Care Home: Cumberland Gate, 44

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What the care home does well Support is provided to the people living at Cumberland Gate to make their own daily decisions and spend their time in activities that they enjoy, including going on an annual holiday, attending college and the resource centre. Everyone living at Cumberland Gate has their own bedroom. The house supports people to live an ordinary lifestyle within their local community. Everyone is supported to go out and about in the community. One person commented, e.g., "Staff are very caring and professional and appear to work well as a team." "Staff are very experienced in this field of care. They are very tuned in to the particular needs of people with autism and so are able to prevent problems from escalating." "I feel that it would be possible to discuss problems with the staff and manager-they are very open to listening to my views-so it is unlikely that formal procedures would be necessary." Staff members commented on, e.g., "The service provides a very professional and holistic approach in all aspects of the service users needs." "We have a good staff team that communicate well." ".........staff training has improved over the years." "Provides a service whereby the service users feel safe and secure. Gives the service users a fulfilled life of their choice." Three residents had support completing their comment card and every person felt they could do want they wanted to do in the day and in the evening. One person uses pictures to choose what they want to do. The registered manager has been in post for many years and continues to provide an effective leadership role and offers great stability to the home. Staff have a good understanding of the people living at Cumberland Gate and work with them to offer choice and independence. People told us that they like the staff team. What has improved since the last inspection? This was a positive visit with a lot of work having been carried out to meet all the requirements from the last inspection to help make the home an even better place to live. There are clear procedures in place for dealing with any concerns that might arise. The manager has helped make the company complaints procedure into an easy read format using pictures so that residents have access to this guidance in their own room. Staff have been provided with updated training in medications so they are up to date in supporting people with managing their medications. Individual service user guides have been prepared for the people who live at Cumberland Gate. These contain photographs and pictures to help people understand the information. They inform people about how the home operates, staffing, how to raise concerns and the support that will be provided. The environment has been maintained and decorated to provide a comfortable place to live. What the care home could do better: Full feedback was given to the manager during and on conclusion of this visit. Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents These reviews should be included with staff and residents and their opinions should be included in the reviews. The company should review their procedures in operating a "lone working policy" and "seconding" permanent staff from Cumberland Gate to help staffing issues in other registered homes. These procedures must be revised because they affect the resident`s rights and choices to do what they want when they have low staffing levels. Some people can become anxious and confused when long-term staff are moved as they think they have left and are missed by the residents. This is not in keeping with the companies` philosophy of support for people with Autism. Staff should arrange updated care management reviews so that care managers can be informed and be kept updated were support plans for residents that have been affected due to lower staffing levels than usual. Any untoward incidents affecting the home must be reported to the commission using forms called regulation 37 forms. All incidents of movement of the staff team from Cumberland Gate to other registered homes and staff shortages must be reported to the commission using regulation 37 forms. The responsible person must make sure that all regulation 26 visits are carried out monthly and reports produced to show there are regular checks from the company on the standard of living offered in the home. To continue developing ways of obtaining residents views regarding the service they receive. For the company to look at financially providing at least a week`s annual holiday for each resident. CARE HOME ADULTS 18-65 Cumberland Gate, 44 44 Cumberland Gate Netherton Liverpool Merseyside L30 7PZ Lead Inspector Diane Sharrock Unannounced Inspection 12th February 2008 15:30p Cumberland Gate, 44 DS0000005238.V355596.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 Cumberland Gate, 44 DS0000005238.V355596.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. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Gate, 44 Address 44 Cumberland Gate Netherton Liverpool Merseyside L30 7PZ 0151 531 6039 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) Cumberland@autisminitiatives.org www.peterhouseschool.org Autism Initiatives Susan Scott Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 LD. Date of last inspection 8th January 2007 Brief Description of the Service: 44 Cumberland Gate is a small home registered for three people who have a learning disability. The service is provided by Autism Initiatives, a local organisation who have charitable status. Autism Initiatives provide a range of services to people who have autism. 44 Cumberland Gate is a four-bedroom property located on a residential housing estate in Netherton, Merseyside. Downstairs there is a living room, dining room and kitchen. Each person has their own upstairs bedroom and there is a shared bathroom upstairs with additional downstairs toilet. There is a small-enclosed back garden with parking available a short walk away. The Service Users are supported by a small well-established staff team. There are staff on duty to support people throughout the day and a sleep in member of staff at night. The registered manager is Ms Susan Scott. The weekly fees are from £1330.86 to £ 1943.69. Cumberland Gate, 44 DS0000005238.V355596.