Care Home: Hoffmann Foundation for Autism 69 Castleton Avenue

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What the care home does well The home belongs to an organisation that has an expertise in caring and supporting people with autism. In fact the whole service seems geared to improving the independence of people with autism and for them to lead fulfilling lifestyles within the local community. We think that the home does this well. To this aim the needs of residents are well addressed in care plans and risk assessments that are agreed with residents and/or their representatives. The care plans and risk assessments are in place to promote the independence and inclusion of residents in the community. The home is on the whole well maintained and is appropriately decorated and furnished. The bedrooms of residents and the communal areas provide a homely and personalised environment for residents to enjoy. The home provides appropriate staffing levels and makes sure that staff are appropriately recruited and trained to meet the needs of residents that are accommodated in the home. Staff understand and are familiar with the needs of residents and support the residents in their daily life in an appropriate Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 manner. Three out of the five members of staff who sent questionnaires said that the standard of training that the home provides, ensures that they are skilled and competent to do their job. The manager of the home is experienced and familiar with running a care home for people with a learning disability. She is aware of the outcomes that are required for the residents. What has improved since the last inspection? During the last key inspection it was noted that there was a lack of lockable space to store residents’ property/valuables and that there was no hot water at some outlets in the home. These issues have now been addressed satisfactorily. The management of medicines during this inspection was of a good standard and the system in use left little margin for error. Staff, who administer medicines have had medicines training and were familiar with the medicines policy of the home. What the care home could do better: While care plans and risk assessments are generally reviewed yearly, the minimum standards state that these should be reviewed every six months. This would make sure that care plans and risk assessments are kept fully up to date. Staff were generally aware of the action to take if there are allegations and suspicions of abuse. We noted that staff were not fully up to date with training in protection of vulnerable adult, as the update was due for 2008. There are a number of people who regularly use the premises, including the five residents who live in the home, about ten members of staff and visitors to the home. It is recommended that paper towels be available in communal bathrooms and toilets to dry the hands, to lower the risk cross infection. The home is generally well prepared should there be a fire but the information that should be in a fire plan were in different places and might not be easily available if there is a fire. It is recommended that all the information be put together in one place to make sure that the information is readily available should there be a fire. Risk assessments and appropriate control measures must be in place to address the fact the window restrictors are easily disabled and that there does not seem to be thermostatic valves at a number of hot water outlets to which residents have access to.Hoffmann Foundation for Autism 69 Castleton AvenueDS0000017432.V376916.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Hoffmann Foundation for Autism 69 Castleton Avenue 69 Castleton Avenue Wembley Middlesex HA9 7QE Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 9th July 2009 11:30 Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hoffmann Foundation for Autism 69 Castleton Avenue 69 Castleton Avenue Wembley Middlesex HA9 7QE 020 8902 1155 020 8900 0930 castletonavenue@aol.com Address 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 Ms Leticia Addo Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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 5th October 2007 Date of last inspection Brief Description of the Service: 69 Castleton Avenue is a registered care home for 6 adults with learning disabilities. It is operated by the Hoffmann foundation for Autism, which is a registered charity that has been working to improve the lives of people with Autism for over 50 years. The home is an extended semi-detached house in a quiet residential road close to East Lane and Wembley High Street. It is within walking distance of shops and bus routes. The area to the front of the house has been paved over to provide off street parking. At the rear of the property is a pleasant garden with a lawn and patio area. The property consists of a ground and first floors and at the front of the house is a ground floor flat (occupied by one of the residents) which is integral to the house. The flat consists of a bed sitting room, bathroom and kitchen. The flat has its own front door and another door, which opens into the ground floor corridor. The rest of the ground floor consists of the kitchen, a laundry, an office, the small lounge (known as the music room), the large lounge and a communal toilet. On the first floor there are five residents’ bedrooms, a bathroom, a shower room and a staff sleeping in room. The fees are on average about £1,480 per week. At the time of the inspection there were five residents accommodated in the home. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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 on the 9th July at 11:30-17:00. The last inspection was an announced key inspection on the 5th October 2007 when the service was rated a 2 star service. There have not been any regulatory activities since then, apart from monitoring the service from notifications that are sent to us and from feedback that we receive about care services from time to time from people who use services and from social and healthcare professionals. The manager completed an Annual Quality Assurance Assessment (AQAA) as part of her obligations and this has been used to inform this report where possible. We also carried out a satisfaction questionnaire survey in March/April of this year and we received four completed questionnaires from residents and five from staff. We have used the result of the survey in this report where possible. We would like to thank the residents for a kind welcome to the home and the manager and all her staff for their cooperation and assistance during the inspection. What the service does well: The home belongs to an organisation that has an expertise in caring and supporting people with autism. In fact the whole service seems geared to improving the independence of people with autism and for them to lead fulfilling lifestyles within the local community. We think that the home does this well. To this aim the needs of residents are well addressed in care plans and risk assessments that are agreed with residents and/or their representatives. The care plans and risk assessments are in place to promote the independence and inclusion of residents in the community. The home is on the whole well maintained and is appropriately decorated and furnished. The bedrooms of residents and the communal areas provide a homely and personalised environment for residents to enjoy. The home provides appropriate staffing levels and makes sure that staff are appropriately recruited and trained to meet the needs of residents that are accommodated in the home. Staff understand and are familiar with the needs of residents and support the residents in their daily life in an appropriate Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 6 manner. Three out of the five members of staff who sent questionnaires said that the standard of training that the home provides, ensures that they are skilled and competent to do their job. The manager of the home is experienced and familiar with running a care home for people with a learning disability. She is aware of the outcomes that are required for the residents. What has improved since the last inspection? What they could do better: While care plans and risk assessments are generally reviewed yearly, the minimum standards state that these should be reviewed every six months. This would make sure that care plans and risk assessments are kept fully up to date. Staff were generally aware of the action to take if there are allegations and suspicions of abuse. We noted that staff were not fully up to date with training in protection of vulnerable adult, as the update was due for 2008. There are a number of people who regularly use the premises, including the five residents who live in the home, about ten members of staff and visitors to the home. It is recommended that paper towels be available in communal bathrooms and toilets to dry the hands, to lower the risk cross infection. The home is generally well prepared should there be a fire but the information that should be in a fire plan were in different places and might not be easily available if there is a fire. It is recommended that all the information be put together in one place to make sure that the information is readily available should there be a fire. Risk assessments and appropriate control measures must be in place to address the fact the window restrictors are easily disabled and that there does not seem to be thermostatic valves at a number of hot water outlets to which residents have access to. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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 69 Castleton Avenue DS0000017432.V376916.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an admission procedure and has systems in place to make sure that people have all the necessary information for them to make an informed decision about using the service. The home is also able to carry a comprehensive assessment of the needs of the residents to make sure that the home will be able to meet the needs of the residents. EVIDENCE: We did not see a service users’ guide (SUG) or a statement of purpose (SoP) on this occasion. These documents have in the past been assessed as suitable for the service that the home provides. The home has not had any new admission since the last inspection. The care records of residents that we saw contained preadmission assessments that had been completed by the manager. There were also copies of the needs assessments of the funding authorities. We noted that the AQAA states that “Detailed initial assessment is carried out by psychologist and the unit manager to find out if we can provide a service to meet the service users needs and a thorough risk assessment, support plan are compiled which takes Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 10 a person centred approach. A comprehensive transition plan is put in place which remains flexible according to the service users needs.” The manager described the admission of residents as a transition period that takes some time, to ensure that residents are given the time and support to adjust from their previous place of stay to the new environment, residents and staff. This includes visits to the home, staying for meals and meeting members of staff and residents. Prospective residents and their representatives can then make the decision if the home is suitable for the prospective resident and the home can also decide if the home is suitable for the prospective resident and if the latter will fit in with other residents who already live in the home. We looked at the contracts/statements of terms and conditions for two residents and noted that these were signed by residents or their representatives and were in place in the care file. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments are in place to address the needs of residents. These promote the independence and rights of residents while taking their safety and that of other people into consideration. EVIDENCE: We looked at the care records of two residents. We noted that all residents have a comprehensive assessment of their needs at the point of admission that is then updated and reviewed when the whole care plan is reviewed. The care plans are in a person centred format for residents and in a more detailed and in depth presentation for staff and health and social care professionals. The care records were on the whole comprehensive and reflected the fact that the home provides a service for people with autism. There was information about the essential features of autism and the particular features that Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 12 individual resident presented with. Care plans and risk assessments were then formulated to address the needs of residents. The personal planning book is presented in an easy to read format and pictures to support residents with understanding the information that it contains. This generally provides a good insight into the behaviours and needs of residents and the things and people that are important to them. The also contains a section on the hopes, dreams and goals of residents for the future. Care records looked not only at the interventions that staff make in the life of residents but also as the things that residents are able to do for themselves and to self-help. For example the section on communication addresses not only communication with a group of people but communication with staff, relatives, other residents and strangers in the community. It then looked at the various behaviours of residents as a way of understanding what the resident feels or wants. There were then individually tailored programme to improve and address any need if a need has been identified. All residents who responded to satisfaction questionnaires said that their care plans match what they want from the service and that they have seen their care plan. Three out of four said that the carers always do the things that are listed in the care plan and one aid sometimes. Each resident has a key worker that works with the resident in implementing and reviewing the care plan. There are monthly recorded updates on how well the care plans are being implemented, what is working well and what is not working so well. This is good practice. The care records showed that residents are involved in a number of activities to develop/maintain or improve independent living skills and to take part in the local community. For example residents travelled alone in the community and take part in house chores. In these cases risk assessments were in place to address any risks that the residents or other people may face. The risk assessments were in place as a way of enabling residents rather than to stop them from taking part in fulfilling and stimulating activities. We noted that risk assessments were agreed with the residents and/or their representatives. There were also guidelines that were drawn up to address particular behaviours of residents and agreed with the residents. We noted that care plans and risk assessments are generally reviewed yearly when the minimum standards said that these should be reviewed every six months. There are yearly reviews of the care plans with residents and/or their representatives. We noted that although the commissioning authority or social workers of the residents were invited for reviews, there were instances that reviews took place without a representative from the commissioning authority. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home supports residents in leading as fulfilling a lifestyle as possible. Residents receive a variety of nutritious meals according to their tastes and choices. EVIDENCE: Each resident has an individual activity plan that includes a range of individual and communal activities that also covers the weekend and not just Mondays to Fridays. Activities that residents have the opportunity to be involved in are varied and take into consideration the individual wishes, interests and choices of residents. These include gardening, arts and craft, photography, walks, film sessions, shopping, group activities such as discos, going to the cinema and bowling. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 14 All residents have a life history that provides a perspective on the background and life of residents. This also provides information on the social and recreational needs of residents. Care plans are then put in place to address the individual needs of residents. The development of residents is also part of the local authority reviews of the needs of residents, when these take place. Once a plan has been agreed in a review meeting, the home then puts the plan into action. Residents in the home were enrolled on courses to develop living skills and general skills such as citizenship for adults with a learning disability. To this aim they are supported by the home and their key workers in finding suitable courses. It was also noted that staff have make contact with a number of organisations and people such as the Disability Employment Advisor, to find work for some of the residents who have been assessed as able to work. In at least one case the home has also made contact with the Volunteering Centre so that residents would get work experience that could then help them in securing employment. The care plans of residents includes action plans and risk assessments about the involvement of residents in the local community. The risk assessments were particularly comprehensive and contained information about the behaviour of residents in public and the control measures to manage situations that might arise. We were informed that a few of the residents have been assessed as able to use public transport and a few use the home’s transport or are accompanied by members of staff. The home has an open door policy and we were informed that the relatives and friends of residents are able to visit them in the home. We noted that residents are able to visit their relatives in the community