Care Home: St Edwards (6).

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What the care home does well Residents are being provided with accessible and up-to-date information about the home. This is sufficient to provide a clear understanding of the services provided and whether the home is able to meet their needs. Any prospective resident can be assured that their individual needs will be appropriately assessed, and that their views and wishes regarding the delivery of their care will be fully respected. Residents and their relatives can be assured that staff have the necessary training, support and knowledge base with which to meet residents` individual needs. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Staff engage with residents in an enabling and person-centred way. Residents are being enabled to participate fully in decisions that affect their day-to-day lives, and are being enabled to exercise choice and control in their daily routines and activities.0Residents are being encouraged to develop their interests and abilities, and are being provided with opportunities for participating in a wide and varied range of activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents` rights and responsibilities are being fully respected and recognised in their day-to-day lives. Residents are being offered a varied and healthy diet, in pleasant and homely surroundings, and are being enabled to make an informed choice regarding their food preferences. Mealtimes are flexible and take account of residents` activity schedules. Residents are positively encouraged and supported to develop an independent lifestyle, with thorough risk assessments being carried out for any activities that involve responsible risk-taking. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. The personal support, physical and emotional health care needs of residents are being well met in this home, with support being planned and tailored according to the individual needs presented. Residents are being protected by the home`s medication policy and procedures, and by the provision of accredited medication training for all care staff. Residents, and their relatives/representatives, can be assured that the home has an appropriate policy and procedure in place for raising any concerns or complaints. This provides clear information and is available in an appropriate format for adults who have communication difficulties. The home`s policies, procedures and practice indicate that residents are generally being well protected from abuse and are living in a safe, secure and trusting environment. All staff receive training in adult protection. Residents are living in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents have rooms that are suited to their individual needs. They present as being safe, comfortable and pleasantly decorated, and reflect residents` individual identities. Residents are having their needs well met by staff, in sufficient numbers, who are appropriately trained and qualified, and who have clearly defined roles and responsibilities.1Residents are being protected by the home`s recruitment policy and procedures. The rights and best interests of residents are being safeguarded by the home`s record keeping policies and procedures. Generally, the health, safety and welfare of residents are being appropriately protected. Residents are living in a home that presents as being clean, pleasant and hygienic. What has improved since the last inspection? Residents` care plans are being reviewed on a regular monthly basis. All staff have now completed statutory adult protection training. All staff have now received accredited infection control training. A detailed record of all incidents and accidents is now being maintained. CARE HOME ADULTS 18-65 St Edwards (6) 6 St Edward`s Close New Addington Croydon Surrey CR0 0EL Lead Inspector Peter Stanley Unannounced Inspection 11 and 14 August 2008 10:00 St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 1 St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 2 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 St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 3 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. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Name of service St Edwards (6) Address 6 St Edward`s Close New Addington Croydon Surrey CR0 0EL 01689 800 960 01689 800 861 croydon@nas.org.uk Vanessahalfacre@nas.org.uk National Autistic Society 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) Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 5 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: 12 16th July 2007 Date of last inspection Brief Description of the Service: St Edwards is situated in a quiet close in New Addington near to local shops and trams. The National Autistic Society leases the building from Croydon Churches Housing Association. All service users have been identified as having an autistic disorder. The service provides residential care for twelve residents, who are divided between two houses, which are separated by an attractive garden area. The houses no longer have a gender divide and are divided into two resident groups. These are determined by the level of dependency, more highly dependent residents tending to be placed in the Conifers. All residents have a single room; all contain a wash hand basin although some are not in use. This is due to the particular needs of the person occupying those rooms and has been agreed with the registration authority as being in their best interests. The furniture in some bedrooms has also been specially adapted where necessary. In addition to the bedrooms there is a communal lounge, dining room, a kitchen, toilets and bathroom in each house. Each house has its own staff team, with one waking member of staff allocated to each and one member of staff sleeping in. All residents attend day care from Monday to Friday, with day care provision being provided according to differing types and levels of need at one of three NAS day centres. These centres provide day care for adults with autism who live in both residential care and within the community. The Coney Hall Day Centre (in West Wickham) provides day care for service users with high St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 6 dependency, and is housed in the same building as many of the National Autistic Societys regional administrative functions such as personnel. Another day centre, Mansfield House, opened in 2007, provides day care for those residents who range from being medium to high dependency, while the Transitions Day Centre in Croydon provides a specialist day care resource for those who have Aspergers syndrome. The NAS provides its own minibuses for transporting residents to and from the day centres. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 7 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 inspection was conducted over one and a half days, the first day taking place at the home, the second half day, at the Coney Hall Day Centre (in West Wickham), which includes the local NAS administrative offices. Some phone sampling of relatives’ views was also carried out with the prior agreement of those concerned. We held discussions with the deputy manager and the domiciliary care manager, who was attending on behalf of the manager, Andrew Lewis, who was on leave. We observed support staff on duty and two residents, with whom it was not possible to engage in discussion. We also observed day centre staff and users at the Coney Hall Day Centre. During the inspection, we examined policies, procedures, staff and service user records, and other documentation relating to the management and running of the home. Service user records included residents’ assessments, risk assessments, care plans, life plans, and records of reviews. Staff records included staff rotas, recruitment records, and records relating to supervision, appraisal and training. The home has also completed an annual quality assurance assessment (AQAA), which provided a further source of information for this inspection. The inspector also completed some small-scale phone sampling of relatives’ views, and observed both users and support staff. The home has not had a registered manager since the departure of the previous manager in