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. We visited the home unannounced on the 12th February 2008 where time was spent reading records and looking at the building and meeting people at the home. A system called, ‘case tracking’ was used as part of the visit. This involves looking at the support a person gets including their care plans, medication, money and bedroom and living area. Case tracking was used to look at life at Cumberland Gate for one of the people living there. We also spent time meeting with people who live there and with staff about how they meet the resident’s needs and choices. Discussions took place with one staff and the manager. We received three-comment card from residents. One from a relative and five cards from staff, their views are included into this report. In total we received 9 comment cards all mainly positive in their views about the home. An easy to read summary of this report is available. If you would like to see a copy please ask the staff working at Cumberland Gate. The manager contributed to the inspection process by completing a selfassessment form, which has helped give us some information about the home. The information gathered from the site visit along with any information about the home that we have received since the last key inspection has been used to write this report. What the service does well: Support is provided to the people living at Cumberland Gate to make their own daily decisions and spend their time in activities that they enjoy, including going on an annual holiday, attending college and the resource centre. Everyone living at Cumberland Gate has their own bedroom. The house supports people to live an ordinary lifestyle within their local community. Everyone is supported to go out and about in the community. One person commented, e.g., Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 6 “Staff are very caring and professional and appear to work well as a team.” “Staff are very experienced in this field of care. They are very tuned in to the particular needs of people with autism and so are able to prevent problems from escalating.” “I feel that it would be possible to discuss problems with the staff and manager-they are very open to listening to my views-so it is unlikely that formal procedures would be necessary.” Staff members commented on, e.g., “The service provides a very professional and holistic approach in all aspects of the service users needs.” “We have a good staff team that communicate well.” “………staff training has improved over the years.” “Provides a service whereby the service users feel safe and secure. Gives the service users a fulfilled life of their choice.” Three residents had support completing their comment card and every person felt they could do want they wanted to do in the day and in the evening. One person uses pictures to choose what they want to do. The registered manager has been in post for many years and continues to provide an effective leadership role and offers great stability to the home. Staff have a good understanding of the people living at Cumberland Gate and work with them to offer choice and independence. People told us that they like the staff team. What has improved since the last inspection? This was a positive visit with a lot of work having been carried out to meet all the requirements from the last inspection to help make the home an even better place to live. There are clear procedures in place for dealing with any concerns that might arise. The manager has helped make the company complaints procedure into an easy read format using pictures so that residents have access to this guidance in their own room. Staff have been provided with updated training in medications so they are up to date in supporting people with managing their medications. Individual service user guides have been prepared for the people who live at Cumberland Gate. These contain photographs and pictures to help people understand the information. They inform people about how the home operates, staffing, how to raise concerns and the support that will be provided. The environment has been maintained and decorated to provide a comfortable place to live. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 9 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 Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 10 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. Procedures are in place to make sure that enough information is obtained and given to people so they can make informed decisions about the home. EVIDENCE: Since the last key inspection no new residents have moved into Cumberland Gate. Therefore it was not possible to measure whether the home provides enough information to any new resident. There are procedures in place to ensure that sufficient information is obtained about the person, including an up to date service user guide which gives a lot of information about the home and would help anyone make a decisions about whether the home can meet the persons needs. Individual service user guides have been prepared for the people who live at Cumberland Gate. These contain photographs and pictures to help people understand the information. They inform people about how the home operates, staffing, how to raise concerns and the support that will be provided. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6/7/9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s individual needs and choices are recognised and supported although they are occasionally restricted by staffing levels. EVIDENCE: Detailed individual care/support plans were available for each of the residents. We looked at one support plan in detail, which was up to date and regularly reviewed. The plans were well presented and gave information about how people communicate their preferred routines, their health and personal care needs and the support that they need and want. Some people use pictures to help them communicate their choices and needs. One person has a staff rota to help reassure them as to what staff are due to come on duty and when staff are on holiday. These records and procedures were able to demonstrate how they meet the diverse needs of residents at the home. This was observed during our visit and support plans reflected the staffs understanding and knowledge and rapport with the residents. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 12 For example one person has regular updated support plans including one used for recycling paper and cardboard and support with medication. During our visit we were able to chat to staff who were able to explain how they support residents to make decisions, and they were able to discuss how their needs are supported and met. During our visit the staff rota showed that just one person was on duty all afternoon and evening due to a staff member being moved to another home to help with a staffing issue. This issue was discussed as usually the home have 2 staff on duty and the residents support plans show they need this amount of staff to enable them to be supported with their plans and helped to choose what they wanted to do. This meant that if any of the residents wanted to go out while there was just one staff member they could not be supported with that choice and would be assisted to stay inside the home. Staff explained that the company operate a, “lone working policy,” which means staff can contact other homes in an emergency when they are rostered to work on their own. This company procedure of moving stable members of the staff team at Cumberland Gate who know the residents very well does not make sense and doesn’t reflect the companies philosophy in supporting people with Autism. There was no evidence to show that the staff being moved was in the best interest of the residents living at Cumberland Gate. Two of the residents have additional funding for one to one support which staff state is provided when they go to the resource centre. We met the residents present at the home, one person was able to talk about what they had done that day and was looking forward to going shopping that week. Three residents had support completing their comment card and every person felt they could do want they wanted to do in the day and in the evening. The manager has just received company questionnaires to be given to all residents to get their opinions about the services and support offered at the home. The manager plans on using them every 3 months and is also awaiting the development of questionnaires that she can issue to relatives and representatives acting on behalf of any of the residents. We looked at residents financial records, which were well kept, accurate and in good order. Records showed that each resident has a bank account in their own name and staff support each person in managing their money. Staff have helped develop Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 13 detailed financial assessments which are good in describing what support needs to be given. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 14 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): 12/12/15/16/17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff provide support to residents to meet their social needs and to be as independent as possible. EVIDENCE: Staff were observed to have a good rapport with residents and were observed to assist residents in various choices. Resident’s rights and choices were seen to be respected especially in giving each person enough space and privacy to be on their own when they wanted to be and in respecting each person’s privacy when they came home from the resource centre. We chatted to staff and looked at records that showed that each of the residents attend day care for part of the week. On other days they are supported by staff to take part in a variety of tasks and activities both in and Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 15 outside the home. The risk assessments have been produced to support residents to overcome difficulties and engage in activities in a safe manner. Everyone can go on an annual holiday if they choose. Staff talked about the last holiday. They said that the residents have enjoyed these holidays and they were looking forward to planning the next one. They explained that the residents pay for their own annual holiday but in the past the company used to pay part of the costs. Staff were unsure as to why the company had stopped paying towards the residents annual holidays. Discussion took place around the national minimum standards were its advised as good practice that the company should provide at least one holiday each year for all residents. In chatting to staff and looking at records they showed that staff support residents to maintain family links and friendships. Records evidenced that family and friends are always welcome and included. One relative commented that, “Communication is very good I visit regularly so am updated then, but also receive phone calls when there is anything additional I need to know.” “I feel my ………. is able to express their needs and make choices. There always have to be compromises within a communal setting but I believe …… has an enjoyable life and certainly appears happy.” The kitchen was equipped with domestic style appliances and staff helped provide meals that residents personally chose. Cumberland Gate, 44 DS0000005238.V355596.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. The residents’ health and personal care needs are supported by staff. EVIDENCE: The care plans and risk assessments provide the staff team with information about the most appropriate and safe way to support residents with their personal care needs. Support plans provided detailed information about the type and level of personal and healthcare support that each person requires. The persons preferred routines with regards to personal care were also available in good detail and kept regularly up-to-date. Information was available which helped ensure that each resident’s privacy, dignity and independence is met. The staff manage all of the residents medication needs including ordering, storing and administering them. Staff have recently attended updated training on medications and how to manage and administer them. We looked at a sample of medications and found them to be stored correctly with clear records kept of the amounts received and given out to residents. This helps to reduce the risk of mistakes occurring and provides a clear audit trail to check people receive their medication correctly. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 17 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. Residents are protected by the homes procedures for responding to concerns and complaints. EVIDENCE: We saw the complaints records during this inspection and there had been no recent complaints. These records showed that the company policy was being followed with the right record keeping in place. There has been no complaints received by the Commission about the home since the last inspection. There are clear procedures in place for dealing with any concerns that might arise. The manager has helped make the company complaints procedure into an easy read format using pictures so that residents have access to this guidance in their own room. One relative commented that, “I feel that it would be possible to discuss problems with the staff and manager-they are very open to listening to my views-so it is unlikely that formal procedures would be necessary.” Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 18 The manager had a company-training brochure for 2008 giving details of all training on offer to help keep staff up to date in all necessary policies and procedures including complaints and abuse awareness. Some staff last had training on “abuse awareness”, 2 to 3 years ago. The manager agreed to look at the required intervals of training to see if this was adequate for keeping her staff team up to date in safeguarding and abuse awareness procedures. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 19 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. Cumberland Gate provides a comfortable environment for people to live in EVIDENCE: Cumberland Gate is owned by a local housing association known as Riverside Housing Association. It is a domestic house located in a residential area of Netherton. The home is located close to shops, pubs and other community facilities including public transport links. We saw a sample of areas throughout the home during our visit. Downstairs there is a lounge with separate dining room, kitchen and toilet. Upstairs each resident has their own bedroom and there is an office and bathroom. The front the house is located a short walk away from the street, which provides some parking and there is an enclosed garden at the back of the property. The home was decorated to a good standard and offered a comfortable home to live in. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 20 We saw bedrooms which were personalised, were some people had various personal items to help them individualise their room. One person said they liked their room and had everything they needed. The manager had developed a 5 year development plan for the home and kept this in the service user guide which helps to keep everyone informed of any planned developments to their home. A sample of maintenance certificates were seen which showed up to date checks as listed in the homes pre inspection questionnaire which helped show what actions were taken to keep the home safe to live in. . Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The people living at Cumberland Gate are adequately supported by staff however sometimes a lack of staffing can impact on the residents’ choices. EVIDENCE: There is a small staff team of 7 Carers and the manager working in the home. Many are long standing members of staff who are familiar with the residents and their needs. Staff files contained evidence that checks are carried out on new and existing staff to ensure they are suitable to work with the people living in the home. This includes obtaining references and Criminal Record Bureau Checks (CRB). At intervals throughout our visit staff were seen interacting well with residents. They were flexible and positive in their approach and appeared to have a good understanding of the needs of the residents. We chatted to staff who displayed a good knowledge of the people they support and their individual support methods and choices. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 22 Most of the staff comment cards explained that they only “usually”, have enough staff and one person said they only, “sometimes” had enough staff to meet the individual needs of the residents. One person commented, “We have funding for the staff- but when someone leaves it takes along time to hire new staff.” We looked at staff rotas and noticed that the company had moved a long standing member of staff who the residents knew very well to another home for “secondment” for 4 weeks to help a situation in another home. This meant that on the day of our visit and on other occasions seen on the duty rota that there was just one member of staff to support 3 people late afternoon and evening. This meant that if any of the residents wanted to go out they couldn’t as the home did not have enough staff to support a resident’s choice to go outside their home. The manager was honest in explaining the duty rota and the company procedures in operating a “lone working policy” for when one staff is on duty and the procedures around seconding permanent staff to other registered homes. These procedures sometimes affect the residents in the home because they affect the resident’s rights and choices to do what they want when they have low staffing levels. Some people can become anxious and confused when long-term staff are moved as they think they have left and are missed by the residents. This is not in keeping with the companies’ philosophy of support for people with Autism. Following our visit we discussed our concerns with a senior manager of the company. They agreed to revise this secondment and move the regular member of staff back to Cumberland Gate