Care Home: Coolhaze

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What the care home does well The registered manager writes in the Annual Quality Assurance Assessment: "Coolhaze exists to provide residential and support services to meet the specific needs of people with Autistic Spectrum Disorders and associated conditions, in a safe, stimulating, low arousal and structured environment. To enable each individual to reach their fullest potential and participate as full and equal members of our society." The needs of people who may come to live at the home are properly assessed. These generate appropriate care plans so staff understand their needs and enable them to be as independent as possible. They are supported by staff to lead a full and active lifestyle, with their rights respected. They enjoy a healthy diet and receive support with personal and health care in ways they prefer and require, while the home`s medication practices protect them. Their views are listened to and complaints acted upon. They are protected from abuse. The layout of the home has been planned to provide a safe and comfortable place to live and meet their needs. They are supported by properly recruited sufficient competent staff. People who live here benefit from a home which is well run, in their best interests, by competent owners and manager who ensure their health, safety and welfare are protected. What has improved since the last inspection? The registered manager writes in the Annual Quality Assurance Assessment: "Redecoration to external and internal parts of the building, better communication with parents via the introduction of a parental diary and weekly communication between the residents keyworkers and parents via phone call. New staff in new roles building successful relationships with the residents, Promotions and staff. Better understanding of the needs of the service users. New bathroom put in for staff and new sleep in bed. The construction of a staff office space for staff to complete their own paperwork. New laundry facility based outside of the service that is hired from JLA. Service user use of the gardens such as swing bought and bouncy trampolines and residents choosing to spend more time in the garden. in risk management and staff flexibility with regards to having at one point three expectant mothers". The improvements comprehensively listed by the manager above leave little for us to add. What the care home could do better: The registered manager writes in the Annual Quality Assurance Assessment: "Implementing training workbooks from wand training in the new year and ensuring all new staff complete their statutory training within their initial six months probationary period. Continue to build a team of bank staff for cover when absenteeism occurs so continuity of staff is increased for the residents. Developing a Coolhaze specific formal quality assurance system that will be able to tell us that the service users are happy and content in their lives within the service. The building of a bigger separate washing facility located around the side of the service that will have a washing machines and shelving for storage of clothing that needs washing to aid infection control. Staff will then take dirty washing directly from the service users flat to the shed where it will be washed. More redecoration of service users flats involving them in the process. Retuning and restoring of one services users piano as he likes when staff use this to sing songs. Replacing flooring in upstairs of the service. Further studio three training and in other areas to incorporate whistleblowing and complaints in general. Putting in a programme to address developing sexuality needs of one resident. He is asking questions of staff about private matters /girlfriend. So we are aiming to introduce some interventions to address these issues. Looking at additional opportunities for service users to access alternative stimulating activities that are safe for staff, the resident and the community. Introduction of structured keyworker time to specificallyaddress needs with residents although this would be somewhat ineffective with two of the residents due to their limited communication. Better understanding of the service users sensory needs although these are not apparent as the service users are not outwardly displaying reactions/behaviours to sensory stimuli. We have attempted to access a sensory room at another service however the residents success with this activity has been mixed. Improve staff retention and addressing absenteeism issues". The issues identified and so comprehensively listed by the manager above leave little for us to add. As they have already been identified they do not need to be repeated as requirements or recommendations. CARE HOME ADULTS 18-65 Coolhaze 119 Howard Road Plymstock Plymouth Devon PL9 7ER Lead Inspector Peter J Wood Unannounced Inspection 15 and 18 January 2008 10:00 Coolhaze DS0000053993.V357865.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 Coolhaze DS0000053993.V357865.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. Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coolhaze Address 119 Howard Road Plymstock Plymouth Devon PL9 7ER 01803 882296 01803 882296 sgjcoolhaze@hotmail.com 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) Peninsula Autism Services & Support Limited Mr Sam George Johnson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2006 Brief Description of the Service: The Registered Provider for Coolhaze is Peninsula Autism and Support, a limited company managed by a Board of Directors. The organisation states that it concentrates solely on providing care services for people with Autistic Spectrum Disorders. Coolhaze is a large detached property and has been arranged into three separate self- contained units. People who live in the home have usually been assessed as requiring high levels of staffing to access opportunities inside and outside the home. The Registered Manager is Mr Sam Johnson. Fees are individually negotiated with sponsoring local authorities and vary considerably depending on the specific needs of the individual resident, but start at around £3,500. Copies of inspection reports can be obtained from the home or from the CSCI website. Coolhaze DS0000053993.V357865.