Care Home: The Ann Coleman Centre

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What the care home does well The home provides a high standard of care for individuals who have complex needs, delivered through a person centred approach. Service users have a varied life at the home, and are able to choose from a range of activities offered at the day centre located on the ground floor of the building. The home actively seeks support from other professionals to help improve the quality of the service it provides to each person. Staff members receive appropriate support, guidance and training to ensure a high standard of service is provided to each person who lives in the home. The home is spacious, well maintained and the furniture and fittings are of a good standard. This ensures a homely environment for each person who lives in the home. The home is well run. The ethos of the service is clear, well communicated and remains focused on positive outcomes for each service user. What has improved since the last inspection? The home has worked to develop social and work opportunities outside of the home for service users as this promotes their independence and provides them with the opportunity to take part in activities of their choice. Staff now receive more frequent supervision sessions and meet regularly as a team. This supports them to provide a good quality of service to each person who lives in the home. The home now has evidence that all staff employed through an agency have had the required checks including Criminal Record Bureau checks. This promotes the welfare and safety of each service user. The staffing arrangements in the home are now clear, including when the manager is working at the home and the member of staff who is to deputise in his absence. This promotes the welfare and safety of each service user. One service user`s needs are now better met as their care plan has been updated to include independence training. The format for Keyworker meetings has now been reviewed, so these relate to individual care plans. This ensures all care plans contain accurate information in relation to each service user`s support. CARE HOME ADULTS 18-65 The Ann Coleman Centre Ridingleaze Lawrence Weston Bristol BS11 0QE Lead Inspector David Smith Key Announced Inspection 18th December 2007 10:30 The Ann Coleman Centre DS0000033586.V351903.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 The Ann Coleman Centre DS0000033586.V351903.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. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ann Coleman Centre Address Ridingleaze Lawrence Weston Bristol BS11 0QE 0117 9380155 0117 9380157 admin@avon-autistic.demon.co.uk 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) Avon Autistic Foundation Mr Andrew Coleman Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Andrew Coleman to take effect as Manager from closure of Longcross. Date of last inspection 15th March 2007 Brief Description of the Service: The Ann Coleman Centre is owned and operated by the Avon Autistic Foundation Ltd, who specialise in the care of individuals who have a diagnosis of autism or Aspergers Syndrome. The home provides personal care and accommodation for up to seven people. Facilities on the ground floor offer a range of social and educational activities. The property is arranged over two floors. The activity centre is based on the ground floor with a computer room, arts and crafts room, large kitchen and dining area and a sensory room. A large conservatory is used to provide an area for games and parties. The residential home is located on the first floor and chair lift access is available if required. Each bedroom has en-suite facilities. Communal space consists of two lounges, a kitchen, bathroom and toilet. To the outside of the property there is a paved area with garden furniture. The property is purpose built and all areas are accessible to wheelchair users. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced visit to the home as part of a Key Inspection of this service. We did announce this visit to the home, giving only a few days notice, as the home is often empty during the day when service users are attending planned courses or activities. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection carried out in March 2007 and the service history, which details all contact with the home including notifications of significant events which they have reported to us. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA, pronounced as ‘aqua’) and a range of survey forms for service users, their relatives, carers, advocates and health professionals, prior to my visit. The AQAA was completed and returned, however no surveys have been returned at the time of writing this report. I gathered additional information during my visit through informal discussions with staff members. A limited amount of interaction and communication between staff and service users was also observed. Care plans and associated records were examined together with Risk Assessments, complaints procedures, medication administration, menu plans, staff personnel and training records and health and safety records. I was also provided with a tour of all communal areas of the home and some of the service user’s own rooms. This inspection was also supported by an ‘Expert By Experience’ who, because of their shared experience of using services, helped us to get a picture of what it is like to live in this home. They visited the home during the afternoon and were provided with a tour of the home, including the day service on the ground floor, and spoke with staff. What the service does well: The home provides a high standard of care for individuals who have complex needs, delivered through a person centred approach. Service users have a varied life at the home, and are able to choose from a range of activities offered at the day centre located on the ground floor of the building. The home actively seeks support from other professionals to help improve the quality of the service it provides to each person. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 6 Staff members receive appropriate support, guidance and training to ensure a high standard of service is provided to each person who lives in the home. The home is spacious, well maintained and the furniture and fittings are of a good standard. This ensures a homely environment for each person who lives in the home. The home is well run. The ethos of the service is clear, well communicated and remains focused on positive outcomes for each service user. What has improved since the last inspection? What they could do better: The home should continue to seek external specialist advice and support for any individual who requires support with personal relationships and expression of their sexuality. This will promote the welfare and safety of service users and ensure their support needs are well met. The home should consider improving Risk Assessments in relation to individuals who may require restrictive physical interventions as part of their behaviour support plan. This would better promote the welfare and safety of each service user and the staff team. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 7 The home should consider improving one service user’s guidelines in relation to managing behaviour, which may be perceived as challenging the service being provided. This will promote this individual’s welfare and safety. 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. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives have access to detailed information in order to make informed choices about where to live. Each service user knows their needs and aspirations will be assessed and met by the home. EVIDENCE: The home has a Statement of Purpose and Service Users’ Guide, which contain comprehensive information about the home and service it is able to provide. A Brochure is also available and I was provided with a copy on the day of my visit. One individual has moved into the home since our last visit. I therefore took the opportunity to view their care records, which show that a comprehensive assessment was carried out by the home to ensure they could meet this person’s support needs. Other relevant information included a ‘Case Study’ which details this individual’s history, likes, dislikes and support needs. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 10 Regular reviews have been carried out since this individual moved into the home, the most recent taking place in September 2007, which was attended by the service user, his family, staff members and a representative from the Funding Authority. I did note that this service user appears to have settled into the home well and that any areas identified at the reviews where the service needed to be improved or adapted has been acted upon. Following their introduction to the home and the reviews, a comprehensive care plan has been developed and put into place during December 2007. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each individual takes into account their changing needs and personal goals, supported by both written information in care plans and risk assessments which are subject to ongoing review. Service users are consulted on, and given opportunities to participate in, all aspects of life in the home. EVIDENCE: I examined two service user’s care plans during my visit. Each plan had been written in an individual way and covered key areas of support people required, such as medication, self-care, communication and work towards their goals. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 12 Regular formal review meetings are held, which include service users, their families, staff members, Social Workers and their Keyworker (one member of the staff team who works closely with one service user). Individuals continue to be supported to prepare for, plan and attend their review meeting if they wish to do so. These meetings are clearly recorded and the outcomes used to update individual support plans. In addition to these formal reviews, the home has now developed a very effective system of reviewing each care plan in-house. Each Keyworker writes an ‘end of month report’ for one service user, which details each significant event that month and gives an overview of their health, mood and progress towards their goals. The home also uses a ‘Re-Assessment Form’ in each section of service users’ care plans. This is completed by either the Manager or his Deputy to ensure each care plan remains up to date and that any changes are noted and communicated to each member of the staff team. These methods are good practice. Care plans can be updated at any time and these systems ensure that if a service user’s support needs change, this will be noted and the support provided adapted accordingly. Each individual also has an ‘Individual Personal Plan’, known as an ‘IPP’. This clearly describes the goals that have been identified and agreed by each service user. The support required to enable each person to realise their goals and the progress of working towards them are both regularly reviewed. I did not speak directly with any of the people who live in the home as they were attending planned activities during the day and had planned a trip out of the home in the late afternoon and early evening. I did observe a limited amount of interaction between staff and service users which show the staff have a good knowledge of the support needs of service users and how to communicate effectively. Service users appeared to be relaxed in the company of staff and spoke openly with them. The home hold regular house meetings, which all service users are invited to attend. There are also individual meetings with each service user, which are called ‘Suggestions or Concerns Meetings’. These cover a wide range of topics and are designed to help each person express their views, likes, dislikes and involve them in their care planning as much as possible. This is a positive development. Our ‘Expert By Experience’ said that the people who live at the home have lots of choices and that staff support them to make choices, but only if this is needed. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 13 Care and support continues to be provided within a risk assessment framework. Each of the person centred risk assessments I examined were detailed and have been regularly reviewed. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual has opportunities and appropriate support to develop, access leisure and educational facilities both locally and in the wider community including day trips and visits to family and friends. Each person’s rights and responsibilities are recognised in their daily lives. A healthy and balanced diet for each individual is promoted. EVIDENCE: Each individual is supported to attend the day centre on the ground floor of the building, which offers a wide variety of sessions and courses. Individuals are also supported to use facilities in the wider community. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 15 The home has worked hard to ensure service users are provided with the opportunity to access community based facilities in addition to the day centre. It is clear that some individuals the home supports do require a specialist service, rather than ‘mainstream’ community services, and the Consultant Psychiatrist has written to confirm this. The records I examined show that service users are taking part in a number of activities such as learning how to use computers, playing various sports, art and craft sessions and making use of the well equipped sensory room. Individuals are also supported in the wider community to go on shopping trips, day trips, ten pin bowling, walks, to attend church, go to the cinema and for meals out. I did see that some of the service users had taken photographs and written their own account of some trips out of the home, which they said they had really enjoyed. This is good practice. Some of the people who live in the home have been supported to attend courses at local colleges, one person has worked at a local restaurant and one service user is due to start a computer course at college next term. Other service users do use the community independently and there are risk assessments in place to support this practice. Our ‘Expert By Experience’ said that service users do a lot of activities in the week and there are timetables with pictures on to help people understand them. If an individual does not wish to take part in a planned activity they are always offered an alternative. The activities which take place include learning how to cook safely, using the computers (which are all new), going hiking, cycling and shopping. They also said if service users wanted to relax they can use the sensory room, where they can play music or operate the various lights using a keypad. There is also a large conservatory where they hold service users’ birthday parties and play games such as snooker and table tennis. On the day we visited service users went out to the Mall at Cribbs Causeway for a meal, then ten pin bowling. Each service user has any goals they are currently working towards noted in their care plan. These goals vary depending on the skills and abilities of each person. The records I examined show that individuals are being supported to learn how to cook, learn about healthy foods, become independent with their personal care and improve general daily living skills. There is a clear process of reviewing the progress each person is making in working towards their goals. The home reviews progress each month and the outcome of the review is added to each person’s care plan. This is supported by the day centre, who also write their own monthly report and provide a copy to the home. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 16 I did note that service users are making progress and if they are not, support is adapted or changed to better support them. I also noted in the review documents I examined that parents had said they felt their relatives are making good progress and any suggestions they have for improvement are noted and acted upon wherever possible. Service users are supported to maintain regular contact with their family and friends and visitors to the home are welcomed. Our ‘Expert By Experience’ said most of the service users are staying with their families over the Christmas period. The home does support one individual who has demonstrated both through discussions with staff members and their own actions that they require support with personal relationships and the expression of their sexuality. The home does have support from a Consultant Psychiatrist but would like to access more specialist support for this service user. I agree that additional support would be valuable, as this is a particularly sensitive area to support people in and I have therefore provided the home with details of a health professional who may be able to offer appropriate specialist support and advice. The home has worked closely with service users in developing a healthy eating menu and I was shown examples of the considerable amount of work which has gone into developing this. Individuals’ likes and dislikes are known as well as appropriate portion sizes and peoples’ mealtime routines. The kitchens are clean, tidy and well organised. Staff are provided with Food Hygiene training and are also now completing the ‘Safer Foods, Better Business’ document provided by the Food Standards Agency. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported in their preferred manner and their personal and healthcare support needs are well met. The policy and procedures relating to administration of medication ensures service users’ welfare and safety. EVIDENCE: The care documentation in place for service users provides clear guidance for staff on how they should support those living at the home with their personal care. The care plans I examined show that service users are registered with a local GP, dentist, optician and chiropodist. Other specialist services are accessed when an identified need arises. Care records show a Consultant Psychiatrist and other relevant health care professionals support the home. Contact with each professional is recorded and forms part of each person’s care plan. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 18 There is a core of experienced staff who have a good knowledge of service users’ healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. It remains evident that the management and staff spoken with are sensitive to the personal, healthcare and emotional needs of those living in the home. There are regular medication reviews carried out by a Consultant Psychiatrist. The frequency depends on the individual concerned and clear records of the outcome of each review are kept as part of each person’s care records. The home uses a Monitored Dosage System of medicine administration. This system is very well managed. The home had a comprehensive Pharmacy Inspection on 26/11/07 and I examined the report. This covered medication storage, self-medication (none of the people who currently live at the home self-medicate), record keeping, handling medication, information and advice available to staff, service user monitoring and retaining medication. I did note that this report showed the home met each of the required standards and the Pharmacist only made some minor recommendations, which the home has acted upon. Each member of staff who dispenses medication is provided with appropriate training, together with an in-house assessment. The Ann Coleman Centre DS0000033586.V351903.