Care Home: Autism Plus

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What the care home does well The organisation is well established the service was found to have good staffing levels and well-trained staff. This enables the service to provide a high standard of consistent care. People were assisted and supported by staff to make decisions and choices about all daily living needs, this included peoples wishes and preferences. The service provided a good standard of direct personal and social care and access to health services. Care plans showed detailed individual information of peoples care needs when assessing and planning health care needs, these were found to be monitored on a regular basis. Parental contact was maintained and supported at an agreed level and in accordance to the needs of the individual person. Parents were kept informed of any issues, concerns and developments. Advocacy services were available when needed. People who use the service live in a comfortable, well-maintained and welcoming environment. The home was clean and tidy and provided a safe environment for people to live in. What has improved since the last inspection? This was the first inspection of the service. What the care home could do better: The organisation should ensure that 50% of staff hold NVQ level 2 qualifications. Continue to develop opportunities for people to take up further education courses. Look at ways in which the organisation can support people to develop employment skills. Key inspection report Care homes for adults (18-65 years) Name: Address: Autism Plus 7-9 Field Road Thorne Doncaster S Yorkshire DN8 4AG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet McBride     Date: 1 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Autism Plus 7-9 Field Road Thorne Doncaster S Yorkshire DN8 4AG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Ian Parish Type of registration: Number of places registered: care home 5 Autism Plus Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of users who can be accommodated is: 5 The registered person may provide the following category of service only - Care Home only - Code PC To service users of the following gender - either Whose primary care needs on admission to the home are within the following category - Learning Disability - Code LD Date of last inspection Brief description of the care home The organisation Autism Plus is a registered charity, and is run from central offices located at Fieldside Court in the centre of Thorne. The organisation recently purchased this property named Wildwinds which as been upgraded to provide care and accommodation for five younger people who have autism. Wildwinds is situated in Thorne town centre and is near a main road that links Thorne Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 5 Brief description of the care home and Doncaster. The home is close to shops, public houses,churches and public transport and is near to the M18 motorway. This house as the appearence of a large ordinary house and has beed converted for this current use. The accommodation is on two floors, the ground floor comprises of all the communal faliilities. Large hallway,one bedroom with ensuite facilities, two lounges,dining room,kitchen /diner and utility room. The first floor has a further four bedrooms with ensuite facilities,communal bathroom and staff accommodation. Fees range from £1275:00 to £3040:63 as at July 2009. Fees are calculated dependent on needs e.g. 1 to 1 staffing required. The fees cover a number of items e.g. holidays, outings, skill development and various therapies. Additional charges are made for, toiletries, mobile phones, sweets and some activities e.g. bowling. For further information contact the service. The central office is at Fieldside Court is where people, families and visitors are able to access lots of information about the service and care provision, including any published inspection report. Care Homes for Adults (18-65 years) Page 5 of 26 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 peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Although this is a newly registered service, the organisation has been operational for some years. This was the first Key Unannounced Inspection of the service, which took place on the 16th July 2009 for seven hours. The service is registered for five places. Prior to the inspection pre-inspection work was carried out on the information received Care Homes for Adults (18-65 years) Page 6 of 26 and other relevant documentation, for example analysis of statutory notifications and complaint records. During the inspection, documentation and records were examined, for example medication, complaints, accident records, staff rotas and staff training files. Three care plans were cross-referenced with other relevant documentation relating to those people who use the service, to evaluate how well their care needs were met. A tour of the premises and direct observation of staff interaction with people who use the service was carried out throughout the visit. Information was gathered from as many different individuals as possible that had contact with people within the home, including individual interviews with management of the organisation and two members of staff. We sent out surveys prior to the inspection, three were sent to parents of people within the home who received the services,and one was sent to another professionals that visits the home. All were received back. Due to the nature of the people living at the home, it is difficult to obtain information directly from some people receiving services. Some judgements about quality of life and choices were taken from surveys received, direct observations of people on the day, followed by discussion with support staff and evidencing records held at the home. The inspector concluded that people were given an good service at Wildwinds and no requirements have been made at this inspection. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 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 Care Homes for Adults (18-65 years) Page 9 of 26 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 that use the service had information about the home and services provided. People were individually assessed prior to admission to ensure their needs would be met and supported to make informal choice. Evidence: People were provided with information about the service and care they would receive in appropriate format. Surveys received confirmed that people who use the service were provided with sufficient information prior to using the services. People came from other units within the service,and were introduced into the new home at a slow pace taking into account background history of each person, risk assessments and a detailed plan of care that reflected any specialist interventions. People had many visits to the new home before moving in on a permanent basis. Three peoples files were checked and these contained information to verify that their needs had been assessed. The information provided detail of each persons individually assessed needs covering physical, emotional, health and social needs. Files also contained peoples preferences,known routines and likes and dislikes. Care Homes for Adults (18-65 years) Page 10 of 26 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. Care plans provided staff with sufficient information to meet the needs of people who use the service. People were assisted and supported by staff to make decisions and choices about all daily living needs. Evidence: Three care plans were checked and discussed with key workers. People had person centred care plans that set out in detail healthcare, personal and social care needs in an individual plan of care. Care plans contained at lot of information,for example pen picture, limit of skills, likes and dislikes. Communication files showed the level of communication, what methods are used and what support was needed. Some people do have the input of speech and language therapy services, who advise staff with what communication methods to use for each person. This ensured that staff deliver the care required and peoples needs were identified and met. People were encouraged and supported by staff to make decisions about everyday tasks. This ensured people were consulted and had choices about daily living needs. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Advocacy services were available when needed. People were supported in taking risks as part of an independent lifestyle, therefore risk assessments were in place to minimise any identified risks or hazards. These plans stated what support was needed for each individual person, and contained approaches and strategies to deal with any issues or concerns. Ensuring staff were well informed about how to support each individual to achieve their maximum potential. Care Homes for Adults (18-65 years) Page 12 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities were provided, promoted and encouraged for the development of social and practical skills. This ensured that people had the opportunity to participate in leisure activities and live as part of the community. People were offered a wholesome and appealing balanced diet with a varied selection of food available to meet peoples tastes and choices. Evidence: Staff said and records showed that people had the opportunities to develop practical life skills and social skills and make the most of their abilities. Daily routines within the home were flexible and individual, for each person who uses the service. Everyone had planned weekly activities programme that is arranged with each individual person. Each person is assessed to see what skills they have regarding the development of employment skills.People were encouraged to continue with education one person Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: within the home attends collage on a weekly basis. The majority of people spent some of their time outside of the home, and had opportunities to mix with other people. For example, day care, college,and swimming the service hires a pool for one hour each week.They also arrange shopping trips, discos and holidays. The organisation had a fleet of vehicles to facilitate these activities and outings. Parental contact was maintained and supported at an agreed level and in accordance to the needs of the individual person. Parents were kept informed of any issues, concerns and developments. People can go home for overnight, weekend stays or holidays on a regular basis. People are nutritional assessed a dietitian was involved who advised staff on a healthy eating plan for menus.This helps staff promote a healthy and nutritious diet, menus seen showed that most people followed a healthy eating plan. People who were capable helped prepare food. They also went shopping with staff to buy food and help plan meals for each week. People were weighed on a monthly basis.,this ensured that nutrition and weight was monitored and reviewed on a regular basis. Care Homes for Adults (18-65 years) Page 14 of 26 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. Peoples health is monitored and arrangements for dealing with health issues were met with support from health professionals. Medication policies and procedures were well managed ensuring the safe administration of medication. Evidence: Care plans showed that peoples health was monitored and staff completed the OK health check, this was used for assessing and planning health care needs for each person. People had access to health care facilities and any relevant specialists such as dentist, optician, psychology and speech and language therapist. Detailed information of peoples personal care needs was available, this included peoples wishes and preferences,when staff provided personal support in daily routines. Records showed that people were assisted and support by staff to make decisions and choices about all daily living needs, with risk assessments in place to identify any risks and how they could be managed. Records were maintained for current medication for all people within the home. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Records were checked all were found satisfactory with good recording systems in place. Storage of medicines was in an appropriate locked cabinet. The service have developed a method for taking medicines to day care or when going on leave to stay with family. For example medicines are dispensed in blister packs in a blue wallet, which is tagged for security. Stock within the wallet is checked when the person goes out and checked back in again when they return. All stocks are recorded and signed for then re-tagged. Care Homes for Adults (18-65 years) Page 16 of 26 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. The complaints procedure was accessible within the home. Policies and procedures were in place on adult protection, this promoted and protected people who use the service. Evidence: There was a comprehensive complaints procedure, this is an appropriate format. Although it was not on display it was accessible to people, advised that this would be good practice for this to be displayed within the home. All surveys confirmed that people were aware of the complaint procedure and knew how to make a complaint. Parents also said that if they had a concern or had raised an issue this was responded to appropriately. Complaint records showed one complaint had been received since the service was registered. Records showed that this had been investigated and a record of the the action taken. The home had safeguarding procedures in place. All staff had checks completed before being employed for example Criminal Record Bureau (CRB) Protection Of Vulnerable Adults (POVA) checks. Fifty percent of the staff have completed safeguarding training, staff confirmed they were aware of protection polices and procedures. Staff were able to describe the action they would take on receiving any allegations. This ensured people who use the service were safe and protected. Care Homes for Adults (18-65 years) Page 17 of 26 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 excellent 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 live in a comfortable and well-maintained environment. The home was clean and tidy and provided a safe environment for people. Evidence: Accommodation within the home consists of shared communal facilities, operating as a domestic household. Each person had a single bedroom with en suite facilities. A tour of the premises found all areas to be clean and tidy and in good decorative order with furnishings and fittings being comfortable and of a high standard,which looked very homely. All bedrooms were single rooms all with en suite facilities, including showers or bath dependent on the preference of each person. All people had visited the home and chosen their bedroom and decor before moving permanently to the home. Bedrooms had been provided with furniture and furnishings in compliance with peoples needs and preference. This provided a sense of ownership about the environment they lived in. Laundry facilities are provided at the home, staff were responsible for either helping people complete this task or ensuring peoples laundry is done when required. Outside the home had a large mature garden at the rear of the home this provided a safe environment for people to use and enjoy. Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: Care Homes for Adults (18-65 years) Page 19 of 26 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. Staff had the skills and knowledge to fulfill their roles. Recruitment policies are followed ensuring the safety and protection of people who live at the home. Evidence: The home was well staffed on the day of the site visit. Staff who were interviewed considered that there were sufficient staff to meet peoples individual needs. This ensured that people could follow their own programmes in the home and in the community. The organisation had a recruitment and selection procedures including an equal opportunities policy. All the required employment checks had been undertaken prior to staff being employed. This ensured people who use the service were safe and protected. Staff files that were checked were excellent, they were well organised and contained a front sheet checklist to ensure all required information was obtained and kept. All staff were employed on a probationary period, and received a performance review of their work and skills at three, six and nine months. Development and training records were checked and discussed with the manager who said training is linked to the organisations aims and objectives of the service. Each member of staff had an individual file, these records showed what qualifications staff Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: had achieved and when staff had completed mandatory training or refresher training. Most staff had completed Learning Disability Award Framework (LADAF) no staff had achieved National Vocational Qualification (NVQ) level 2 in care,however most staff are working toward this qualification. Staff said that the organisation offered excellent training opportunities and that they received supervision on a regular basis and have yearly appraisals. Care Homes for Adults (18-65 years) Page 21 of 26 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 organisation had good policies and procedures in place to protect and safeguard people who use the service. The organisation continue to make improvement in the provision of services to ensure effective outcomes for people. Evidence: Management structure of the service was discussed with various members of the management team at the main office. The manager was registered with the Commission for Social Care Inspection. He had completed two management courses this year one being the Registered Managers Award. Health and safety and safe working practice were discussed with management and some members of staff during the visit. Examination of some records indicated that all appropriate fire safety is carried out as required. Training records showed the majority of staff had received training and updates in first aid, moving and handling, health and safety and fire training. Quality monitoring within the service is done by the organisation and by the manager. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: Internal and external questionnaires had been sent to parents and relatives to gain their views on the care and services received, these are to be collated and published for people to read. The organisation have policies and procedures in place for staff to follow and evidence was seen that some are to be reviewed. Surveys were received from three parents and some positive comments were made Im happy with the service and it meets the needs of my relative.The service provides information where necessary and pay attention to suggestions and requests. We find people very amicable and willing to help where possible and nothing is to much trouble. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 24 of 26 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 Requirement 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 Requirement 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 2 22 32 Complaints procedure to be displayed within the home to ensure this is available for all people and visitors. The organisation should ensure that 50 of staff hold NVQ level 2 qualifications. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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