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 was an unannounced though expected inspection, further to a telephone conversation with the manager as to his availability and the appropriateness of giving some notice to the people who live in the home who may be disturbed by their changed routine. The inspection was undertaken over two days in January 2008. The focus of this inspection was to inspect all key standards and to seek the views of people who live in the home, staff, relatives and professional visitors to the home, the latter using survey forms. At the time of writing this report, no surveys have, unfortunately, been returned. This may be a result of the new CSCI policy and business model, which may have caused some delay. We spent considerable time with the manager examining documentation, particularly that relating to client assessment and care planning, staffing and health and safety, but particularly discussing the philosophy of this specialist home. Staff who were on duty were consulted briefly during the course of their work, while two staff kindly volunteered to be interviewed in some depth. We saw all three people who live in the home, though verbal communication is difficult and relied on the experienced staff to communicate with them. A full tour of the whole building was undertaken, including the flats of the people who live there. As part of the inspection process we reviewed the Annual Quality Assurance Assessment (AQAA), a substantial document amounting to fifty-eight pages written by the manager, parts of which are quoted throughout this report. What the service does well: The registered manager writes in the Annual Quality Assurance Assessment: “Coolhaze exists to provide residential and support services to meet the specific needs of people with Autistic Spectrum Disorders and associated conditions, in a safe, stimulating, low arousal and structured environment. To enable each individual to reach their fullest potential and participate as full and equal members of our society.” The needs of people who may come to live at the home are properly assessed. These generate appropriate care plans so staff understand their needs and enable them to be as independent as possible. They are supported by staff to lead a full and active lifestyle, with their rights respected. They enjoy a healthy diet and receive support with personal and health care in ways they prefer and require, while the home’s medication practices protect them. Their views are listened to and complaints acted upon. They are protected from abuse. The Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 6 layout of the home has been planned to provide a safe and comfortable place to live and meet their needs. They are supported by properly recruited sufficient competent staff. People who live here benefit from a home which is well run, in their best interests, by competent owners and manager who ensure their health, safety and welfare are protected. What has improved since the last inspection? What they could do better: The registered manager writes in the Annual Quality Assurance Assessment: “Implementing training workbooks from wand training in the new year and ensuring all new staff complete their statutory training within their initial six months probationary period. Continue to build a team of bank staff for cover when absenteeism occurs so continuity of staff is increased for the residents. Developing a Coolhaze specific formal quality assurance system that will be able to tell us that the service users are happy and content in their lives within the service. The building of a bigger separate washing facility located around the side of the service that will have a washing machines and shelving for storage of clothing that needs washing to aid infection control. Staff will then take dirty washing directly from the service users flat to the shed where it will be washed. More redecoration of service users flats involving them in the process. Retuning and restoring of one services users piano as he likes when staff use this to sing songs. Replacing flooring in upstairs of the service. Further studio three training and in other areas to incorporate whistleblowing and complaints in general. Putting in a programme to address developing sexuality needs of one resident. He is asking questions of staff about private matters /girlfriend. So we are aiming to introduce some interventions to address these issues. Looking at additional opportunities for service users to access alternative stimulating activities that are safe for staff, the resident and the community. Introduction of structured keyworker time to specifically Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 7 address needs with residents although this would be somewhat ineffective with two of the residents due to their limited communication. Better understanding of the service users sensory needs although these are not apparent as the service users are not outwardly displaying reactions/behaviours to sensory stimuli. We have attempted to access a sensory room at another service however the residents success with this activity has been mixed. Improve staff retention and addressing absenteeism issues”. The issues identified and so comprehensively listed by the manager above leave little for us to add. As they have already been identified they do not need to be repeated as requirements or recommendations. 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 be made available in other formats on request. Coolhaze DS0000053993.V357865.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 Coolhaze DS0000053993.V357865.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people who may come to live at the home are properly assessed to give them and their relatives confidence that the home can meet their needs. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “New service users are admitted after a pre admission assessment is carried out involving senior management of Peninsula Autism Services. The pre admission assessment is robust and involves parents, staff and previous placements if appropriate as well as Multidisciplinary teams such as the challenging behaviour service based at Westbourne. There have been no recent admissions since the last inspection due to the stability of all three residents placements. Prospective service users are able to visit the service and have a trial stay at the home to establish whether they wish to move in. Within the organisation we have access to a range of communication services to involve the service user in the admission process the pre-admission assessment is available on request, all prospective service users and families would be offered opportunity to visit home and meet staff, view the rooms in which they would live. Any service users placement would be reviewed Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 10 continually for its appropriateness and effectiveness. Coolhaze does not have emergency admissions. Regular contact is maintained with all residents families by the allocated keyworker and the registered manager to ensure they are well informed about the activities and welfare of their son and that their concerns are effectively listened to and dealt with in an appropriate manner.” As part of the inspection process we (The Commission for Social Care Inspection, hereafter referred to as ‘we’) consulted the manager and staff and the three people who live in the home as best we may. We examined documentation and observed activity in the home. Examination of this substantially confirms the statements above. The home produces good documentation, including a statement of purpose and service user’s guide, and has a website which describes the company’s philosophy of care. All this provides good information for people who may come to live in the home and their families and sponsors. We saw that assessments are completed prior to admission to the home. If appropriate, people who may come to live in the home visit the home for a further assessment period when their needs are more closely identified and a judgement is made as to whether this is the right home for them. We saw from documentation that the home liaises closely with health and social care professionals and the relatives of people who live in the home in the formation of that decision. Coolhaze DS0000053993.V357865.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 excellent. This judgement has been made using available evidence including a visit to this service. Proper assessments generate appropriate care plans for people who live in the home. This enables staff to understand their needs and goals and the action staff need to take to enable people who live in the home to be as independent as possible. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment in relation to the first Key Standard: “Each of the three residents at Coolhaze has a very detailed care plan that details all assessed care needs and how staff should meet these. The care plan focuses on areas such as daily structure / routine, physical and emotional needs, specific intervention relating to the daily structure, health needs and health promotion, Cultural and religious needs. It also details contact with parents and recreational activities. The care plans details any behaviour which may challenge staff and how staff should address these if they occur. Regular reviews take place to update and amend Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 12 these care plans to ensure they are relevant and in line with the current needs of the residents. Within the care plan it clearly states assessed need, intervention techniques and why. Restriction on freedom and choice are based on an evaluation of the service users mood and anxiety levels and whether it is safe for the resident to access activities in Coolhaze / community. Due to the complex needs of the service users and the fact that their autism is profound their involvement in the care planning process is limited however keyworkers and allocated staff will attempt to ascertain their views and amend the care plans to reflect these. Each resident has a daily living file which contains all information pertaining to being able to work effectively with the resident. Within this file there are specific guidelines around the management of challenging behaviour, communication, risk assessments, Person cantered planning information and information with regard to the medication each resident is prescribed. A keyworker is assigned to each resident on the basis of their professional working relationship being effective with the individual and with the residents consent. They are asked to spend regular time with each resident ensuring their responsibilities are met with regard to the keyworker role.” As part of the inspection process we consulted the manager and staff and the three people who live in the home as best we may. We examined documentation and observed activity in the home. Examination of this substantially confirms the statements above. The assessed and changing needs and personal goals of people who live in the home are reflected in detail in their quality individual plans. People who live in the home make decisions about their lives with assistance as needed. Risks and choices are appropriately and skilfully balanced. Each of the three people who live in the home had a very detailed care plan, which recorded all assessed care needs and how staff should meet these. The plans also noted any behaviour that may challenge staff, and how staff should address these. Regular reviews had taken place to update and amend the care plans. These also identify the long term goals of people who live in the home, and the steps required to achieve these goals. We saw in these plans considerable evidence of multi agency involvement, particularly from the challenging behaviour service. Restricting choice for people on the autistic spectrum are sometimes necessary as too many choices may be too difficult to cope with. Restriction of choice or freedom are based on that understanding and a risk assessment, which is agreed with the person and / or representative and were regularly reviewed. Physical interventions are only used as a last resort, and staff will use distraction methods and diversion techniques as a primary way of diffusing potentially difficult situations. Any physical interventions are recorded. People who live in the home have weekly activities planners that detail activities for the week, and use symbols that they can make a choice from. People who live in the home participate in the day to day running of the home depending on their abilities. All records were stored. Staff were aware of the need for confidentiality. Coolhaze DS0000053993.V357865.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): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported by staff to lead a full and active lifestyle, with opportunities for personal development. Their rights are respected, and they enjoy a healthy diet. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment in relation to the first Key Standard: “The structured activity programmes and timetable are devised with the intention of giving the residents the opportunity to participate in activities that are developmental in their nature and have a specific interest to the resident. The timetables are regularly reviewed by the activities and programmes coordinator and specific activites can be changed before the review time if the resident is choosing not to participate or whether staff deem the activity is unsuccessfull. There are recording sheets in place to Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 14 monitor how well the service users are participating in the activities including length of time engaged in the activity, social communication behaviours observed during the activity, level of participation, support required to achieve activity as well as rating the individual overall mood for the duration of the activity.The service users can choose activities within their timetable on a weekly basis. All the residents at Coolhaze are unable due to their needs and profound autism to seek employment or other work related schemes. Staff will engage residents in literacy skills within their timetable at their level of understanding which may include writing stories on a mega sketcher or assisting service users in writing lists of what their interests are, music sessions with the manager. We have attempted to access a college course for one resident but his anxietys meant that this was not viable and he refused to start the course.” Evidence from our discussions with the manager and staff, coupled with written confirmation such as from care plans and minutes of meetings in the home, together with observations we made throughout the inspection substantially evidences the statements as above. People who live in the home were involved in lots of activities. Some of this took place in each person’s own flat. However, although none of the people who live at the home have much contact with each other, they nevertheless have considerable opportunities to take part in leisure activities in and around Plymouth. As far as possible these activities use ordinary public facilities, though some of the timings have be selected when members of the public do not have access at the same time. Activities are individualised, and set out on the activity plan of each person who lives in the home. Any activities are fully risk assessed. Every six months these activities are evaluated and updated, to establish which activities are valuable, and which activities the people who live in the home enjoyed or did not enjoy. When verbal communication is difficult, this is established by staff assessing each person’s behaviours. The activities focus on communication, socialization, and independent living skills. Included on these plans are guidelines for staff on how to encourage, motivate each person to try the activity and how to analyse the outcome. Likes and dislikes of each person regarding activities are also gained from the families of people who live in the home. Indeed, contact with families and friends is encouraged and supported. People who live in the home have their own separate flats, and although they have been assessed as requiring 1:1 or 2:1 staffing levels, the manager confirmed that their privacy is respected, as is their need for their own space. We observed throughout the inspection that staff demonstrated an awareness of the rights of their clients, and were respectful at all times. Staff also demonstrated an understanding of their care needs and how these could be met. Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 15 We looked at the menus; these demonstrated that the home encourages healthy eating whilst catering for the likes and dislikes of each people who live in the home. Their health records confirmed that the home has referred to a dietician when required. The people who live in the home have their own dining and kitchen areas and are supported to partake in shopping and food preparation dependent on their skills and risk assessments. They are able to have a holiday, which are specially selected according their choices and abilities to cope with changes in their daily routine. Coolhaze DS0000053993.V357865.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 this service. People who live in the home receive support with personal and health care in ways they prefer and require. The home’s policies and practices regarding medication administration protect residents. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment in relation to the first Key Standard: “Personal support in ongoing and intensive as the needs of the service users dictate that in order for them to achieve activities /routine and manage their anxieties. Staff support is essential to ensure they can live as full and active lifestyle as possible while staff strive for them to achieve these goals as independently as possible. Coolhaze staff operate a strictly hands off approach when managing behaviours that challenge within the service and externally, although as a last resort studio three hands on techniques may be required to ensure the safety of the service user, staff and members of the general public and to guide the service user to an area such as their flat/vehicle where staff can safely breakaway. All Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 17 incidences of going hands on are recorded on incident report forms. Service users are monitored closely by allocated staff after such occurrences. Dignity is of up most importance and staff ensure that residents dignity is maintained at all times key areas that are focused include clothing and dignity around nakedness. Service users do need support in completing intimate care such as baths however this support is limited to tasks as in washing hair/face and staff will then give the service users privacy. The service users have choice of when they eat and go to bed although these are similar day to day due to their need for routine. Support workers will provide support with regards to assisting residents in completing their personal hygiene routine which include supporting them to keep clean, shave. Sometimes due to behaviours and anxiety levels it is difficult to achieve these as service users may refuse to participate in this baths, shaves. Occurrences of refusal are monitored on a personal hygiene monitoring form. The residents are supported in choosing their own clothes on shopping trips in to Plymouth City Centre and their appearance very much reflects their personality. Service users have a