Care Home: Salisbury Autistic Care Ltd

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What the care home does well Assessments of new prospective residents are done to very high standard. The home does not offer care or support, if needs cannot be met or prospective residents are not compatible. The home is using sign language, picture board, objects of reference and other communication methods to communicate with residents and involve them in their care. Care plans provide staff with very detailed information about the person, care plans are person centred and residents are involved in the care planning process. People using the service are supported to access community facilities and are offered a wide range of activities, which are community based. Cultural needs are addressed in care plans. The home has procedures and guidelines in place, assisting people to meet their cultural and ethnic needs. Health care records are of very high standard and residents are supported to access health care facilities and appointments. Staff are very positive about the manager and the support provided. " I like working here" (Staff comment). What has improved since the last inspection? We have made three requirements during the inspection in January 2008, the home has met two of them and systems are put into place to work towards achieving the last outstanding requirement. The quality rating has improved from good to excellent. The home has reviewed their statement of purpose and service users guide; new prospective service users are issued with a welcome pack. The carpets in the living room and hallway have been replaced and the risk of residents or staff injuring them has reduced. There are still loose tiles in the bathroom, but new maintenance procedures will address this soon. CARE HOME ADULTS 18-65 Salisbury Autistic Care Ltd 28 Holt Road North Wembley Middlesex HA0 3PS Lead Inspector Andreas Schwarz Key Unannounced Inspection 7th August 2008 09:00 Salisbury Autistic Care Ltd DS0000063728.V364441.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 Salisbury Autistic Care Ltd DS0000063728.V364441.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. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Salisbury Autistic Care Ltd Address 28 Holt Road North Wembley Middlesex HA0 3PS 020 8908 1760 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) maynard@salisburyautisticcare.com Salisbury Autistic Care Ltd Mrs Glenis Randall Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Salisbury Autistic Care Ltd DS0000063728.V364441.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: 5 7th January 2008 Date of last inspection Brief Description of the Service: Holt Road is a five bedded home in Wembley and trades under the name of Salisbury Autistic Care Ltd. Mrs Glenis Randall manages the home and the Registered Individual is Mr Maynard Harry. The home was registered under the Care Homes Act 2001 in October 2005. The home is specialising in providing care for young adults who are within the autistic spectrum disorder and present some challenges to the service. The building is a detached property on a quite residential street in North Wembley, close to public transport, shops and other amenities. There is a large garden, spacious open plan kitchen and dining room on the ground floor. The home is providing separate rooms for activities, relaxation or cool down times for people using the service. There is off street parking for approximately three cars and unrestricted street parking. The home is providing a people carrier, which can be used for outings; shopping and other activities. The home has currently two vacancies. Fees and charges can be obtained on request from the registered manager. Salisbury Autistic Care Ltd DS0000063728.V364441.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 3 stars. This means the people who use this service experience excellent quality outcomes. This unannounced inspection started at 09:15 am and finished at 17:00 pm. We spoke to the registered manager and two members of staff. People using the service are non-verbal. We observed staff interacting and supporting residents. We looked at care plans, staff files and other documents. We did not receive any surveys we send to the home prior to this visit. The home returned a completed Annual Quality Assurance Assessment, which provided us with good evidence about the care provided by Holt Road. What the service does well: What has improved since the last inspection? We have made three requirements during the inspection in January 2008, the home has met two of them and systems are put into place to work towards achieving the last outstanding requirement. The quality rating has improved from good to excellent. The home has reviewed their statement of purpose and service users guide; new prospective service users are issued with a welcome pack. The carpets in the living room and hallway have been replaced and the risk of residents or staff injuring them has reduced. There are still loose tiles in the bathroom, but new maintenance procedures will address this soon. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 6 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. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 7 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 Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 8 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): We assessed National Minimum Standards 1 and 2 during this inspection. People using the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides information about the service and the specialist care the home offers. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: We implement our procedures in written and picture format so that it is accessible to a wider audience. We ensure that all assessments are implemented into the individuals care plan. We continue to carry out full comprehensive assessments on any potential person that we would provide care and support for. We reviewed the service user’s guide and the statement of purpose. We carry out our assessments for prospective people in a manner Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 9 that will not cause too much anxiety for them with their transition. We ensure that we assess the people’s individualised aspirations and needs. This is what we found during this inspection: We viewed the homes statement of purpose and service users guide, which has been reviewed in December 2007. Both documents are of good standard and provide the necessary information to prospective residents. The home has designed a welcome pack, which includes the statement of purpose, service users guide, complaints policy and previous inspection report. The service users guide is available in pictorial format. The home had one new admission since the last inspection. The registered manager and a senior support worker undertook the assessment. The assessment was very detailed and person centred. The person’s needs, behaviours and conditions have been assessed. The home involved the persons family using fax, sign language and text messaging to enable them taking part in the assessment process. The assessment had Autism in the centre and all support structures build around this condition to ensure the person is supported appropriately. The assessment is of very high standard and provides vital and necessary information about the person. Information obtained during assessment is incorporated in the care plan. At the end of the assessment the home has produced a summary of needs and plans how these needs could be best met. It is evident by reading the assessment, that assessors have very good understanding of Autism and how to work with people who have this condition. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 10 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): We assessed National Minimum Standards 6,7 and 9 during this inspection People using the service experience an excellent outcome in this area. This judgement has been made using available evidence including a visit to this service. Staff is committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own decisions and have the right to take risks in their daily lives. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: We have implemented individual communication systems to meet the needs of the individual complex learner. This has been carried out through comprehensive in house training for Makaton, liaising with the speech and language therapist. We also utilise symbols from board maker communications, use photos and objects of reference. Care plans are reviewed Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 11 regularly and formal reviews are undertaken every six months, with the involvement of families and outside professionals. Our care plans are available in pictorial form and are person centred. Autism specific needs are tailored around this such as the triad of impairments is addressed. The guidelines for each person are very comprehensive, so therefore support staff are enabled to provide a consistent approach when working with people. We document the likes and dislikes of the people so we provide person centred support. All restrictions are clearly documented in guidelines and care plans. The registered manager is acting as appointee to both people and all transitions regarding their finances are recorded accordingly. Full comprehensive behaviour guidelines are in place, which provide reactive and pro-active approaches to challenging behaviours. All risk assessments are detailed and give clear guidelines to staff in how to minimise risk in the community, at home and in the car. Our risk assessments are reviewed at once if risks change. This is what we found during this inspection: We assessed one care plan in detail during this inspection. The registered manager is currently in the process of implementing the care plan of the person who moved in recently. Other care plans have been assessed during our key inspection in January 2008. Care plans use pictures to enable residents take part in the process. Autism specific issues such as Triad of Impairment (Communication, socialisation and imagination) are in the centre of the care plan. The care plan is also looking at what motivates the person doing things, what triggers challenging behaviours and what is the best way to manage challenging behaviour. To overcome communication barriers the home is using different communication methods such as Makaton, picture boards, PECS (Picture Exchange Communication System), gestures. All residents have a communication passport and staff is trained in the use of Makaton. Residents have detailed morning, afternoon and evening routines, which are task based, with a clear beginning and end to complete the task. Care plans have been reviewed involving the residents, the person’s family, social worker, key worker and registered manager. Care plan files include the statement of purpose, service users guide and contract. We noted that the service users were encouraged to mark the review notes. Staff told us that due to residents being autistic, choices might be limited as this can upset the person and lead to challenging behaviour. However staff encourages residents to choose their cereal, drinks during breakfast. Days are structured to meet the individual needs. The home is managing people’s finances. The manager is appointee for two of the people living at the home. We assessed financial records, which were of good standard and correct. Previously the home asked one person to pay for damages and money taken Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 12 from the person has been returned. We noted in financial records that residents contribute to the minibus; this however is not recorded in the service users guide. The registered manager told us that the registered provider is providing purchasers with information regarding residents’ contribution. This information must be forwarded to the Commission for Social Care Inspection. Each individual care plan folder contains risk assessments. Risk assessments are very detailed and provide staff with guidance in how to manage the risk and how to support the person safely. The home is responding to new areas of risk quickly, for example the home recently purchased a trampoline, the use of this has already be risk assessed. Risk assessments have been reviewed on 09/05/08. The registered manager and staff demonstrated clear understanding of the risk assessment process and that risks can be minimised through a robust risk assessment process Salisbury Autistic Care Ltd DS0000063728.V364441.