March 2006. Since January 2007 the home has been managed by Andrew Lewis. Mr Lewis has not, as yet, completed his registration with CSCI as the registered manager for the home. This needs to be completed as a priority. The home as with previous inspections providing a pleasant and congenial environment, with a homely atmosphere pervading each of the two residents’ houses. An ongoing programme of decoration of residents’ rooms and communal areas has been taking place. The home provides good facilities and attention is paid to detail in ensuring that the home provides a safe, accessible, empowering and inclusive environment. The home provides excellent staff induction and training, which is both wideranging and specific to meeting the needs of this client group. There is a key worker system in place that assists in providing focussed and individuallybased support. As most residents attend day and activities throughout the day, there were, at the time of inspection, relatively few users present at the home, but from his observations the inspector observed respectful and St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 8 appropriate staff interactions with residents and attention to individual needs. From the evidence provided there is excellent employment and development of communication tools and strategies. The home employs a wide variety of approaches including the use of TEACHH, Spell and Makaton in helping to facilitate communication with residents. The use of choice photos and symbol boards, enabling users to indicate preferences and choices of activity or food/drink are in daily use. There are group settings for activities, with staff support at varying levels, discussion groups, and picture exchange systems. Regular meetings are held for residents with guidance notes for helping to facilitate individuals’ participation being available to staff. There is evidence of a positive and continuing commitment towards meeting the complex and challenging needs presented by residents, and in providing opportunities for enabling the development of individual abilities and potential. There is a very positive view of risk taking with individual residents being encouraged to develop their independent abilities and potential whether in learning new skills or engaging in physical and risk-taking activities. There is a person-centred emphasis in the home’s approach and philosophy that permeates all of its thinking and work with users. Senior support staff have attended Person-centred Facilitator training, and Person-centred training has been rolled out to all support staff. The home is developing its personcentred approach, this being reflected in its life plans, care plans and other key documentation relating to individual needs, wishes and preferences. We completed some phone sampling to obtain the views of relatives. The views expressed were generally very favourable, with relatives speaking highly of the home and the support provided by staff. There is a highly developed programme of day care, which is spread across three separate sites, each of which provides for a specific area of needs and abilities. The key worker system in place allows for focussed support for each individual, with dedicated day care staff providing more specialised inputs. There is an excellent programme of outdoor and indoor activities offered with individuals being encouraged to pursue their interests and achieve their goals. Whilst the evidence from this inspection indicates that the home is generally providing good outcomes for individuals, there was one major area of concern which relates to staff supervision. This is a long-term concern, dating back to 2006, and was addressed at the last key inspection. From the evidence of this inspection there has been no overall improvement in the regularity of supervision received by staff who work at the home, but rather a deterioration. Of 17 staff records examined, none met the required frequency of at least 6 supervisions per year, as detailed in Standard 36.4 of the National Minimum Standards. 6 staff were found to have had just one supervision in this period, a further 4 having had just two supervision sessions. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 9 This is an unsatisfactory and potentially worrying situation that must be addressed as a matter of urgency. Without regular supervision staff are not being appropriately supported and monitored as to their continuing progress and development. This has potential implications for the level of awareness, competency and good practice that staff present, and for the welfare and well being of this vulnerable client group who are being accommodated and supported at St Edwards. The continued failure to achieve a minimum level of supervisory meetings with staff may result in enforcement being taken by the Commission if a significant improvement is not achieved within the timescales agreed. Following consultations with the lead representative for the NAS at the inspection, it was agreed that notification of all two-monthly staff supervision sessions throughout the 12 month period to August 2009 be forwarded to the Commission. As a result of this inspection there are 4 requirements and 2 recommendations. The inspector would like to extend his thanks to the domiciliary care manager, the deputy manager at St Edwards, and to staff at Coney Hall Day Centre, for their assistance in helping to facilitate this inspection. What the service does well: Residents are being provided with accessible and up-to-date information about the home. This is sufficient to provide a clear understanding of the services provided and whether the home is able to meet their needs. Any prospective resident can be assured that their individual needs will be appropriately assessed, and that their views and wishes regarding the delivery of their care will be fully respected. Residents and their relatives can be assured that staff have the necessary training, support and knowledge base with which to meet residents’ individual needs. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Staff engage with residents in an enabling and person-centred way. Residents are being enabled to participate fully in decisions that affect their day-to-day lives, and are being enabled to exercise choice and control in their daily routines and activities. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 10 Residents are being encouraged to develop their interests and abilities, and are being provided with opportunities for participating in a wide and varied range of activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents’ rights and responsibilities are being fully respected and recognised in their day-to-day lives. Residents are being offered a varied and healthy diet, in pleasant and homely surroundings, and are being enabled to make an informed choice regarding their food preferences. Mealtimes are flexible and take account of residents’ activity schedules. Residents are positively encouraged and supported to develop an independent lifestyle, with thorough risk assessments being carried out for any activities that involve responsible risk-taking. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. The personal support, physical and emotional health care needs of residents are being well met in this home, with support being planned and tailored according to the individual needs presented. Residents are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. Residents, and their relatives/representatives, can be assured that the home has an appropriate policy and procedure in place for raising any concerns or complaints. This provides clear information and is available in an appropriate format for adults who have communication difficulties. The home’s policies, procedures and practice indicate that residents are generally being well protected from abuse and are living in a safe, secure and trusting environment. All staff receive training in adult protection. Residents are living in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents have rooms that are suited to their individual needs. They present as being safe, comfortable and pleasantly decorated, and reflect residents’ individual identities. Residents are having their needs well met by staff, in sufficient numbers, who are appropriately trained and qualified, and who have clearly defined roles and responsibilities. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 11 Residents are being protected by the home’s recruitment policy and procedures. The rights and best interests of residents are being safeguarded by the home’s record keeping policies and procedures. Generally, the health, safety and welfare of residents are being appropriately protected. Residents are living in a home that presents as being clean, pleasant and hygienic. What has improved since the last inspection? What they could do better: Issues relating to bereavement and loss are being handled with respect, and in accordance with individuals’ wishes. Training in this area has not, as yet, taken place. While, generally, residents’ best interests are being protected through the service’s training and support of staff, this is being offset by the home’s continuing failure to ensure regular staff supervision. Whilst residents are living in a home that is being generally well managed, there are concerns relating to staff supervision which run counter to their best interests, and which must be rectified. The home has been without a registered manager since November 2005. It is in the best interests of the home’s residents and staff that the home’s manager completes his registration with the CSCI. The home is not currently demonstrating that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. The home’s Fire Risk Assessment needs to be updated. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 12 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. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 13 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 St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 14 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): People using this service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are being provided with accessible and up-to-date information about the home. This is sufficient to provide a clear understanding of the services provided and whether the home is able to meet their needs. Any prospective resident can be assured that their individual needs will be appropriately assessed, and that their views and wishes regarding the delivery of their care will be fully respected. Residents and their relatives can be assured that staff have the necessary training, support and knowledge base with which to meet residents’ individual needs. EVIDENCE: The home aims to meet the specialist needs of people diagnosed with autism and Aspergers syndrome. Most residents present profound communication difficulties, and some present challenging behaviour. Individuals’ cultural and religious needs are being met in consultation with family members. While some residents possess varying degrees of verbal understanding and ability to communicate, others are unable to do so and use Makaton or other systems for communicating. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 15 The home has compiled a statement of purpose. This outlines the aims and objectives of the home, and the facilities and services that it provides. The Statement of Purpose includes all the information required. The home’s service user’s guide is called a ‘Welcome Pack’. This is available in a format and language that is appropriate to meeting the varying communication difficulties experienced by residents. The pack contains information that is relevant to residents’ day-to-day lives and involvement in the home. This includes the upkeep of their room, their laundry and their contribution to communal household tasks. It also gives general information in reasonably simple statements about the running of the service. Both the statement of purpose and the service user’s guide have been reviewed and updated in March 2008. Vacancies at this home are few and far between, all but one resident having lived in the home for 10 years or more. A panel takes decisions regarding any admission to St Edwards. This includes senior staff and a range of other professionals who have knowledge of the person. Staff from St Edwards carry out thorough and detailed assessments, with assessment visits being made to meet with the individual and his/her family. A comprehensive history is obtained which includes a history of behaviours and a medical diagnosis. There is the opportunity for any prospective resident to visit the home, usually with family members, when a placement is being considered. The initial visit has previously taken place when other users are not present. The prospective resident is then invited to make a transitional visit, to see the home, meet with staff and residents, and possibly stay for an meal. Overnight stays may be arranged, but this depends on the needs and wishes of the individual. Prior to admission, a transitional plan is drawn up. Following an admission, there is a six-month trial period with a review after three months. This is to allow for a full assessment and is normal professional practice within the NAS (National Autistic Society). Residents are assisted to make decisions about admission to the home and the activities which interest them. Each resident has a key worker who provides individualised support, assists day-to-day decision-making, and provides support at reviews. There has been one new admission to the home since the last inspection. We examined the new resident’s file. This evidenced a pre-admission transition plan, a care needs assessment, a risk assessment for each area of activity and risk, together with a care plan and behaviour support plan. A six-weekly review meeting has taken place, and the care plan and risk assessments evidenced St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 16 the necessary review. We were advised that the resident did not have the usual transitional visit prior to admission, the admission being a straight transfer from hospital to St Edwards, rather than returning to his previous placement. Staff were observed on duty interacting with residents. Staff presented as being enabling and person-centred in their approach, using verbal and nonverbal means of engaging with residents. Those residents observed presented as being settled and at ease in their home environment, and to have good relationships with staff. Staff are trained to develop relevant communication and social skills with which to interact in a patient, caring and skilled way. There is an emphasis on one-to-one working, with a key worker being allocated for each resident. Key workers escort residents to their day care setting, where there are day care staff with specific skills, including social skills, art, dance and drama therapy. The NAS has a comprehensive and ongoing programme of staff training, which includes autism awareness training and training in specialist teaching techniques. Training in how to manage challenging behaviour is also provided. The home’s approach is to try and identify triggers and take preventative action if possible, using the least intrusive method of control if this is required. Two assistant psychologists are available for assessment and support sessions with residents, with access to consultation from a clinical psychologist. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 17 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 to 10 People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Staff engage with residents in an enabling and person-centred way. Residents are positively encouraged and supported to develop an independent lifestyle, with thorough risk assessments being carried out for any activities that involve responsible risk-taking. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 18 EVIDENCE: There is a detailed care plan, individual learning plan and life plan for each resident, together with individual risk assessments, a health check and a medication profile. Care plans provide information relating to residents’ support needs and short-term goals throughout the year. These are being signed and dated. We looked at a small sample of residents’ files which showed that they were reviewed monthly, together with more formal six-monthly and annual reviews. Those invited include the resident, his/her key worker, care manager, and nearest relative(s), friend or advocate, and any professionals who are involved. Residents are assisted to make choices and decisions in regard to their daily lives, including those relating to their health, personal care and support, and those relating to their daily living, learning and development, interests and activities. Each resident has a key worker who provides individualised support, assists day-to-day decision-making, and provides support at reviews. Independent advocates are used, whenever possible, in drawing up and reviewing the individual care plan. There are regular weekly residents’ meetings in which residents are consulted regarding their daily lives including their preferred activities and choice of food. A system, including guidance notes for staff, has been developed to help facilitate the participation of residents in their house meetings. Minutes of meetings are recorded and a copy is kept in each house. Residents are also involved in staff recruitment. Short listed candidates are invited to the home prior to the final offer of appointment and the views and reactions of residents are taken into account. Feedback and observation indicates that residents are involved in making choices and decisions for themselves regarding their day to day routines and activities, and that their views and feelings are being respected. Residents are being consulted regarding their support and care needs, their interests and activities, their likes and dislikes, preferred choice of food, and wishes regarding holidays away with relatives, friends or staff. Service user questionnaires, written in an appropriate format, cover all aspects of day to day living and activities, and provide a means for ascertaining individuals’ wishes and choices. Residents are actively enabled to exercise choice through the use of choice photos and symbol boards, and the use of makaton. These are tailored to individuals’ specific communication needs. Staff are trained to use a communication learning package called TEACCH. This includes the use of St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 19 symbols, pictures, photos, objects, Makaton, written and verbal communication. The home has a policy of encouraging positive risk taking. Residents’ potential for developing independence is encouraged and enabled wherever possible, subject to safe strategies for managing risks being in place. Each activity undertaken is risk assessed. A sample of residents’ files was examined. These included individual risk assessments covering a range of identifiable risks, together with risk management strategies. Residents are supported to use local shops independently and to undertake small monetary transactions. There is training with view to enabling individuals to access public transport and travel independently. All residents are given ID cards to carry with them when going to places they are not familiar with. Staff carry mobile phones when supporting residents in the community. A Missing Persons Policy is in place. The home has a confidentiality policy in respect of personal information held in relation to service users. The policy states that residents have the right to access personal information held about them by the home. The NAS is a registered organization under the Data Protection Act. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 20 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): People using this service experience excellent quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are being enabled to participate fully in decisions that affect their day-to-day lives, and are being enabled to exercise choice and control in their daily routines and activities. Residents are being encouraged to develop their interests and abilities, and are being provided with opportunities for participating in a wide and varied range of activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents’ rights and responsibilities are being fully respected and recognised in their day-to-day lives. Residents are being offered a varied and healthy diet, in pleasant and homely surroundings, and are being enabled to make an informed choice regarding their food preferences. Mealtimes are flexible and take account of residents’ activity schedules. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 21 EVIDENCE: The evidence provided in key information documents, such as the statement of purpose and the service user guide, emphasises the need to promote independence and develop individual abilities and potential. Respect for the rights of residents is characterised in both the philosophy of the home, and in the wealth of detail, contained in care plans and activity programmes, that relates to residents’ day to day living, routines and activities. This is a home with an excellent track record in providing a wide and varied range of activities. Residents are fully consulted regarding their interests and choice of learning and activities. Residents’ activity programmes are reviewed at six-monthly intervals. This involves full consultation with each individual regarding his/her choice of activities and learning, and whether there are any changes that he/she would like to see introduced. Staff maintain records relating to the daily routines and progress of residents. These are well maintained and evidence an ongoing record of each service user’s attendance, activities and development. The NAS provides a range of day care activity, which is spread across three separate sites. These centres provide a day care resource for both residents at St Edwards and for adults with autism who live within the community. The Coney Hall Day Centre (in West Wickham) provides day care for adults who have more severe communication or behavioural difficulties. Another day centre, Mansfield House, in Croydon, which opened in 2007, provides day care for those adults whose difficulties range from being moderate to severe, while the Transitions Day Centre in Croydon provides a specialist day care resource for those adults who have aspergers syndrome. The NAS provides its own minibuses for transporting residents to and from the day centres. The day centres provide each individual with a structured programme of activities, which is tailored according to his/her needs. Activities include art, woodwork, drama, computer use, writing skills, and communication sessions. The inspector again visited the Coney Hall day centre and observed day care staff and users at the centre. There were some purposeful interactions observed between staff and service users. Lunch, snacks and drinks are provided at each centre, pictorial symbols being used to denote the choices on offer. Residents are assisted to develop their daily living skills through participation in daily routines at the home. Close working relationships with the day service staff enables individuals to benefit from continuity of care and behavioural St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 22 management. There are Behavioural Management guidelines for individual residents, with staff having access to specialist advice from psychiatrists and psychologists. The philosophy of the home is a positive one, encouraging and assisting residents to realise their full potential and to participate as fully as possible in the wider community. Residents’ care plans and activity programmes confirm that individuals are being offered varied choices regarding their interests and activities. There is a wide and varied range of community-based activities offered at the home. Physical activities include trampolining sessions at a local sports centre, regular weekly swimming sessions at a local swimming baths, and weekly visits to the gym. Other physical activities offered include rock climbing, canoeing, cycling, horse riding, ten-pin bowling, badminton, basketball and other ball games. The inspector was advised that hydro pool sessions are being arranged for the new resident. All residents have a yearly holiday, which can be taken with relatives or individually/small groups, with key workers escorting them. The cost of this holiday is included in the basic contract price. The inspector spoke with a support worker who informed the inspector that she would be escorting two residents on two separate week-long holidays to the West Country