core group of staff who are deemed by the service user and the senior team to be the best at working with them. Each service user is told the plan of who will be supporting them throughout each day and due to their selectivity and anxieties over certain staff this is very much prescribed although they do have choice within this. The staff team will have to be flexible as in accommodating changes throughout the day if a service user requests a different staff member or if there has been an incident the staff member may want to approach the shift leader to work with another client. At coolhaze we have access to a range of specialist support to gain advice such as speech and language, physiotherapists, Chiropodists. Each resident has a designated keyworker chosen if capable by the resident who is responsible for ensuring the daily living file/routines and care plan are up dated. All staff ensure continuity and consistency as best as possible by following guidelines and care plans which include routines.” Evidence from our discussions with the manager and staff, coupled with written confirmation such as from care plans and minutes of meetings in the home, together with observations we made throughout the inspection substantially evidences the statements as above. The individual plans of people who live in the home detail their personal, emotional and health care needs, their preferences and routines, and how they are met. We saw that medication is appropriately and securely stored and that the Medication Administration sheets were well recorded. Staff about to give medication answered in detail the medication policy and procedure and demonstrated their practice. This includes two staff members checking every time medication is given to each person who lives at the home. Staff appeared well trained and knowledgeable about the medication process and administration of medication. People who live in the home are registered with a local General Practitioner, and have access to all local and specialist health services. Coolhaze DS0000053993.V357865.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 this service. People who live in the home and their relatives can be confident that their views will be listened to and any complaints will be taken seriously and acted upon. People who live in the home are protected from abuse, neglect and self harm. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment in relation to the first Key Standard: ” Coolhaze has complaints procedure displayed in the communal hallway of the service that is both effective and clear in its nature which includes stages of and timescales. Within the service user guide it is shown that if a service user is unhappy they can contact myself as the registered manager or the homes CSCI inspector, contact details of which are located on the guide. There is a service user orientated complaints form in the communal kitchen. The staff team listen and act on the view of the residents before they come to issues that could potentially be complaints. Discussion on issues is held with service users by the manager and keyworkers and within individualised core group meetings. At Coolhaze we have never had a complaint however should a complaint be put in we are confident that the processes for dealing with this are both accurate and efficient and that records of all complaints would be kept in the service.. Any complaints will be responded to within 28 days. Service users can talk to staff if they have any concerns, complaints although at times we find ourselves doing this for them Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 19 as in they lack the ability, due to the nature of their autism at times to complain. Staff will then report any thing of major concern directly to the registered manager. Service users and families are welcome to make complaints if they feel justified in their actions and any complaints will be dealt with constructively by the service and in a manner that does not victimise or alienate the complainant.” Evidence from our discussions with the manager and staff, coupled with written confirmation such as from care plans and minutes of meetings in the home, together with observations we made throughout the inspection substantially evidences the statements as above. Neither the home nor the Commission for Social Care Inspection have received any complaints regarding this service since the last inspection in July 2006. The home has a written complaints procedure, and this is displayed in the communal hallway of the home. The manager stated that he makes efforts to speak to the parents of the people who live in the home on a regular basis, and the daily communication book outlined several examples of regular contact between the home, parents or relatives of people who live in the home, and health and social care professionals. People who live in the home have a range of communication methods, and rely very much on staff to articulate for them any dissatisfaction they may have. We saw that the staff have positive relationships with them that enables them to communicate their needs. Each service user has a separate file containing in-depth daily reports that can be analysed to understand any triggers and respond to non verbal forms of concerns or complaints. The latest Alerter’s Guide (this is a booklet produced by local and health authorities and others containing procedures to follow in the event of a suspicion of abuse) was available to all staff. All staff have received Safeguarding (protection of vulnerable adults) training. The manager has received additional training in this area. All physical interventions and restraints are recorded, and all staff members have undertaken Studio 3 (behaviour management) training as part of their induction and this is updated regularly. In addition there are also lone working procedures, debriefing, staff meetings and individual supervision to ensure that staff receive sufficient support and advice when working with people who live in the home who may present challenging behaviours. We saw that the records relating to finances of people who live at the home were in good order. Coolhaze DS0000053993.V357865.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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The layout of the home and its accommodation have been specially planned to provide a safe and comfortable place to live and meet the individual needs of the people who live there. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment in relation to the first Key Standard: “Coolhaze provides accomodation within a large detached house that has been divided up into three separate self contained units that have their own front door, living area, bathroom, bedroom and garden area. Each area has adequate space to meet the minimum standards. Information on the living space is included in the service users guide. The layout of the accomodation has been planned around the needs of the residents as in separate flatlets with no resident access to communal hallways. Coolhaze is well decorated and homely although due to the needs of Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 21 three residents this can mean redecoration needs addresseing more frequently than it due to behaviours and as such projects need careful planning as the service users due to their autism need to be well prepared and supported to cope with any changes. Each flatlet reflects the individual personality of the service user living in there and is both safe and comfortable for the resident to live in. There has been issues in the past with odourous problems with regard to one residents incontinence on carpets however we have addressed this area by buying a heavy duty waterproof bed and re flooring his living area with vinyl and putting washable rugs down to ensure his comfort if he sits on the floor. Furnishings and fitting within the service arein good order and the maintenace team address and resolve any issues that may be caused by damage to property or items within as a matter of urgency. We employ a domestic to ensure that the service is clean and fresh. The premises is well heated and ventilated and has suitable lighting for each flat and the communal areas. The service has met the requirements of the local fire service and envirnmental health department. The service has a service development plan that is updated annually that includes major maintenance work that needs carrying out. Due to the challenging behaviour needs of the residents maintenance is carried out on a reactionary basis as in mending damage done. Due to the building being staffed 24/7 there is no CCTV cameras within the service howver where the office is situated means that the manager is able to see any individuals accessing the driveway to come to access the service. Regular checks are carried out by the waking night staff on the external grounds and security of the premises and on the residents.” Evidence from our discussions with the manager and staff, coupled with written confirmation such as from care plans and minutes of meetings in the home, together with observations we made throughout the inspection substantially evidences the statements as above. Coolhaze is a large detached house that has been divided into three separate self-contained units that have their own front door, lounge, bathroom, bedroom and garden area. There is a communal kitchen, manager’s office and staff room / sleeping in room. Each unit is fitted with emergency call bells, and the doors are alarmed. This is with the agreement of relatives and care managers and is documented. We inspected the whole of the property during the inspection. This included the three flats of each person who live in the home. All areas were clean and tidy and reflected the characteristics, personal interests and hobbies of those who lived there. There is an ongoing maintenance programme. Any changes of redecoration and refurbishment are carefully planned, as the people who live in the home need to be well prepared and supported to cope with any changes, owing to their autism. The bedroom of one person was in need of repainting, but he would be distressed if painters invaded his space to do their work, as he would with the smell of the fresh paint. Repainting has to be carefully planned to dovetail with a “holiday” or “break” away from the home. Coolhaze DS0000053993.V357865.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): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are cared for and supported by staff in sufficient numbers and with the qualities, skills, and qualifications to meet their needs. The procedures for the recruitment of staff safeguard people living in the home. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment in relation to the first Key Standard: “Staff are recruited on the basis of the basic principles that they have the qualities of personality to build and maintain successful relationships with the staff team but more importantly the residents. Having experience due to the complex needs of the residents is also highly desirable. Staff are friendly and approachable and feel comfortable in the work they do. Regular supervision and appraisal gives both the staff member and the manager/supervisor the opportunity to discuss how the job is going and to decide whether the type of work is suitable to them. Staff are employed on a 6 month probationary contract. This benefits both themselves as in working out Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 23 if the work is suited to them and the management teams more flexibility around ending employment if unsuitable although this is rare. All staff are CRB and POVA checked and two written references are sought that form part of the recruitment process to ensure they are reliable and honest and all staff are good listeners and communicators and any issues around these areas. Written communication guidelines are in place within the residents daily living file that staff are given to read to aid their interaction with the residents two of which have specialist communication methods. Training is given and thus staff have skills and experience they can put into practice in the areas of management of physical and verbal aggression, knowledge of autism and good practice generally within care. Certain Senior staff have contact with external professionals such as care managers, general practitioners and staff working in other care homes both within and outside Peninsula. These links enable staff to share ideas, good practice and empower them in their work. Generally because we request that all staff have some experience we do not have trainees or staff under the age of 18. We are pleased to have 2 staff undertaking their NVQ3 at present with 4 staff having achieved this and NVQ2 that still work at the service 2 staff have achieved an NVQ 4 in care that still work at the service and we have staff that when they feel ready too and some of whom havent completed