to help the stability and support to the residents at the home and prevent low staffing levels. Two weeks after our visit we had information to say the same member of staff had been moved yet again for 3 days to another registered home to help a staffing situation and again the secondment procedure had been put into practice. This practice of moving stable members of the team who know the residents very well seems to be done without reviewing the affects to the residents and is not in keeping with the residents needs of having a stable staff team at all times. The registered manager is responsible for making sure she has appropriate staff in place to adequately support the residents with their support plans. Following our visit we have discussed with the manager any untoward incidents affecting the home must be reported to the commission using forms called regulation 37 forms. The manager has agreed to submit a record of all Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 23 incidents of movement of the staff team from Cumberland Gate to other registered homes and staff shortages must be reported to the commission using regulation 37 forms. We looked at Autism initiatives training brochure for 2008, which offered dates for staff for different training sessions. The brochure covered a diverse list of training necessary to keep staff up to date in supporting residents. Some staff had attended training in the mental capacity act and were aware of residents rights. The majority of staff have been supported in obtaining a care qualification necessary to support residents. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37/39/42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well managed home. EVIDENCE: The registered manager of the home is Ms Susan Scott. The manager has been at the home for many years and offers a great stability and rapport to all the residents and staff. The manager was seen to have an open and positive management approach and worked regularly as part of the team. The manager tries to organise at least 7 hours managerial hours per week to help manage the home effectively. She is experienced at working within a care setting and during the site visit displayed a good awareness of supporting people with autism and of resident’s individual choices and support needs. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 25 As part of the homes quality assurance process and in accordance with Regulation 26 of the Care Homes Regulations a senior representative for the company visits the premises monthly. It is important that the company to check the standard of care in the home does this. Records show that the visits and reports are not always carried out each month as required. The last visit and report seen was dated April 07. Staff explained that the company are looking at implementing new procedures for regulation 26 reports and cluster duties. They felt that additional funding and hours are going to be provided so any additional duty doesn’t affect the management of their registered home. We discussed these proposed procedures with a member of the company’s quality assurance team who agreed that it would be beneficial to arrange a meeting with the commission to discuss any forthcoming changes. The manager continues to organise regular staff meetings. Staff minutes were seen of recent meetings and showed details of various topics about the home. This ensures that staff members have a regular forum to discuss issues that may affect the service provided to residents including, support plans, training and practices within the home. We looked at information provided in the pre-inspection questionnaire and a sample of health and safety records, which showed that the necessary checks have been carried out on the environment to help maintain a safe environment to live and work in. Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 26 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 X 3 3 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 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 Regulation 18 1a Requirement Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should also include staff and residents/relatives opinions. The company must show evidence of how they have covered any staff absences so that enough staff are in place to provide the right support for residents. As part of the homes quality assurance process and in accordance with Regulation 26 of the Care Homes Regulations a senior representative for the company must visit the premises at least monthly. It is important that this is done to check the standard of care and support in the home. Timescale for action 23/04/08 2. YA39 26 23/04/08 Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Staff should arrange updated care management reviews so that care managers can be informed and be kept updated were support plans for residents have been affected due to lower staffing levels than usual. The company should review their procedures in operating a “lone working policy” and “seconding” permanent staff from Cumberland Gate to help staffing issues in other registered homes. These procedures must be revised because they affect the resident’s rights and choices to do what they want when they have low staffing levels. All policies and procedures relating to appropriate staffing to each registered home must be in keeping with the companies’ philosophy of support for people with Autism. To forward regulation 37 reports for any untoward incident including the movement of permanent staff from Cumberland gate which may affect the staffing levels and support being given to residents at the home. To continue developing ways of obtaining residents views regarding the service they receive. For the company to look at financially providing at least a week’s annual holiday for each resident. 2. YA33 3. 4 YA39 YA14 Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Extracts may not be used or reproduced without the express permission of CSCI Cumberland Gate, 44 DS0000005238.V355596.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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