and the Norfolk Broads. Residents are able to attend Further Education classes at Sandown F.E College where subjects offered include English, mathematics, cookery, assertiveness and crafts. Some residents have been able to train for accredited qualifications while others have been able to gain work experience through taking part in employment projects. The home supports residents in maintaining close links with family and friends, both by telephone and through visits. Many residents have extensive contact with relatives and visit them at weekends. Telephone contact is maintained with some relatives who live abroad. A Visitor’s Policy is in place, with relatives and friends being able to visit at any reasonable time. If required, staff will support residents during a home visit and provide transport. From comments previously received by relatives, the home provides a very homely and welcoming environment. The home encourages the close involvement of relatives and friends with the home’s operation and activities. As part of this involvement, a Partnership Day, to which relatives and friends are invited, is held every six months, where relevant issues are discussed and a buffet provided. Family barbecues are also held from time to time in the summer months and a party organised at Christmas. Residents are also assisted to develop daily living skills through St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 23 guidance/support with participating in daily routines within the home, and are encouraged to access shopping, leisure and educational facilities in the local community, within a risk management framework. The home has developed its’ community links, helping residents to facilitate access to leisure centres, churches, pubs, libraries, museums, colleges, shops, theatres, restaurants, leisure and sports and any other facility identified by the needs of individual service users. The home assists residents to access public transport, and has four of its’ own vehicles and discounted bus and rail passes, to enable easy access to the community.Residentss are also given the opportunity to attend local clubs in order to extend there peer relationship circles. Each of the two houses has a pleasant dining area where residents can take their meals. Meals are provided at the day centre at lunchtime and at the home at breakfast and in the evening. Mealtimes are relaxed and flexible to suit individual work and activity schedules. The inspector looked at the kitchen areas and found there to be good standards of cleanliness and hygiene. Fresh foods are being stored appropriately, and records relating to fridge/freezer and oven temperatures are being routinely maintained. Residents are encouraged to assist with food preparation, as they wish, and according to their capabilities. This includes preparing snacks and drinks between meals. The NAS has a corporate food policy, which states a commitment to healthy eating. A rotating menu, developed by the University of Sunderland, aims to ensure a nutritious and well balanced diet. The menu for the week includes pictures of the meal options for which residents take it in turn to make a choice for the main option each day. A random sample of menus indicates that a wide variety of different food options are available in the home. Where the published menu option is not desired on the day alternatives are provided as residents wish, and a detailed record is kept of the food actually provided. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 24 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 to 21 People using this service experience excellent quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The personal support, physical and emotional health care needs of residents are being well met in this home, with support being planned and tailored according to the individual needs presented. Residents are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. Issues relating to bereavement and loss are being handled with respect, and in accordance with individuals’ wishes. Training in this area is planned to take place. EVIDENCE: St Edwards sets high standards in addressing the personal support, physical and emotional health care needs of this client group. The Society’s policies and procedures, and comprehensive staff training programme, provide the St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 25 framework for developing and sustaining good practice, and ensuring that each individual’s care and support needs are fully assessed and addressed. We examined a sample of residents’ assessments, risk assessments and care plans. These showed a varied range of personal support needs, the support offered being tailored according to individuals’ specific needs, wishes and goals. From observations, and the feedback provided from the sampling of relatives’ views, and at reviews, there is a positive and enabling ethos in the home, and that residents’ personal care and support needs are generally being well met. From observations of both support and day care staff at the home and at the Coney Hall Day Centre, there was evidence of positive and skilled interaction with service users, with support being offered in a calm and reassuring way. We observed examples of good practice in engaging with individuals, and of a caring and professional ethos in their general approach. Guidelines are in place to assist staff, in their interaction with residents, with objects of reference for those who require help with knowing which activity is about to take place. The Service has a policy on Administration of Medication and Medical Treatment, home medication remedies, positive risk taking and service user’s protection procedure. OK Health Check documents are kept for each service user, they have annual medication reviews with their GP and 6-monthly reviews, where necessary, with the psychiatrist. Weight charts are in place, regular check-ups with the dentist and doctor, access to a chiropodist. Allergy testing and nutritional specialist available. The healthcare needs of residents are evidenced as being very well monitored and met. Records and notes examined on a sample of files indicate that the physical, behavioural and psychological health needs of residents are being routinely monitored, with detailed health records being maintained. Residents receive regular annual health checks from a GP. Any potential complications or health problems are identified and referred to the appropriate health care professional. All personal medical information is recorded on the OK Health Check. Doctor and dentist reports are written following consultation, and residents’ previous medical history are all stored in their personal files. Weekly weight charts are maintained for all residents. Dietary and nutritional advice are available as and when these are required. All medical/health appointments or visits are recorded in the resident’s file. Records indicate that GP’s and other community based medical/health care professionals are contacted as and when appointments are required. Residents are registered with one of two GP practices. There is access to a wide range of community-based services. These include dentistry, optician, community nurses, dietician, chiropody, and physiotherapy services, and access to aromatherapy and reflexology. Through a comprehensive St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 26 programme of training, staff at the home have developed a specialised knowledge of autism and individually specific specialist needs associated with autism, learning disabilities and challenging behaviour. The home also has access to a range of psychologcal and psychiatric support services. The service has its own full time assistant psychologist who works to a clinical psychologist. She helps to develop guidelines and programmes to support individual behaviours, and is able to offer 1:1 support sessions. The home has appropriate medication policies and procedures in place. These cover the administration of medication and medical treatment, risk assessment and the protection of residents. The home has appropriate secure storage for medication and for the separate secure storage of any controlled drugs. The inspector was advised that there are no residents using any controlled drugs. All