or go out on outings trip with them. The care records of residents also address issues about relationship and sexuality. This demonstrates that the home looks at all the needs of residents in a wholesome (holistic) manner and not at a single need, separate from other needs. We noted that residents had their own mobile phones to keep in touch with their relatives and friends. Some residents also had their own computer with internet access. The home arranges outings for residents in the mini bus that is driven by staff. Records suggest that residents go on holidays from time to time. The manager stated that there were plans to arrange a holiday for residents. The care records also contained guidelines to manage individual residents’ needs and behaviour when they are on holidays. The home has a menu system that is decided by residents in the residents’ meetings. The menu suggests that the meals that are provided are of a homely nature and are varied and nutritious. Some examples of meals include toad in Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 15 a hole, curry chicken with rice, meat balls and pasta, roast chicken and tuna pasta bake. We were informed that the meals are prepared by members of staff with the assistance of residents at times. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are appropriately cared for and supported, to make sure that their personal and healthcare needs are met. Medicines management is carried out appropriately to ensure the safety of people who use the service that the home provides. The needs of residents with regards to ageing and end of life care are accounted for and addressed in the care records, to ensure a comprehensive approach to care planning. EVIDENCE: All residents during the unannounced inspection presented as clean, appropriately dressed and well cared for. There were no residents in the home when we started the inspection, as the residents were out and no one in the home knew that we were coming. The residents later came into the home after they had completed the various activities that they were involved in. All residents who responded to our survey stated that staff always listen and act Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 17 on what they (the residents) say. Three out of the four residents stated that their privacy and dignity is always respected by staff and one said sometimes. The care records of each resident contained a health action plan. This contained information about the support that residents required in order to meet their healthcare needs. There was information about the eye tests of residents, dentist appointments, hospital appointments, GP appointments and psychiatrist and psychologists input in the care of residents. We noted that residents were referred to the various healthcare professionals when staff observed changes in the healthcare needs of residents. For example there were clear records when a resident was referred to the psychologist for changes in their behaviour. A plan was then formulated and included in the care records of the resident for staff to implement and to manage the particular behaviour of the resident. The care records of residents also contained sections on health promotion such as alcohol and cigarettes consumption, advice on diet and exercise. We looked at the management of medicines in the home. We noted that the home uses a ‘blister pack’ system (Venalink dosage system) for the management of medicines. These are prepared by the chemist according to the prescription that the GP has written and brought to the home for staff to administer. The home does not use homely remedies. All medicines are administered and witnessed by a second member of staff to make sure that these are being administered correctly. The signatures of both persons are recorded. This does provide a good system to prevent errors. We noted that staff in the home were testing the blood sugar of one resident, but they were not using a professional lancing device as per guidance from the Medicines and Healthcare Products Regulatory Agency (MHRA). According to this guidance lancing devices for self-testing should not be used by a third party to draw blood for blood sugar testing. Care records contain information about the wishes and instructions of residents and/or their relatives about end of life care. There was also a section about plans for the future and the expectations of residents for the future. The manager clarified that residents are able to stay in the home as long as their needs are being met. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes complaints and allegations and suspicions of abuse seriously and makes sure that these are dealt with appropriately. EVIDENCE: The home had received two complaints that were appropriately recorded and addressed. These were not directly related to care issues or to the provision of a care service. The service users’ guide contains a copy of the complaints procedure and the residents that we spoke to, said that they would approach members of staff if they had any concerns. All four residents who returned questionnaires said that they knew how to make a complaint. Members of staff were clear that they had to report all complaints and concerns to the manager. The training records showed that all members of staff have had training on abuse, but a few needed an update in 2008, that did not seem to have occurred. We discussed the management of allegations and suspicions of abuse with the manager and she demonstrated that she was aware of the procedure to follow if she comes across these. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely and maintained environment where the needs of residents can be appropriately met. EVIDENCE: The paved area in the front and the area at the back of the home was maintained appropriately. There is a patio, lawn area, a small garden and mature fruit trees at the back. We also noted some items of broken furniture that were waiting to be disposed of. The exterior of the building was in a good condition. The communal areas consisted of a dining area, a main lounge, a smaller area where staff kept some files and where there was also seating if residents wanted to sit there. The lounges were appropriately decorated and furnished. There was enough seating in the main lounge for all the residents that were Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 20 accommodated in the home. A TV and SKY service were available for residents. We noted that a radiator in the main lounge needed to be repaired or replaced. The kitchen was a through kitchen with the dining area at one end. There was a range of kitchen equipment and utensils to use. The dining area also had seating for all the residents in the home. This area was kept clean and tidy. There is a laundry room on the ground floor and we were informed that residents do their own laundry or are supported by staff according to their abilities. All equipment in the laundry was working appropriately. We looked at the toilets and bathrooms that were available in the home and noted that these were clean and appropriately decorated. We could not see thermostatic valves in the bath and wash basin on the ground floor. There was also no thermostatic valve at the hot water outlet in one of the resident’s room. There were no risk assessments either to manage the risk of scalding (see section under Administration and management). The bedrooms of residents were personalised to a good standard and were in an appropriate state of decoration. We were informed that some residents had keys to their rooms according to a risk assessment. The bedrooms that we saw during the inspection contained a lockable space for residents. During the last inspection it was noted that there was a lack of lockable space for residents. The home has boilers to provide adequate hot water for residents to have their baths/showers and for washing up. During the last key inspection, it was noted that the hot water supply was not adequate. The home produces some clinical waste and there was an arrangement with the local authority for the disposal of this waste. There was evidence that most staff have had infection control training. We however noted that there were no paper towels in the communal bathrooms and toilets, despite a relatively large number of people who use the premises. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides appropriate staffing levels to make sure that the needs of residents would be met. Staff receive a range of training to make sure that they are skilled and competent to do their job. A few however, were not fully up to date with mandatory training. EVIDENCE: The manager informed us that there are two members of staff during the day and one waking and one sleep-in member of staff at night. The shifts run from 07:30-15:30 and 15:00 to 22:00. She reported that more staff is provided when this is required such as, when residents need escorting or when a special activity is arranged. Most of the staff are permanent members of staff (6), but there are a few bank staff (3). The bank staff work within the care homes of the Hoffmann’s foundation and are familiar with the needs of the residents and the policies and procedures of the care homes. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 22 Recruitment of staff is carried out with the assistance of head office staff. We looked at the personnel records of one member of staff. There were some records in the home but the application form and the references were not available in the home. We were therefore not able to fully assess the recruitment of staff in the home but the systems that were in place in the home and within the organisation seem to suggest that recruitment is generally carried well, to safeguard people who use the service. There was evidence that new members of staff undergo an induction that starts at the head office and continues in the care home. We were informed that the induction includes the common induction standards from Skills for Care and lasts over three months. All five members of staff who responded to our survey stated that they had a comprehensive induction when they started work in the home. They also said that they have the right support, knowledge and experience to meet the different needs of people who use the service. The head office arranges for training sessions in various areas. The home then books staff on the relevant training and sends staff to attend the training. The manager kindly provided a training matrix for the home. We noted that apart from mandatory training, training is also provided in a range of areas such as, conflict management, challenging behaviour, communicating with people with a learning disability, makaton and person centred planning. According to the training records that were provided, we noted that most staff were up to date with medicines training, manual handling training and health and safety. We also noted that only one member of staff out of ten was up to date with food hygiene training and four were up to date with fire training and first aid. We had earlier mentioned that five members of staff were not up to date with training in protection of vulnerable adults. The above records showed that the provision of training could be made more robust by making sure that all members of staff have the updates in mandatory training within the appropriate time scales. The training records also showed that six out of the ten members of staff have at least an NVQ level 2 qualification in care. Discussion also took place with the manager about qualification of staff and the Learning Disability Award Framework. She said that a number of staff already has this qualification and that a few were working towards that. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is able to fully discharge her responsibilities of running the home in an open and inclusive manner. The home has an effective quality management system to monitor the quality of the service that it provides. Health and safety issues in the home are generally addressed appropriately, but a few issues were noted that must be addressed to fully ensure the safety of all people who use the premises. EVIDENCE: The manager stated that she has worked in the care sector for about fifteen years and in her current position since 2000. She has an NVQ 4 qualification in care and the Registered Managers Award. During our discussion she Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 24 demonstrated a good knowledge of the needs of the residents that are accommodated in the home and her responsibilities as the registered manager. We discussed the quality assurance system that the home/organisation uses. The manager stated that satisfaction surveys are sent by the head office annually. We were however not able to see a report of the results of the survey in the home, although the manager stated that she receives feedback about the survey. It is required that a summary of the survey be prepared and that this be made available to residents and to other stakeholders. The manager reported that the organisation monitors the quality of the service by carrying out audits of key areas of the service at given intervals. For example there are audits of activities that are available for residents, and staff training and supervision. Monthly visits as per regulation 26 of the Care Homes Regulations 2001 take place regularly. A visit took place while we were in the home and minutes of other meetings were available in the home. The organisation is also accredited to Investors In People (IIP), demonstrating its commitment to staff training and development. A business and development plan for the home was available for inspection. The manager stated that staff supervision takes place every 4-6 weeks. Members of staff that we spoke to also said that they receive regular supervision. The home has a number of certificates to demonstrate that items of equipment are maintained as required. There was a wiring certificate and we were informed that the work that had been identified to make the system satisfactory, has been carried out. A portable appliances test certificate and a gas safety certificate were also available for inspection. There was evidence that the environmental health officer and the fire officer had visited the home. There was a health and safety monthly check list that was completed appropriately. Fire detector tests were carried out weekly, and emergency lights tests and fire drills were carried out monthly. The times of the fire drills were however, not recorded and it is recommended that be done. The home had a fire risk assessment but did not have a fire emergency plan. The various pieces of information that make the fire emergency plan were in various places and should be put together in one place, so that the information that should be contained in an emergency fire plan, will be available immediately, if there is a fire. We noted during the tour of the premises that there were no thermostatic valves at the hot water outlets to the bath and to the wash hand basin in the bathroom on the ground floor and to the wash basin in the bedroom of a Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 25 resident. We did not find any risk assessment in place addressing the risk of scalding from hot water. The windows on the first floors had restrictors to prevent them from fully opening. However, these were easily disabled by hand and therefore these might not be that effective to reduce the risks of residents falling through a window, to an acceptable level. Appropriate risk assessment must be carried out and the appropriate control measures must be put in place, as required. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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 3 2 3 3 3 4 3 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 3 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 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000017432.V376916.R01.S.doc 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 x 3 x x 2 x Version 5.2 Page 27 Hoffmann Foundation for Autism 69 Castleton Avenue 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 YA19 Regulation 13(2) Requirement The home must ensure that the appropriate lancing devices are in use to draw blood for blood sugar testing for people who have diabetes. All members of staff must be fully up to date with mandatory training such as food hygiene training and fire training. That a report summarising the satisfaction survey be made available to residents and to all stakeholders. There must be a risk assessment to address the risks that residents might face with regards to scalding from hot water. Control measures, such as thermostatic valves must be in place where required. There must be a risk assessment to address the risks that residents might face with regards to falling through windows because the restrictors on the windows can be easily disabled. Control measures must be in place as required. Timescale for action 31/08/09 2 YA35 18(1)(c) 30/09/09 3 YA39 24 30/09/09 4 YA42 13(4) 30/09/09 5. YA42 13(4) 30/09/09 Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.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 2 3 4 5 Refer to Standard YA6 YA23 YA24 YA30 YA42 Good Practice Recommendations That care plans and risk assessments are reviewed every six months That training updates in protection of vulnerable adult be provided to staff that require this update as soon as possible, as the update was due for 2008. The radiator cover in the main lounge should be repaired/replaced as soon as possible. Paper towels should be available in communal bathrooms and toilets to prevent cross infection as much as possible. It is recommended that all the information that should be in a fire plan be put together in one place to make sure that the information is readily available should there be a fire. Hoffmann Foundation for Autism 69 Castleton Avenue DS0000017432.V376916.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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