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): We assessed National Minimum Standards 12, 13, 15, 16 and 17 during this inspection. People using the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to develop and maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the individuals using the service. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: People’s activities are clearly recorded in the daily records, which evidence activity participation, interactions with staff, and other professionals, and Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 14 families. All appropriate people are informed of any decision that is made on behalf of the person; again this is clearly recorded in the contact file. To ensure that we are able to clearly communicate choice, dignity, respect, social relationships, competence skills, community presence and participation; we have an individualised communication system for each person. This is evidenced and recorded in their support plan via a communication passport, which explains that we use photographs, picture symbols, Makaton, objects of reference and at time verbal and body language. We promote independence; encourage individuals to maintain family relationships. We encourage the people to have great participation in the community. Each individual is registered on the electoral role. We provide a well-balanced and cultural appropriate diet. We monitor and record the likes and dislikes of the people. People using the service have unrestricted access to all communal areas and their bedrooms. We promote being an autism specific service at all times and offer structured activities in-house and in the community that meet their individual needs. This is what we found during this inspection: Peoples activities are clearly recorded in daily records, which are of excellent standard and provide information of what food was eaten, peoples behaviour, activity participation, interactions with staff and other people using the service, personal care, etc. People using the service are not in any paid or unpaid employment and do not access colleges; this is due to their ability and challenging behaviour. The home is however using gyms, swimming pools; activity centres to access and facilitate community based activities. A pastor visits the home for regular church service. A member of staff informed us that they are planning to access local church services for one of the people living in Holt Road. People using the service go regularly for drives, local parks for walks or to play football. During the day of this inspection, staff supported residents to do shopping for the home and themselves. The home has restructured people’s activities. All residents have a detailed, individual activity plan in place. Behaviour specialists from Brent Learning Disabilities Partnership previously recommended this. We observed residents taking part in household activities such as cleaning the bathroom. This is a major achievement and shows that guidance implemented is working and people’s lives have improved since the last inspection. The home has taken photos of activities, which are used to communicate with the residents and inform them of their activities. Another residents has a picture board, were staff put pictures of activities as stated in the persons plan and the person removes the picture once the activity is complete. All activity programmes are structured, but allow space for free time. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 15 The home is supporting individuals to maintain family relationships, by inviting relatives to meetings and encouraging visits. We have seen records of visits from family members over Christmas. One person is calling his parents weekly in the West Indies. Peoples sexuality is discussed in care plans and specialists are involved to provide support to people using the service and staff. People using the service have unrestricted access to communal areas and their bedroom. The office, bathrooms and food storage areas are locked to ensure peoples safety and reduce ritualistic behaviours due to their Autism. People are not issued with keys due to the risk of absconding; this is clearly recorded in care plans and separate guidance. We observed staff interacting professionally and patiently with people using the service, during this key inspection. Residents are involved in cooking and preparing of the meals. We observed one resident pouring his juice with support by staff. The home is providing a varied, healthy culturally appropriate diet. We looked at the homes menu; residents have two cooked meals per day. Food is purchased from a local supermarket and is of very good standard. The home is recording food eaten by people using the service and menus are based on likes and dislikes, which have been documented by staff over the past. The registered manager informed us that the home is currently in the process of taking pictures of different dishes; this is to enable resident’s choosing meals and take a more active part in menu planning. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 18, 19 and 20 during this inspection. People using the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive effective personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Individual plans clearly record people’s personal and healthcare needs and detail how they will be delivered. Staff responds appropriately and sensitively in all situations involving personal care, ensuring that it is conducted in private and at a time and pace directed by the person receiving the care. Regular appointments are seen as important and there are systems to ensure they are not missed. The home arranges for health professionals to visit residents at home when necessary. Staff is trained and competent in health care matters. The home has developed efficient medication policy, procedure and practice guidance. The home has a sustained record of full compliance with the administration, safekeeping and disposal of medication. EVIDENCE: Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 17 This is what you told us in your Annual Quality Assurance Assessment: We have a strong relationship with Brent’s multidisciplinary team that enables us to offer the appropriate support and therapies to the people. Regular health checks are carried out; reviews take place accordingly. All personal care and any health appointments are also clearly recorded in the appropriate files. We have an outside Dentist, and optician that visit the home, but the people attend the chiropodist. Personal support is provided in private and intimate care is delivered by the same gender. We now use the Boots monitoring dosage system. None of our people self medicate. The administration and storage of medication is carried out accordingly. A file is accessible for all staff to read regarding all the medication we administered and what possible side effects could occur. People are supported for annual health checks in private either by visiting the surgery or at the home. Both people using the service are allocated a key person to meet their needs and advocate on their behalf. They are responsible for the reviewing and the maintenance of the care plans and any risk assessments. People’s weights are recorded and regularly monitored on a monthly basis. This is what we found during this inspection: We viewed personal guidance in all care plans assessed during this inspection. All residents have clearly documented morning and evening routines. This ensures a consistent approach by care staff. For example toiletries are in a basket, which is located in the bathroom on the same place every day. The manager informed us that this reduces anxieties and encourages residents being more independent in their personal care and hygiene. All bedrooms have en-suite facilities, but residents choose having their personal care in the communal bathroom on the first floor. Bathrooms and toilets can be locked from the inside to ensure peoples privacy. Due to residents not being able to cope with clothes in their bedroom, the home is keeping clothes for two resident in a separate room. Staff employed by the home comes from different cultural and ethnic backgrounds. The registered manager informed us that the home might admit a person from central Africa. One member of staff is able to speak the person’s language and has good understanding of the person’s religious needs. All residents are fully mobile and technical aids to move people are not required. The home has good links with Brent Learning Disabilities Partnership and can access psychiatrist, speech and language therapists, behaviour specialists, psychologists, etc. During the day of this inspection we overheard the manager arranging an appointment with the speech and language therapist to assess one of the residents. The home is Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 18 using a key worker system. Key workers informed us that they are responsible for the care planning and updating of guidelines. One member of staff told us that he is also advocating on behalf of his key clients, if he feels that his needs are not met. Residents have a heath assessment in place, which is using symbols and pictures. The home has also taken pictures of health care appointments to communicate with residents if they have an appointment. The home is recording outcomes of health care appointments and all residents have an individual appointment diary, which is backed up by the homes diary. Staff told us that this ensures appointments are not missed. The home has a visiting dentist and optician. The registered manager informed us that the home has excellent relationships with the General Practitioner, who will visit the home if required or if residents choose not to visit the surgery. The home is monitoring people’s weight. Staff is supported to access Autism and Challenging Behaviour training. The home is using the Monitored Dosage System by Boots. Medicines returned and received are recorded and signed by the pharmacist and staff. A list of staff authorised to administer medication is in the medication file and staff have received medication training. Medication is locked away and stored safely. None of the people living at the home is using controlled drugs. The General Practitioner has reviewed medication and any changes to medication are clearly recorded. The Medication Administration Sheets are of good standard and had no gaps. Previous inspections assessed the medication policy compliant with National Minimum Standards. Salisbury Autistic Care Ltd DS0000063728.V364441.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): We assessed National Minimum Standards 22 and 23 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. It is available on request in pictorial form to help anyone living at, or involved with, the service to complain or make suggestions for improvement. People using the service are protected though robust adult protection guidelines. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: We have a complaints procedure that is available in the service user’s guide and on the notice board in the homes office; this is formulated in picture format so it’s available for a wider audience. We record all our complaints and they are dealt with in a 28-day time frame. We have a whistle blowing policy. All staff attended protection of vulnerable adults training and the staff received physical intervention training. This is what we found during this inspection: The home has a complaints policy in place, which is available in the service users guide and on the notice board in the homes office. The home received Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 20 one complaint since the last key inspection and actions and outcomes are recorded. The complaint has been dealt with and resolved to the complainants’ satisfaction. The home started to record compliments and feedback given by family members was very positive about the care and the home. All staff attended Protection of Vulnerable Adults training and staff spoken to demonstrated good understanding of reporting and recording adult abuse allegations. The home has a whistle blowing policy in place and staff has received Physical Intervention training. Previous inspections noted that one resident paid for damages due to his challenging behaviour; the home has reimbursed the money to this person and updated the statement of purpose. The home has Safeguarding adults’ procedures from the funding and hosting borough in place. Salisbury Autistic Care Ltd DS0000063728.V364441.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): We looked at National Minimum Standards 24 and 30 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The physical environment does meet the specialist needs of the people who use the service. The home does have an on-going maintenance programme in place. People using the service live in a safe, clean and well-maintained environment. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: We ensure that all accessible areas to the people remain clutter free at all times this is tailored to meet the needs of the people using the service. We ensure that our people live in a homely, comfortable and safe environment. We have managed to resolve the outstanding requirements. We have a named staff member that reports any maintenance issues immediately. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 22 This is what we found during this inspection: The home has done a substantial amount of work since the last key inspection. Bedrooms have been redecorated, loose wiring has been repaired and all requirements in regards to the environment have been met. The home has now an ongoing maintenance programme and the registered manager is monitoring maintenance issues monthly and reports to the proprietor for funding. Some of the tiling in the first floor bathroom came of the wall and should be attended to. The home has replaced the carpet in the lounge area and the walls in the hallway have been re-plastered. The home is decorated homely and meets the needs of people with Autism and Challenging Behaviour. Staff told us that the response to repairs has improved. One of the support workers is responsible to report maintenance issues to the registered provider. The utility room is located on the top floor of the property and people using the service are able to use a washing machine and clothes dryer. The washing machine has a cycle for hot temperature and soiled clothes can be washed above 65 º Celsius. The home was clean and free of offensive odours during this key inspection. The home has Infection Control procedures in place and cleaning materials were stored safely. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 23 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): We assessed National Minimum Standards 34 and 25 during this inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service recognises the importance of training, and delivers a programme that meets any statutory requirements and the National Minimum Standards. The manager is aware that there are some gaps in the training programme and plans to deal with this. The service has overall good recruitment procedure that clearly defines the process to be followed, there are some gaps in staff records. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: The home manager has managed to resource all National Vocational Qualification in Care for level 2, 3 and the registered manager’s award with government funding from different training organisations that are able to offer Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 24 this service. We also access all the free training that is offered through Brent council. All our mandatory training is up to date, and some staff attends the seminars that are run by the national autistic society to improve their knowledge and awareness on autism. All our staff files are up to date with references, CV’s, identification, Criminal Records Bureau checks and all of their supervision notes and appraisals. All staff receives a thorough induction and complete a probationary period of six months. Regular staff meetings that are also used as training sessions. We do not employ staff of 18 years and under. Each staff receives an individualised training development plan. All staff have received either level 2, 3 or the Registered Managers Award training, they have been certificated or will complete shortly. This is what we found during this inspection: We viewed four staffing files during this inspection. Two of the records were in order and necessary documents such as Criminal Records Bureau checks, references, and application forms, proof of the right to work in the United Kingdom were in place. We noted in two staffing files that references and Criminal Records Bureau checks were not in place. The manager informed us of this before we assessed staffing records and reassured us that staff does not work unsupervised, this was confirmed by staffing rotas assessed during this inspection. We asked the home to apply for POVA first and Criminal Records Bureau checks. The home has send invoices of the application to the Commission for Social Care Inspection following this inspection. In addition to this we asked the home to risk assess if staff is safe working supervised with vulnerable