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): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect service users from the likelihood of abuse, neglect and self-harm. EVIDENCE: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. There have been four complaints since our last visit to the home. I examined details of each complaint and found these were all relatively minor in nature, however they had been taken seriously, investigated in accordance with the home’s policy and the outcome recorded and explained to the complainant. Staff members now spend time every month with service users in their ‘Suggestions or Concerns Meetings’, referred to earlier in this report. These meetings do provide an opportunity for each individual to either say or show if they are unhappy about any area of the service provided by the home. A clear record of each meeting is kept as part of each person’s care plan and all issues are acted upon. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 20 Due to the communication difficulties experienced by some of the people who live at the home this appears to be an appropriate method to use, rather than relying on every service user to use the formal complaints procedure, as it is very unlikely some individuals would be able to use this effectively. All staff are provided with training in relation to the Protection of Vulnerable Adults and are subject to ‘enhanced’ Criminal Record Bureau disclosures (known as ‘CRB’s) before they start work in the home. Each agency who supply staff to the home has now provided written confirmation that their staff are subject to robust employment checks, including CRB Disclosures. The home has clear guidelines in place for supporting service users who are distressed or presenting behaviours which may be perceived as challenging the service provided. Each care plan has details of known trigger points and the appropriate defusing techniques. One plan I examined did not clearly show the behaviours this individual may display and although these were discussed in other documents within the care plan, the behaviour plan should be improved to ensure these are included and then regularly reviewed. Staff receive training in understanding and responding to these behaviours, using in-house training materials. This training is more focused on theory rather than more practical or physical responses. Some individuals may require physical interventions, including staff using block or breakaway techniques, however these do not form part of the general in-house training programme. Some staff have previously had physical intervention training (provided by an external trainer), and this is now due to be delivered to all staff at a training session planned for January 2008. Service users are generally supported within a risk assessment framework; however, there are no clear risk assessments currently in place relating to the use of physical interventions with those individuals who may require this level of support. These should be developed as soon as possible and I did share the Department of Health Guidance on Restrictive Physical Interventions, which the home may wish to use to support these developments. The home maintains clear records of all accidents and incidents and notifies us of any significant event which occurs. The Ann Coleman Centre DS0000033586.V351903.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): 24, 25, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Ann Coleman Centre provides a very homely, comfortable and safe environment for service users to live in. EVIDENCE: The Ann Coleman Centre is purpose built and comprises both a residential home and day centre in the same building. The residential accommodation is on the first floor and the day centre, together with office space, is located on the ground floor. The home is situated in a quiet residential area close to local amenities and bus routes. There is a car parking area at the front of the house and a patio area to the side and rear. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 22 Whilst the services are separate, the individuals who live in the home are able to use the day service as well as some of the facilities on the ground floor such as the kitchen, large conservatory and the sensory room when the day service is not open. On the first floor there are service users’ bedrooms (all of which have en-suite facilities), a kitchen, lounge diner, a separate lounge area and a workstation for staff. There is an additional toilet and bathroom which service users are able to use if they wish. There is one bedroom, which the member of staff sleeping-in uses and this also has en-suite facilities. There is a chair lift to access the first floor, however this is not required by any of the individuals who currently live at the home. I did view all of the communal areas, along with one of the service user’s rooms and the sleeping-in room. All areas of the home were tastefully decorated, very clean and tidy and furnishings and fittings are of a good quality. Our ‘Expert By Experience’ said that each service user likes light and space in their home. Each room is large, airy and has high ceilings. They feel it is a homely place for people to live. There is a large patio area outside, with a range of furniture which service users are free to access when they wish. The Ann Coleman Centre DS0000033586.V351903.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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clarity of staff roles and responsibilities along with staff training and supervision helps to provide a consistent approach to the support of staff and service users. The home’s recruitment policy promotes both service users’ rights and their safety. EVIDENCE: There is a core of experience staff who work in the home and some newer staff have also recently joined the team. The roles and responsibilities within the team are clear and there is a copy of each staff member’s job description in their personnel file. The member of staff I spoke with said they enjoyed working in the home and were well supported in their role. They feel able to discuss any issues in an open and honest way and are always listened to. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 24 Staff who work in the home may also support individuals during their day activities. This ensures a consistent approach in the support provided to each service user and helps reduce anxiety for some individuals who find change difficult to manage. The home’s rota has now been re-designed, and it is now easy to see which staff are working within the home and the precise times of their shifts. The staffing arrangements for the day service are now kept separate from the residential home. The home does have vacancies for two full time Support Workers, however these hours are currently being covered by regular agency staff. Staff meetings have now resumed, with the last meeting held on 30/10/07. Clear records are kept of each meeting, together with the names of staff who attend. There are other, more informal meetings or discussions with staff, which are also recorded. I examined the personnel records of three staff members. These contained their photograph, copies of their Application Form, at least two satisfactory references, documents confirming identity and eligibility to work in the UK, contracts of employment and a record of their induction to working in the home. (The details of Enhanced Disclosures from the Criminal Records Bureau are discussed earlier within this report). Staff are provided with a variety of training opportunities, most of which are provided in-house and some by external training providers. The records I examined showed that staff have had training in First Aid, Adult Protection, Food Hygiene, Challenging Behaviour, Medication Administration and Fire Safety. The organisation has developed their own comprehensive induction and training package for staff, with a particular focus on the Autistic Spectrum and Aspergers’ Syndrome. This is known as ‘Avon Autistic Foundation Induction and Theory’ and has three separate stages. Each member of staff works through each stage and then sits a written test under ‘exam conditions’. This test paper is then marked and each member of staff must complete each stage before moving on to the next, higher stage. Staff are encouraged to work towards a National Vocational Qualification (known as an ‘NVQ’). The ‘AQAA’ provided by the home confirms that each member of the staff team either holds or is working towards this award and this is commended. Each member of staff is provided with regular formal supervision, with the frequency being improved since our last visit. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 25 Clear records of each meeting are kept which both parties sign. Staff spoken with said they continue to find supervision helpful and supportive. The Ann Coleman Centre DS0000033586.V351903.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): 37, 38, 39, 40, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-run and service users benefit from the ethos, leadership and management approach of the home. Service users views are sought in relation to the monitoring and review of the service provided by the home. Each person’s rights and best interests are promoted by the home’s record keeping and the organisations’ policies and procedures. The health, safety and welfare of people living in the home is promoted and protected. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Registered Manager, Mr.Andrew Coleman, was not present during my visit. He is suitably qualified to manage this home as he holds a postgraduate Diploma in Management (Health and Social Care), has a number of years experience supporting people in the Autistic Spectrum and attends training to ensure his knowledge and skills are updated. Mrs Ann Coleman and Mr John Coleman, the Registered Providers were both present during my visit and supported the inspection process fully. Through my discussions with Mr. and Mrs. Coleman and staff it is clear the management approach remains open and positive, with a clear sense of direction and leadership. The ethos of the service is person centred with the views of service users being sought, as far as possible, as part of this process through their monthly meetings with staff members and the house meetings, which all service users are invited to attend. The management structure and lines of accountability within the home are clear and straightforward. The Registered Manager is supported by a Deputy Manager and one other person currently training as a Deputy Manager. Out of hours management support is always available for staff, as the organisation operates an ‘on call’ system. The management team within the home meet regularly, with the last meeting held on 8/11/07. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is very good, with all records required during my visit easy to access and stored securely when not in use. Avon Autistic Foundation have comprehensive policies and procedures to support the home, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager on the AQAA he completed as part of this Key Inspection process. The registered provider makes regular visits to the home, and produces a report of his findings. A copy of each report is forwarded to us each month. There are recording systems in place to support Health and Safety within the home, which are being used consistently. Records examined included hazardous products used within the home, fridge and freezer temperature checks and tests on the temperature of high-risk foods. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 28 The home’s ‘AQAA’ confirmed that portable electrical appliance safety checks were carried out in June 2007, and that the safety of the gas appliances in the home were checked earlier this year. There are a number of general Risk Assessments in place to ensure the welfare of service users and staff. These have all been recently reviewed. The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 4 3 3 The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA15 Good Practice Recommendations The home should access specialist support and advice to support service users with their personal relationships and to express their sexuality. There must be clearer guidelines in place for one service user who presents behaviours which may be perceived as challenging the service being provided. Risk Assessments for service users who may require physical interventions should be improved to promote the welfare and safety of both service users and staff. YA23 YA23 The Ann Coleman Centre DS0000033586.V351903.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Ann Coleman Centre DS0000033586.V351903.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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