Care Home: Hoffmann Foundation for Autism 11 Pear Close

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What the care home does well The home has a welcoming and calm atmosphere. The home is staffed efficiently, with particular attention given to busy times of the day, and changing needs of people who use the service. People using the service take part in a variety of activities that meet their varied needs, and preferences. Staff receive varied and appropriate staff training, which ensures that they have the skills needed to provide the care and support needed for people using the service. Staff have a good understanding of the significant needs of people using the service, particularly with regard to the residents communication needs. The manager has put some systems in place to improve the service for residents, and is motivated and keen to continuously develop the quality of the care and support provided to people who use the service. What has improved since the last inspection? The home has appointed a manager, who has the experience and competency to run the home. Requirements and recommendations from the previous key inspection have been met by the care home. There has been redecoration of some bedrooms and bathrooms, and some maintenance issues have been resolved. Staff have received infection control training. Staff recruitment selection procedures are now more robust. Residents care plans are being reviewed more frequently, and more goals and objectives of residents have been identified. What the care home could do better: CARE HOME ADULTS 18-65 Hoffmann Foundation for Autism 11 Pear Close Hoffman De Visme Foundation 11 Pear Close Kingsbury London NW9 0LJ Lead Inspector Judith Brindle Key Unannounced Inspection 22nd July 2008 09:00 Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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 Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hoffmann Foundation for Autism 11 Pear Close Address Hoffman De Visme Foundation 11 Pear Close Kingsbury London NW9 0LJ 020 8200 8667 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) Hoffmann Foundation for Autism Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 21st August 2007 Date of last inspection Brief Description of the Service: The home is one of a number of care homes owned by the Hoffmann Foundation for Autism. It provides accommodation and personal care for 6 adults with learning disabilities. The home is located within a residential area of Kingsbury, within the London Borough of Brent. It is close to local shops, and bus routes and there is parking outside the home. There are two bedrooms on the second floor and a shower room with a toilet. Four bedrooms, two offices and a bathroom, with toilet, are situated on the first floor. On the ground floor there is a lounge, a large kitchen/dining room, a laundry room, a toilet and an activity day care room/staff ‘sleep in’ room. Leading from the day care room is a bathroom, with a toilet, and a small kitchen. Access to the garden is through patio doors leading from the lounge and from the kitchen/dining area. Information regarding the fees charged may be obtained, on request, from the manager, and or owner of the home. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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. The unannounced key inspection took place throughout a day in July 2008. There were no vacancies at the time of the inspection. We were pleased to meet, all the people living in the home. The manager was present during most of the inspection. Prior to this unannounced key inspection the Commission for Social Care Inspection (CSCI) provided the care home with an Annual Quality Assurance Assessment (AQAA) document to complete. The AQAA is a self- assessment of the service provided by the care home, and is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. This document was satisfactorily completed prior to the inspection. A number of surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, relatives/significant others, health and social care professionals, and staff. At the time of writing this report, we had not received any completed surveys. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Also assessed was relevant information from other organisations, and from what other people might have told us about the care home. All of the people using the service were spoken with. The residents have significant communication needs, some of who respond to questions with gestures and/or sounds or words. Due to the varied communication needs of the residents, observation was a useful, and significant tool used during this inspection. Documentation inspected included, three of the care plans of people using the service, risk assessments, staff training, and staff personnel records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether the requirements from the previous inspection had been met also took place during this inspection. These were judged to have been met by the care home. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 6 27 National Minimum Standards for Adults, including Key Minimum Standards, were inspected during this inspection. The inspector thanks the people living in the care home, the manager, and the staff, for their assistance in the inspection process. What the service does well: What has improved since the last inspection? The home has appointed a manager, who has the experience and competency to run the home. Requirements and recommendations from the previous key inspection have been met by the care home. There has been redecoration of some bedrooms and bathrooms, and some maintenance issues have been resolved. Staff have received infection control training. Staff recruitment selection procedures are now more robust. Residents care plans are being reviewed more frequently, and more goals and objectives of residents have been identified. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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 Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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): Standards 1, 2 and 5 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information needed to choose a home that will meet their needs. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need People using the service have a contract, statement of terms and conditions. EVIDENCE: The care home has a statement of purpose and a service user guide, which provide prospective residents with the information that they need to make an informed choice about whether the care home can meet their needs. This information includes a record of the fees, and a summary of the complaints procedure. The service user guide is recorded in written format, and includes some pictures. The manager spoke of his plans to develop and improve the format of this document (and other documentation) to improve its accessibility to those residents who have difficulty reading. This is recommended. The statement of purpose needs to be reviewed to ensure that it includes the up to date changes in regard to the present manager being in post in the care home. The present contact details of the Commission for Social Inspection, and the date of the document should be recorded in the statement of purpose. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 10 Care plans inspected included a recorded individual statement of terms and conditions/contract. These documents should include a record of the fees paid, and should be signed by the resident, and if they are unable to sign, this should be documented. The home has an admission procedure. The people using the service have lived in the care home for several years so there have been no recent admissions to the care home. The manager told us of the admission process, which involves a referral from the funding local authority, and a comprehensive initial assessment from a competent person from the organisation, with participation from the prospective resident, and sometimes their relatives. We were told that the psychology team from the organisation are involved in this initial assessment process. Care plans inspected included evidence of assessment each person’s care needs. We were told that when a person decides to move into the home, there would be planned process of transition, which would include visits to the home so that a prospective resident would be able to meet residents. There is a trial period of living in the home before a placement is confirmed. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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): Standards 6, 7, and 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service each have a plan of care. There could be some development in the care plans to ensure that it is evident that they are working documents, and that the information is more accessible to residents. People using the service are supported and encouraged to make decisions and choices, and are supported to take risks as part of an independent lifestyle. EVIDENCE: All the people using the service have an individual plan of care. During the visit we checked the care plan files for three people living in 11 Pear Close. The care plans showed evidence that they had been reviewed regularly, and included personal goals and preferences that covered aspects of resident’s health, personal care needs and social needs. It was not always evident from records of care plan review meetings that residents attended these review meetings. That manager told us that residents do have the opportunity to attend their care plan review meetings. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 12 Resident’s attendance (or decision not to attend)at these meetings should be documented. Guidance to meet residents agreed goals was documented. Though there was some evidence in some care plans of a personal planning book, which had some pictures in them, most of the care plan information was in written format. There could be development with regard to the format of some of the care plans, to make the information more accessible to those residents who have difficulty reading and/or particular sensory needs. It could be more evident that care plans are up to date ‘working’ tools, used by the individual, and all involved staff, to ensure that a personalised, and consistent person centred service is provided to people using the service. The care plans could indicate more understanding, and assessment of the strands of diversity, including race, gender identity, disability, sexual orientation, age, religion and belief. This was discussed with the manager, who spoke of plans to ensure that staff receive up to date equality and diversity training. Each person using the service has a key worker. A staff member spoke of their key working role, which includes shopping with residents for their personal toiletries, and clothes, and also participating in the review of the person’s care plan, as well as arranging and accompanying residents to health appointments. The manager told us of the plans that he had to give residents the opportunity of being involved in regular key worker meetings. This is positive. During the inspection there were several examples seen of staff providing residents with choices, and supporting people with making decisions about their lives. Examples of this were observed during the inspection. Residents made choices about what to eat and what activities they preferred to participate in. The care home has a policy/procedure with regard to the management of the finances of people using the service. All the residents have support with their finances. Staff, and records told us that residents are fully supported with being as fully involved as possible in managing their monies. Records of financial allowances, and expenditure are maintained. We were told that regular checks of balances and expenditure are carried out. The home has a missing person’s policy. It was evident that individual resident’s risk assessments are carried out, which are reviewed regularly. These are positive in addressing safety issues, while aiming to improve outcomes for people, and include assessment of risk with regard to community based activities such as shopping, swimming, and going for walks. There are also assessments of ‘in house’ activities including Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 13 participating cooking sessions. Risk assessments were discussed with the manager. These could be further developed to include show that action is taken to minimise all significant identified risks and hazards with regard to meeting resident’s health and safety needs. For example bathing risk assessments, and use of the stairs could be included in each resident’s care plan. This was discussed with the manager. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.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): Standard 12, 13, 14,15, 16 and 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Meals provided are varied, and people who use the services can choose what to eat. EVIDENCE: All the people using the service have an individual activity programme. The communication board located in the kitchen displayed some photographs of the day’s activities. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 15 It was noted that these were followed during the inspection. Activities include, attendance at day resource centres, walks, shopping, jigsaw puzzles, foot spa’s, bus and train rides, going to restaurants. ‘In house’ activities also take place. These include cooking sessions. The home has an activity room with equipment including an exercise bike for residents to access during their leisure pursuits. Residents participated in activities, within this room during the key inspection. The care home has access to a passenger vehicle. We were told that all residents have public train and bus travel passes, and that several residents have ‘taxi cards, which enables them to have access to cheaper taxi travel. AQAA information told us that since the previous inspection, residents have been supported in accessing more community activities, facilities and facilities. We were told that most residents have recently been on holidays including vacations abroad. This is positive. Staff spoke of how the residents had seemed to enjoy their time away. Records, and staff told us that resident’s birthdays are celebrated in the care home. A person using the service had recently enjoyed a party held in the garden. During this visit all the residents participated in an activity. These included attendance a day resource centre, community based activities and ‘in house’ leisure pursuits. We were told that people using the service participate in household duties. A resident was observed to carry his/her laundry basket to the laundry room from his bedroom, another resident helped in the kitchen. The visitor’s record book informed us that the home had visitors. These included relatives of people using the service, and other stakeholders such as Care managers. We were told that some residents regularly visit their family members. Staff told us of the positive contact that residents had with their families. Care plans we saw included a record of the person’s life story, and contact details of each person’s relatives/next of kin. The menu was available for inspection. This was a four-week menu. Staff spoke of how this was developed with regard to the communication needs of residents. Staff told us that they get to know and understand the meals that residents preferred, by talking to family members, observing what residents enjoyed eating, and by offering choice. We were told that care staff cooks meals, and that people using the service participate in some aspects of the meal preparation. Staff, and records confirmed that staff had received food and hygiene training. The manager spoke of his plans to improve the format of the menu so that it’s information is more accessible to people using the service. He told us that he Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 16 plans to have photographs taken of meals on the menu, and display these prior to each meal. This is positive. A variety of fresh, frozen, dried and tinned foods were stored. Fresh fruit was accessible in the kitchen. A resident helped herself to some fruit during the inspection. Other people using the service were offered a choice of fresh fruit. Lunch during the inspection was freshly cooked and was judged to be nutritious and wholesome. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 17 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): Standards 18, 19 and 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Systems are in place to ensure that medication is stored and administered safely to people using the service. EVIDENCE: Care plans indicated that the individual health and personal care needs of people using the service were assessed. Records confirmed that the personal care needs of people using the service are assessed and met by the home. Records and staff have their health care needs met. A health assessment was included in a person’s care plan file. Appointments to the dentist GP and optician are documented. We were told that a resident had recently seen their GP due to the symptoms of a particular ailment. Records confirmed that resident’s weight is monitored. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 18 Staff told us that all residents except for one person receives chiropody care and treatment. Due to the person’s behaviour needs one person has his/her toenails cut by one staff member. It needs to be evident that all staff that cut people toenails have received appropriate training by a qualified competent person, to ensure that there is minimal risk to the residents health and safety. This was discussed with the manager. Staff respected residents privacy, and dignity during the inspection, and were sensitive when supporting and assisting residents with meeting their needs. Staff ensured that situations involving personal care are conducted in private. Residents freely approached staff, and interacted with them in a positive manner. It was evident from observation that staff members are very alert to changes in mood, behaviour and general well being of people living in the care home, and understand how and when they should respond to them. The home has a medication policy. Medication is stored in a medication cabinet, which was not secured to the wall. To minimise the risk of the medication cabinet being removed from the home and/or falling, it needs to be secured to the wall. This was discussed with the manager. We checked the medication administration record sheets. These were well completed by staff and we saw no errors or omissions in these records. The manager told us that he monitors the medication records to ensure that staff have always signed this documentation. Staff, and records informed us that staff receive medication training from a pharmacist, and from the organisation, and during their staff induction programme. Funeral arrangements of several residents are recorded in their care plans. The manager told us that the other residents were on the waiting list for an advocate to support them in the planning of their funeral. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 19 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): Standards 22 and 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to an effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The care home has a complaints policy, which includes timescales, and recording procedures. A summary of this procedure is recorded in the service user guide. The format of the written complaints procedure could be improved, and developed to possibly include pictures or be in audio format, to make it more accessible to residents who may have difficulty in reading. The home has a complaints record book. Staff who spoke to us knew how to respond if they received a complaint from a person using the service and/or others. The care home has a safeguarding adult’s policy/procedure, and a copy of the lead Local Authority safeguarding adult’s guidance. The AQAA, records and staff told us that staff had received safeguarding adults training, so that they knew what action that they need to take if there is an allegation or suspicion of abuse. We spoke with most of the staff on duty during the visit and they all demonstrated a good understanding of the home’s safeguarding procedures. Records informed us that recruitment and selection procedures include ensuring that staff receive a Protection of Vulnerable adult’s (POVA) check (to gain information as to whether the person is recorded on the POVA list, and so Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 20 not allowed to work with people who receive care and support from services) prior to their employment. There are procedures in place for ensuring that accidents/incidents are recorded and reported appropriately. We were told that the care home has a whistle blowing policy/procedure, and a counter bullying policy. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 21 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): Standard 24, 26 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, warm, and comfortable. The premises are suitable for the care home’s stated purpose, there are areas of the environment that could be improved. Resident’s bedrooms, meet their individual needs, and are individually personalised. EVIDENCE: The home is located in a quiet residential road close to the amenities, and facilities of Kingsbury, and Edgware. There are public bus and train facilities near to the care home. The inspection included a tour of the care home. The home was clean and odour free. We were told that there are areas of the care home that had been redecorated since the previous key inspection. These areas include the exterior of the building, some bedrooms, and the paintwork in bathrooms. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 22 There are still areas of the interior of the care home that could be improved. Paintwork should be repainted in the areas that are worn, particularly on skirting boards. The bath panel of the bath located on the first floor has a hole in it and should be repaired or replaced. The front door could be re-varnished. A light fitment in a bathroom was not covered. This needs a suitable lampshade to minimise any risk to people’s safety. The carpet in the communal stairways and corridors is worn in some areas, black tape covers areas were the carpet is torn, and frayed, and in some areas the tape is ruffled. The carpet needs to be repaired or replaced. Until this is carried out, there needs to be risk assessment to ensure that there is guidance in place due to the possibility of the carpet being a trip hazard for people using the service, staff and visitors. The manager should look into ways of improving the environment of the care home, such as using colour paint to differentiate the various rooms in the home so aid people’s orientation, so meets the particular varied needs of people living in the home. Advice could be sought from organisations that have particular knowledge of the particular specialist needs of people using the service. The forecourt/entrance area of the home looked unattractive, flowerbeds on the forecourt contained numerous weeds, and there was litter on the ground. The appearance of the forecourt area of the home could be improved to be more pleasing to people living in the care home and to visitors. Potted plants could be an attractive feature, and something that residents might enjoy being involved in caring for. The garden had garden furniture accessible to residents, but was there were areas of the garden that were very ‘weedy’, and should be better maintained. Bedrooms inspected are individualised, and included personal possessions, televisions, music systems, and some pictures. The manager spoke of plans to review (with staff and residents) the décor and furnishings of the bedrooms. The laundering facilities are located away from the kitchen. Suitable hand washing facilities are located in most areas of the home. In a bathroom these facilities were not accessible. The manager told us that the reason for there not being soap and hand towels in a bathroom, was due to these items being of risk to some residents because of their behaviour needs. He told us of the procedure where residents and others wash their hands in another room. There needed to be clear recorded guidance with regard to this, and the guidance needs to be displayed so visitors, staff, and others know where to wash their hands. There needs to be individual risk assessments in place for each resident in regard to having access to soap and hand towels. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 23 Following this inspection the manager promptly supplied the Commission for Social Care Inspection (CSCI) with a copy of ‘Guidelines to support residents with hand washing’, which he confirmed staff had been informed about. Staff wear protective clothing, including disposable gloves, when supporting residents with their personal care needs. Records and staff told us that they had received infection control training. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 24 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): Standards 32, 34, 35 and 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices promote the safety and welfare of the clients. Staff receive training that supports the aims and objectives of the service and legislative requirements. People using the service would benefit from it being evident that they are being appropriately supervised. EVIDENCE: At the beginning of the inspection there were two care staff on duty. We were told that another staff member who was meant to be on duty had not arrived for his/her shift. The manager came on duty within an hour of the start of the inspection. At the commencement of the inspection the care staff were supporting the residents with their personal care needs. An up to date staff rota was available for inspection. This told us that there are generally three staff on duty (plus the manager) during the day. A ‘wake night’ staff member and a ‘sleep in’ staff member are on duty at night. We were told that residents generally have a one to one staff ratio when they are participating in activities., and that staffing numbers are flexible to ensure Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 25 that resident’s needs and changing needs are always met. A part time domestic staff member is also employed. She was working during part of the inspection. There is a communication notice board. On this was displayed the names and photographs of staff on duty, the residents and pictures of the day’s planned activities. Staff told as that they always receive a comprehensive ‘handover’ prior to each shift so that they have knowledge and understanding of the up to date needs, and changing needs of residents. Staff told us that they completed a comprehensive induction programme when they started working in the care home. This included ‘shadowing’ more senior staff, reading and learning about the policies and procedures of the home, and being given health and safety and fire training. The care home has an up to date staff training plan. Staff, and records informed us that the care home ensures that staff receive varied and relevant training to so that they are skilled, and competent to meet the multiple needs of people using the service. A staff member spoke of the care home providing ‘lots of training’, which kept them up to date with new ways of working. Training includes statutory training such as food and hygiene, health and safety, moving and handling, basic first aid training. Other training includes epilepsy, infection control training, break away techniques, supervision and autism training. The manager told us that he would look into staff having the opportunity to receive training with regard to their role the Mental Capacity Act 2005 (which empowers, protect and supports people who lack mental capacity). Information given by the AQAA told us that the home has achieved the standard of a minimum of 50 care staff qualified to National Vocational Qualification (NVQ) level 2 in care. Two staff told us that they had achieved this qualification (NVQ) level 2 in care. Another staff member spoke of having almost completed his/her NVQ level 2 care course. A staff member was positive about this course and told us that it had helped them to gain more knowledge and skills to carry out his/her role and responsibilities in supporting people using the service. We looked at three staffing files during this inspection. These informed us that the staff had an up-to-date enhanced Criminal Records Bureau check (a check to ascertain whether a prospective staff member has a criminal record), in place, and other required records including at least two references. The files included all the information needed to make sure that staff are suitable to work with vulnerable adults. A previous requirement with regard to appropriate checks of references being carried out was judged to have been met. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 26 We looked at supervision records during this inspection. There was one record of a one to one staff supervision of a care staff member that took place in April 08; no other recorded staff supervisions were available. When requested the manager could not access the supervision documents of two other staff. We were told that this was due to the supervision records having been removed temporarily from the care home. It needs to be evident that all staff receive regular supervision sessions to ensure that they have the opportunity to receive support, and a planned meeting to particularly focus on improving outcomes for residents. Records confirmed that the manager was in the process of compiling a staff 1-1 staff supervision plan. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 27 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): Standards 37,39 and 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems, which ensures that a quality service is provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. EVIDENCE: The manager has been managing the care home for a few weeks. Prior to that he has worked as a deputy manager in another of the organisation’s care homes, and has worked with people who have a learning disability for several years. He is currently in the process of achieving a National Vocational Qualification level 4 in management and care. The manager confirmed that he Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 28 had completed an induction programme. He informed us that he was in the process of commencing registration with the Commission for Social Care Commission. It was evident that he had a number of plans and ideas to improve and develop the service for people using the service. The manager presently works during the weekdays 