medication records are signed and countersigned by staff for each administration of medication. Each resident has a medication profile and photograph held in their individual medication file, together with an individual risk assessment for medication. Residents are supported to administer their own medication where appropriate, with clear guidelines being written to demonstrate that this is administered in accord with each individual’s wishes. While a resident can, in theory, be supported to take their own medication, none of the residents at St Edwards has been risk assessed as being safely able to do so. The home is now receiving 3-monthly medication audits from the Croydon Primary Care Trust. These have evidenced that the home is maintaining satisfactory and appropriate medication procedures. We were advised that the home’s manager, Andrew Lewis, has completed training to become an accredited medication trainer. This enables him to roll out training to staff. An internal accredited medication training pack has been developed by the service. All staff who work at the home have been confirmed as having completed accredited medication training. The wishes of residents and their relatives concerning the eventuality of their death are recorded and placed on their files. A questionnaire is sent out to relatives to request clarification of their wishes in the event of their own death or, subject to the individual’s agreement, their wishes in the event of his/her death. A training package has been developed, which provides comprehensive information and training materials on bereavement and loss. The need for staff to undertake training in the area of bereavement and loss has not, as yet, taken place. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 27 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents, and their relatives/representatives, can be assured that the home has an appropriate policy and procedure in place for raising any concerns or complaints. This provides clear information and is available in an appropriate format for adults who have communication difficulties. The home’s policies, procedures and practice indicate that residents are generally being well protected from abuse and are living in a safe, secure and trusting environment. All staff receive training in adult protection. EVIDENCE: The home has a complaints procedure that has been given to all the homes residents and care staff. The complaints procedure is made available in the language/format appropriate to the communication needs of each resident. Information about the complaints procedure is also included in the statement of purpose. A simplified copy of the complaints procedure is on display in both homes, using large print and Makaton symbols for the benefit of residents. The home maintains a complaints record, one complaint having been recorded since the last inspection. The record of complaints is appropriately maintained, and includes details of any investigation, its outcome, and action taken. All St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 28 complaints are responded to within twenty-eight days after the date on which the complaint was made. A concerns and compliments log is kept in the reception area, so as to provide a channel for both criticism/concern and positive feedback from relatives and other visitors. We discussed the outcome of the investigation into the complaint, from an exstaff member, which alleged poor practice in certain areas. We were advised that a manager from another home had completed a thorough internal investigation and had responded to the complainant. The outcome of the investigation did not substantiate any of the concerns raised and the handling of the complaint was dealt with an appropriate manner. The home has an adult protection policy and procedure, which is in line with Croydon’s multi-agency vulnerable adult procedures. The home also has an appropriate whistle blowing procedure. Physical and verbal aggression by a service user is understood and dealt with appropriately, in accordance with the homes physical intervention policy. All staff have undertaken restraint and breakaway techniques training in accordance with Department of Health guidelines. The home has a rolling programme to ensure that all staff undertakes statutory adult protection training. The home has developed its’ relationships with the Croydon Safeguarding Adults team. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 29 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 30 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents have rooms that are suited to their individual needs. They present as being safe, comfortable and pleasantly decorated, and reflect residents’ individual identities. Residents are living in a home that presents as being clean, pleasant and hygienic. All staff have undertaken training in infection control. EVIDENCE: St. Edwards was purpose built for people with learning disabilities. The home is well laid out and meets the needs of the service users. The garden is well laid St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 30 out and maintained. There is a ramp to the front door but no lift. In style it blends in well with the local community. The premises were inspected and found to be homely, comfortable and safe. Fittings, adaptations and equipment are of good quality, and domestic in scale. The home is divided into two separate houses, each of which accommodates six residents, with six single rooms in each house. There is a security code on the main front door, all bedrooms having a lock, with each resident having a key to their own room. Each house has a lounge, dining room, and a quiet room. The home is decorated to a reasonably high standard throughout and presents as being pleasant and comfortable. There is consultation with residents regarding any redecoration or refurbishing of rooms that takes place, and a planned programme of maintenance for the redecoration of the home. There are four toilets and two bathrooms in each house. One of the toilets is on the ground floor where there is also a shower. All afford privacy to users. A new walk-in bath has been installed in the Willows to assist two residents, who experience mobility problems. The two houses share a pleasant, reasonable sized garden area with covered seating. Each house has a separate lounge and domestic style kitchen and dining room. These are homely, with comfortable furniture and pictures. There is a small room in each house, which can be used as a quiet room. The medication is also stored here as is the white board with information about shift plans. Residents’ rooms have individualised symbols on the door, indicating whose room it is. These present as being pleasantly arranged and decorated, reflecting individuals’ personalities and tastes. Each bedroom is decorated in low arousal colours, with safe and secure furniture and specific flooring. Each resident is consulted about their choice of colour scheme and furniture. Throughout the house there are personal possessions such as games, CD’s, videos, pictures, etc. There has been some redecoration of both houses, which includes the ongoing redecoration of communal areas and residents’ bedrooms. All internal doors have been replaced, and carpets throughout communal areas have been replaced. The lighting in both houses has been upgraded. Furnishings and fittings are adapted to meet the needs of individual residents. While these are suited to the needs of the present residents, they would not be suitable for anyone who uses a wheelchair. All rooms have washbasins. Some of these are not in use as residents are not able to use these appropriately. This is indicated in the individuals’ care plans as not being appropriate. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 31 Generally, the home presents as being a safe environment, the necessary aids and adaptations being in place with which to meet the needs of the present residents. The environment has been adapted to meet the needs of the residents and to reduce any risk of harm. The home was last assessed by an occupational therapist on 10/4/07 and received a generally good report. The environment has been adapted to safely meet the needs of the home’s residents. This includes the use of metal plug sockets, boxed in toilet systems and sinks, extension to external garden fences, and boxed in fire alarms. These adaptations are designed to ensure that any risk of harm is reduced and that the environment is safe. There are two Health & Safety Officers on site who hold Safety Action Group meetings, and a Health & Safety checklist is completed quarterly. Maintenance records are kept, and work is carried out by approved contractors who are inducted regarding the special needs of the residents. Annual checks are made on fire equipment, boilers, gas, etc. The home presents as being clean and hygienic in most areas. The home’s policies and procedures manual contains various policies for the prevention and control of infection including dealing with spillages, HIV and Hepatitis B. A requirement for all staff to complete training in infection control, has been met. A requirement for all staff to attend accredited infection control training has been met. The houses have separate laundry areas, which are domestic in scale. The laundry facilities are suitably positioned to ensure that any soiled articles/foul laundry is never carried through areas where food is stored, prepared or eaten. The homes washing machine is capable of thoroughly cleaning foul laundry at appropriate temperatures (minimum of 65 Degrees Celsius). The inspector was advised that due to previous problems with breakdowns of equipment, the home has now changed contractors, with new washing machines and driers having been installed. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 32 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): 31 to 36 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are having their needs well met by staff, in sufficient numbers, who are appropriately trained and qualified, and who have clearly defined roles and responsibilities. Residents are being protected by the home’s recruitment policy and procedures. While, generally, residents’ best interests are being protected through the service’s training and support of staff, this is being offset by the home’s continuing failure to ensure regular staff supervision. EVIDENCE: In terms of recruitment practice, induction, training and general staff support, the home is generally maintaining good standards of practice. However further positive developments are being held back due to the continuing failure of the home to ensure the regular supervision of staff. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 33 The evidence from this inspection indicates that staff are appropriately trained and qualified, and have clearly defined roles and responsibilities. There are clearly defined job descriptions, and a key worker system is in place. Each key worker has a clear responsibility for developing a one-to-one relationship with an allocated resident, providing both a supportive and enabling role. Key workers escort residents to a wide range of community-based activities, and accompany them to their day care service, where they work alongside specialist day care staff. This is seen as encouraging a consistent approach to the support and care of each individual. Staff are evidenced to be sufficiently skilled and qualified, and available in sufficient numbers, for meeting the high level of needs presented by this vulnerable client group. There is a high staff ratio of 2:1, with several residents receiving 1:1 support at key times during the day. There is a senior support worker on site, and a senior on call, at all times. The staff rota is organised on a 3-week rolling rota and confirms that there are 3 staff on duty in each house at all times during the day, with 1 waking night staff for each house at night. There is also a sleep in member of staff who is shared between the two houses. Staff photo boards are used to enable residents to know which staff are working at any given time. The home’s manager is on-call during weekdays from Monday to Friday, and covers alternate weekends in tandem with the deputy manager. There is also an on-call Out of Hours Service provided within the organisation for providing cover for any emergencies that may arise. All new staff (including bank staff) now undertake a comprehensive 12-week induction programme. New staff are provided with an induction pack which includes a copy of key policies and procedures, and details of the induction programme. The induction programme includes ‘autism awareness’ and introduces staff to the aims and objectives of the service, policy and procedures. Induction also includes observation at the home and at the three local NAS day care services, and involves the new staff member shadowing an experienced staff member. In line with Skills For Care, the induction programme now covers all mandatory training. This includes Health and Safety, Medication, POVA, Person-centred Care, Equality and Diversity, First Aid and Manual Handling. It also covers specialised units in basic autism and Aspergers syndrome, and includes training in the use of techniques for communicating and working with autistic adults, including Spell, Teacch and Basic Makaton. There is evidence of a strong commitment by the NAS towards meeting the training and development needs of staff. Staff possess relevant qualifications and experience, and are actively encouraged to develop their skills and abilities, and to work towards obtaining their NVQ Level 2, 3 and 4 St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 34 qualifications. Approximately 90 of staff have achieved an NVQ Level 3 or above, and that just 2 staff have yet to complete their NVQ studies to this level. The NAS organises an extensive and ongoing programme of generic and specialised training. Staff at the home are able to access in-house training, both locally and at the NAS national training centre, and also attend relevant external training courses. The region has developed an autism-specific rolling training plan for all staff. All staff attend training on autism awareness, and on how to manage challenging behaviour. Staff records provide documentary evidence of qualifications obtained by staff. These include statutory training in adult protection, basic food hygiene, first aid, health and safety, fire safety, medication, equality, diversity and rights, person centred planning and epilepsy training. The Service is committed to using a person-centred approach in drawing up residents’ care plans and life plans, and in fully consulting and involving residents in all areas of their daily lives and activities. The inspector was advised that three senior support workers have completed a PCP Facilitator course and that the home has extended training in person-centred planning to all support staff. The Service has an appropriate recruitment policy and procedures in place. These are based upon equal opportunity principles, and with the safety and well being of service users in mind. Four new staff members have been recruited since the last inspection. The staff files were checked; this evidenced that up-to-date CRB checks had been completed for these staff, together with all the other necessary recruitment and identity checks. Whilst evidence indicates that staff are being well supported through training and development, there has, however, been no improvement in terms of supervision. This is a long-term concern, dating back to 2006, and was addressed at the last key inspection, an assurance being provided by the home’s manager, Andrew Lewis, that supervision would thenceforth be provided on a regular basis. From the evidence of this inspection there has been no overall improvement in the regularity of supervision received by staff who work at the home, but rather a marked deterioration. Of 17 staff records examined, none met the benchmark frequency of at least 6 supervisions per year; 6 staff were found to have had just one supervision in this period, a further 4 having had just two sessions. This is an unsatisfactory and potentially worrying situation that must be addressed as without regular supervision, staff are not being appropriately supported and monitored as to their continuing progress and development. This has potential implications for the level of awareness, competency and St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 35 good practice that staff present, and for the welfare and well being of service users. In order that the service can show that there is sustained improvement the Commission will require information to be sent to it in respect of all twomonthly staff supervision sessions throughout the 12 monthly period to August 2009. The Society should, however, be aware that any continuing failure to meet the unmet requirement, to provide regular two-monthly supervision, is likely to result in enforcement action being taken. The deputy manager advised that supervision is being undertaken by the manager and deputy manager, and by two senior support workers, and that supervision and appraisal training has been provided. With the delegation of supervision a rigorous system of monitoring needs to be introduced. This would assist in ensuring that regular supervision of staff is taking place However a number of staff files did not include an up-to-date staff appraisal. The manager is reminded that all staff should be appraised annually. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 36 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): St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 37 37 to 43 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst residents are living in a home that is being generally well managed, there are concerns relating to staff supervision which run counter to their best interests, and which must be rectified. The home has been without a registered manager since November 2005. It is in the best interests of the home’s residents and staff that the home’s manager completes his registration with the CSCI. The home is not currently demonstrating that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. The rights and best interests of residents are being safeguarded by the home’s record keeping policies and procedures. Generally, the health, safety and welfare of residents are being appropriately protected. However, the home’s Fire Risk Assessment needs to be updated. EVIDENCE: The home appointed a new manager, Andrew Lewis, in January 2007. Mr Lewis has had 15 years experience of working with people with learning disabilities. This includes 7 years experience in his previous post as an assistant manager at a social services day centre for adults with learning disabilities, and 2 years experience of working with people who have mental health problems. This is a home with a very good track record, and there is a loyal and committed staff group who work to very clear guidelines and values. Since being in post Andrew Lewis has been settling into his role and has been looking afresh at the day-to-day management of the home. As Mr Lewis was on annual leave at the time of the inspection, it was not possible to discuss his role or the issue of supervision. We were advised that Mr Lewis has not, as yet, been registered with the CSCI as the home’s registered manager. It is in the best interests of the home’s residents and staff that this is completed as a priority. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 38 The manager consults regularly with staff, holding regular weekly house meetings with senior staff, and individual house meetings for all staff once a fortnight. There are also occasional staff training days. The Deputy Manager has been studying for his NVQ Level 4 management qualification, which he completed in March 2008. He has had many years experience of working at the home as a senior care worker and presents as being very knowledgeable and professional in his approach. The home has a robust and innovative approach to Quality Assurance using an accepted tool ‘Accreditation for People with Autism.’ This includes an evaluation over a period of 2-3 days carried out by a panel of 4-5 people, which includes a layperson. There is not, however, evidence of any feedback from surveys of the views of relatives and professionals regarding the quality of support and services provided at the home. Or of a quality assurance audit report that summarises feedback from the home’s surveys. A requirement applies. The Service Support Committee, which had included relatives, staff and a community representative, has now been disbanded. There are, however, two six-monthly Partnership Days, to which relatives and friends are invited, and at which issues relating to the home are discussed. There is a strong ethos in the home towards fully involving residents in decisions which affect their day-to-day lives and the running of the home. This is evidenced in the detailed individual care and learning plans, and in the feedback received from residents. The minutes of residents’ meetings indicate that their views are regularly canvassed, with discussion of such topics as forthcoming choice of activities, the upkeep of the home, their daily routines, and food choices for the week ahead. The home has developed strategies for facilitating effective communication with residents. This includes the use of role-play, newsletters and questionnaires, and the use of listening and talking cards within residents’ meetings. An annual assessment questionnaire is completed with residents, with these being produced in an appropriately comprehensible format, using widget symbols. The home’s policies and procedures are being centrally reviewed and updated on an ongoing basis via the NAS intranet. All staff have access to the homes’ policies and procedures, which are brought to their attention during the induction period, and any changes are bought to their attention. The Deputy Manager confirmed that, in line with a recommendation from the last inspection, a checklist, detailing when policies were last reviewed, has been included in the Policies and Procedures Manual. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 39 The health and safety of residents is generally being well protected in this home. All health and safety checks were evidenced to have been completed and to be up to date. The home has had a recent fire inspection and has held fire awareness training for staff, in March 2007. Fire drills are taking place on a regular monthly basis, most recently on 1/8/08. A Health and Safety Risk Assessment was last completed on 5/5/08. However, a Fire Risk assessment, which was last completed in July 2006, needs to be updated. A requirement applies. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 40 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 4 4 3 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 4 25 4 26 4 27 4 28 4 29 4 30 4 STAFFING Standard No Score 31 4 32 4 33 3 34 4 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 4 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 2 3 2 3 3 3 X St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 41 Yes 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 YA36 Regulation 18(2) Requirement Staff supervision. All staff must receive regular supervision at least once every 2 months. Without regular supervision, service users are potentially at risk. Not met from previous two inspections. Timescale extended. A record of all twomonthly staff supervision sessions, for the period August 2008 to August 2009, must be notified to the inspector. 2 YA37 8(1)&(2) Management of the home. 31/12/08 Timescale for action 31/12/08 St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 42 The manager must complete his registration with the CSCI to become the home’s registered manager. 3 YA39 24(1)&(2) Quality assurance The home must evidence feedback from surveys and other sources, and include the findings in a quality assurance audit report. 4 YA42 13(4), 23(4) Fire Safety To assist in ensuring the safety of residents and staff, an up-todate Fire Risk assessment of the home must be completed. 31/10/08 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA21 YA36 Good Practice Recommendations The inspector recommends that staff undertake training in the area of bereavement and loss. The inspector strongly recommends that the home’s manager institutes a system for routinely monitoring the DS0000025839.V366433.R01.S.doc Version 5.2 Page 43 St Edwards (6) frequency of staff supervision undertaken. St Edwards (6) DS0000025839.V366433.R01.S.doc Version 5.2 Page 44 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. 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