adults, the home forwarded the risk assessments to the Commission for Social Care Inspection. We judged the risk assessments of good standard and people using the service are protected appropriately from unsuitable staff. Staff told us that they had an interview and were asked to provide documentation and referees prior to being offered the post. The home has nine staff in permanent employment; four staff hold National Vocational Qualification in Care Level 2 or above and five staff work towards achieving this qualification. We spoke to one new member of staff; he informed us that he is in the process of completing his induction. The home is using Skills for Care induction standards and competency. Staff has attended medication training, Safeguarding adults training, Health and Safety training, etc. The home has planned challenging behaviour training (2 staff) and Autism Training (4 staff), which is offered by Brent social services. Training and development records are up to date and staff confirmed that they are happy with the training provided. One member of staff has taken part Son-Rise program in the USA. “The Son-Rise Program® teaches a specific and Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 25 comprehensive system of treatment and education designed to help families and caregivers enable their children to dramatically improve in all areas of learning, development, communication and skill acquisition.” Supervision records are in place and staff confirmed of having received regular supervisions provided by the registered manager. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 26 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): We assessed National Minimum Standards 37, 39 and 42 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Manager has the required experience and qualification to run the home. People who use the service are protected by safety checks and procedures, from Health and Safety hazards. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: We have reviewed our annual development plan, with the view to ensure that all staff receives adequate training and meet their desired needs to help them Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 27 develop professionally. The home manager has been working in Social care since 1981 and has a thorough understanding of the needs of the people that live at the service. She has seven years experience in a supervisory and management role. This is what we found during this inspection: The registered manager is very experienced in care and has been working with people with Autism for a number of years. Staff spoke very positive about the registered manager and told us that she is very supportive and listens to all problems. The registered manager informed us that she has completed her Registered Managers Award. The home has employed a senior support worker and is currently in the process of recruiting a deputy manager. The senior support worker holds a Registered Managers Award and has supervisory as well as management experience from previous employments. A valid public liability insurance and registration certificate is displayed in the homes office. Staff is taken part in regular team meetings, which are recorded and records show that improvements to the live of people using the service is documented. Staff informed us that the staff group meets every four to six weeks for meetings to discuss people using the service and their progress and any other issues relating to the home. Residents living in Holt Road are non-verbal. The home has produced a questionnaire, which the registered manager is planning to send out to clinicians, social workers, families, to obtain feedback on the care provided. We have received a very detailed Annual Quality Assurance Assessment; evidence provided in this Annual Quality Assurance Assessment has been used in this report. We have seen a copy of the homes annual development plan, which was judged of good standard and detailed. The fire system was checked in December 2007, the emergency light was checked in June 2008 and the last planned fire evacuation was undertaken in July 2008. We sampled the Portable Appliances Test Certificate, which has been renewed in December 2007, as stated in the Annual Quality Assurance Assessment provided by the home. The home has a list of approved cleaning materials displayed on the notice board in the office and staff have received Health and Safety training. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 28 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 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 X Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 29 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 YA7 Regulation 5(1)(b) Requirement Timescale for action 15/09/08 2. YA34 The registered person must provide residents with clear information about financial contributions for the use of the car. Evidence of this must be send to the Commission for Social Care Inspection. 19(1)(b)(i) The registered person must Schedule obtain POVA first checks for all 2(7) staff until they receive a valid Enhanced Criminal Records Bureau check, to ensure people using the service are protected from unsuitable staff. 15/09/08 Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 30 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. Refer to Standard YA24 YA34 Good Practice Recommendations The loose and missing tiles in the upstairs bathroom should be repaired to protect people using the service from injuries. The registered person should risk assess all staff working in the home without a Criminal Records Bureau check and establish if people using the service are protected from unsuitable staff. Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 31 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 Salisbury Autistic Care Ltd DS0000063728.V364441.R01.S.doc Version 5.2 Page 32 - 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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