9-5pm. He spoke of his plans to work all the shifts to gain an understanding of the nature of every shift worked by staff. The home has systems in place to monitor the quality of the service provided to people using the service. We were told that the organisation ensures that stakeholders (relatives/significant others/people using the service) are provided with the opportunity to feedback/comment on the service provided to residents. Monthly monitoring of staffing, complaints, staff training, activities and other systems is carried out. Records confirmed that a representative of the organisation carries out monthly audits of the service provided to people using the service. During this visit we checked a variety of care records kept in the home, including care records, risk assessments staff files and medication records. We felt that records were up to date and generally well maintained. Records confirmed that regular staff meetings take place. Records, and staff confirmed that there is monitoring of health and safety systems in the home. The service has sound policies/procedures. AQAA information told us that these are regularly reviewed. There should be evidence that staff have read the policies and procedures. The home has a health and safety policy/procedure. No health and safety issues were noted during the inspection. Regular health and safety checks of the care home are carried out. Records confirmed that required servicing of gas and electrical systems in the home is carried out, and are up to date. Fire safety systems are monitored closely. Regular fire drills take place. The home has a fire risk assessment. Fridge/freezer temperatures are monitored. Radiators in the home are have protective covers. The home has up to date employer’s liability insurance. Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 30 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 YA1 Regulation 4(1)(c) Requirement The statement of purpose needs to be reviewed to ensure that it includes the up to date changes in regard to the present manager being employed in the care home. It needs to be evident that all staff that cut resident’s toe nails have received appropriate training by a qualified competent person, to ensure that there is minimal risk to the resident’s health and safety. To minimise the risk of the medication cabinet being removed from the home and/or falling, it needs to be secured to the wall. There needs to be risk assessment and guidance in place with regard to the possibility of some areas of the carpet in the care home being a trip hazard. A light fitment in a bathroom that is not covered, needs a suitable lampshade to minimise any risk to people’s safety. DS0000017476.V365950.R01.S.doc Timescale for action 01/10/08 2 YA19 12(1)(a) 13(4) 01/09/08 3 YA20 13(2)(4) 01/10/08 4 YA24 13(4) 23(2) 01/09/08 5 YA24 13(4) 23(2) 01/09/08 Hoffmann Foundation for Autism 11 Pear Close Version 5.2 Page 31 7 YA36 18(20 8 YA37 4(3)(b) 8(1) CSA Part 11 It needs to be evident that all staff receive regular supervision sessions to ensure that they have the opportunity to receive support for focusing on improving outcomes for residents. The manager needs to be registered with the Commission for Social Care Inspection. 01/10/08 01/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The format of the service user guide could be developed to improve the accessibility of the information to people using the service. The statement of purpose should be dated. The up to date contact details of the Commission for Social Inspection should be recorded in the statement of purpose. The resident’s contract and/or statement of conditions should include a record of individual fees paid. There could be development with regard to the format of some of the care plans, to make the information more accessible to those residents who have difficulty reading and/or particular sensory needs. The care plans could indicate more understanding, and assessment of the strands of diversity, including race, gender identity, disability, sexual orientation, age, religion and belief. It could be more evident that care plans are up to date ‘working’ tools, used by the individual and all involved staff, to ensure that a personalised and consistent person centred service is provided to people using the service. Resident’s attendance at their care plan review meetings Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 32 2 3 YA5 YA6 4 5 YA9 YA17 6 YA22 7 YA24 should be documented. Risk assessments could be further developed to ensure all significant risks and hazards are identified and guidance in place to meet resident’s health and safety needs. The format of the menu should be improved and developed so that its information is more accessible to people using the service, who have difficulty in reading or understanding the written word. The format of the written complaints procedure could be improved and developed to possibly include pictures to make it more accessible to residents who may have difficulty in reading. The carpet in the communal stairways and corridors is worn and torn in some areas, and should be repaired or replaced. Paintwork should be repainted in areas that are worn, and or damaged. The bath panel of the bath located on the first floor has a hole in it and should be repaired or replaced. The appearance of the forecourt area of the home could be improved to be more pleasing to people living in the care home and to visitors. The garden could be better maintained. 8 YA24 The front door could be re-varnished. The manager should look into ways of improving the environment, such as using colour paint to differentiate the various rooms in the home so aid orientation, and meet the particular needs of the people living in the home. Advice could be sought from organisations that have specific knowledge of the particular specialist needs of people using the service. There should be evidence that staff have read the policies and procedures 9 YA39 Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Hoffmann Foundation for Autism 11 Pear Close DS0000017476.V365950.R01.S.doc Version 5.2 Page 34 - 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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