their probationary period yet, we will look to start them on their NVQ training. There are three staff members with relevant higher level degree qualifications including psychology and community studies.” Evidence from our discussions with the manager and staff, written confirmation and our observations throughout the inspection substantially evidences the statements as above. Staff we consulted were very aware of their own roles and responsibilities within the home. It was clear that staff are very knowledgeable about the care needs of the people who live in the home and how these needs are to be met. We examined the personnel files of four staff to ensure that proper recruitment, induction, training and supervision arrangements were in place. We also received the Annual Quality Assurance Assessment (AQAA) from the manager. Discussions with him and his staff complemented this documentary evidence. Staff reported that the correct recruitment procedures were carried out with them, including an application form, POVA First (a check against a list of people considered unsuitable to work in care settings) and CRB (Criminal Record Bureau) checks and ID (identity) checks being carried out before employment. We saw that staff training profiles indicated that staff have received training in a number of areas including health and safety, medication, food hygiene and fire safety. First aid training is also provided, and specialist training in working with people who have autism and physical restraint training. The majority of staff had completed NVQ 3 training in care. A comprehensive induction programme is available for new staff. There is a culture of training in this home. Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 24 The people who live in the home at Coolhaze have complex care needs and present behaviour that may challenge the service. In view of this, the people who live in the home are assessed as requiring individual or 2:1 staffing support inside and outside of the home. The home’s risk assessments and duty rota confirmed that this level of staffing is in place. There are four or five staff plus the manager on duty during the day, and the home employs a cook and cleaner. There is a four weekly staff rota. Staff confirmed that they were happy with the staff rota and believed that the home is adequately staffed. Staffing levels are regularly reviewed. They told us that the training they received was good and helped them with the people who live in the home they cared for. Staff confirmed that they receive regular supervision and notes for these were available. In addition to supervision there are regular staff meetings, handover meetings, and debriefing available following a difficult incident. We observed that staff interaction with the people who live in the home was positive and enabling. Staff understood the need for consistency and clear boundaries when working with the people who live in the home, and this was apparent in their approach. Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live here benefit from a home which is well run, in their best interests, by competent owners and manager. Their health, safety and welfare are promoted and protected, and they benefit from the open and clear management approach taken in this home. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment in relation to the first Key Standard: “The Home Manager …… Sam Johnson ..has a degree with honours in Community and Youth work, has achieved his NVQ level 4 and is currently working towards the final module of the Registered Managers Award, which [he hopes] to have completed in the next month. Sam has worked in a senior managerial role in services for adults and young people Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 26 with autistic spectrum disorder and challenging behaviour for the past seven years and has been managing coolhaze now for three years. He also has a background in youth work and has a nationally recognized JNC youth work diploma. The registered manager is accountable to his job description and has overall responsibility for the service to ensure that primarily the well being of the residents and the duty of care, the budget is managed effectively, the home meets the standards as set out by the commission for social care inspection, certificates and licenses are obtained and displayed where appropriate. The registered manager undertakes regular periodic training and has attended recent national autistic society conferences and meetings within the south west representing the organisation.” The inspection of Coolhaze substantially confirms the statements above and elsewhere within the Annual Quality Assurance Assessment (AQAA). Peninsula Autism Services and Support Ltd., is the Registered Provider for Coolhaze. The company is run by a board of directors while the homes within the company are managed by Registered Managers. The principal of the company is well known to have long experience of running quality care homes for people with learning disabilities with a specialism of working with people on the Autistic Spectrum. Mr Sam Johnson is the Registered Manager of this care home. Mr Johnson has undertaken a wide range of training and has an excellent knowledge of autistic spectrum disorders. He provides strong leadership and ensures the home is well organised and safe. A member of staff undertakes that all health and safety issues are checked, and issues a quarterly report. We saw no health and safety concerns at this inspection. We saw that all relevant policies and procedures have been written, are reviewed regularly and cover all the activities in the home. Accidents and incidents are properly recorded. Fire safety systems have been properly maintained and tested. The home is working towards, but does not yet have a formal quality assurance system, but has an annual audit from the company, and is accredited by the National Autistic Society. Further details can be obtained from the Annual Quality Assurance Assessment (AQAA), a substantial document amounting to fifty-eight pages written by the manager. Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 X 3 X 3 X 3 X X 3 X Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard Good Practice Recommendations Coolhaze DS0000053993.V357865.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Contact Team Colston 33 33 Colston Avenue Bristol BS1 4UA 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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