken to make sure that the people who live at the home and their representatives are asked about the quality of care and services provided and their views recorded and acted upon within the homes quality assurance processes. This will help to make sure that the home continues to be managed in the best interests of the people live there. Autism Initiatives seeks to ensure the health and safety of all employees and people who live at the home. The manager and deputy manager make sure that risk assessments are carried out for all working practices. Significant findings are recorded and reviewed so people are safe. Information about the home that we were sent before our visit and records kept in the home confirm that fire precautions are in place. Routine maintenance checks of gas and electrical systems, electrical appliances,heating system, water temperatures and fire alarms are carried and up to date so people are safe. Staff had a good understanding of the importance of equality and diversity. However, they told us that they had not received training on this and the issues were not raised and discussed at staff meetings or through supervision. Equality and diversity should be promoted at the home to ensure that staff are aware and kept up to date with legislation, guidance and best practice. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 A service users guide should be produced in a format that is suitable for the people who may be interested in living in the home so they have the information they need to make a decision about moving into the home. Each persons care plans, support plans and All about Me plans should confirm their full range of abilities regarding communication so staff have the guidance they need to help the person express themselves and make their needs known Any limitation on a persons choice or power to make decisions must be agreed with them or a person acting on their behalf. Where there is any doubt about a persons ability to make important decisions an assessment of their capacity must be made. The assessment should determine the level of support the person needs to make the decision and who should be asked to act on their behalf. This will ensure that the people who live at the home always receive the support they need to help them with their decision making. All medication errors should be followed up and where 2 6 3 7 4 20 necessary staff should receive retraining on medication and have their competency assessed before they are allowed to administer medication. This will help to ensure that people always receive their medication as their doctor prescribed it. 5 22 The complaints procedure should be produced in a variety of formats, which may include illustrations, symbols, or photographs so all people are helped to understand the information should they need to make a complaint. All staff should have training on communication including Makaton sign language so they have all the skills they need to communicate with the people who live at the home. Equality and diversity should be incorporated into the homes staff training programme and discussed at staff meetings and at supervision meetings so staff are aware of and kept up to date with legislation, guidance and best practice. The quality assurance procedures for the home should be based on seeking and acting upon the views of the people who use the service and their representatives. These views should be recorded and action taken to address quality issues in the annual quality assurance report so the people who live at the home know their views are acted upon and taken seriously. 6 35 7 37 8 39 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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