Care and Social Services Inspectorate Wales

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1 Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection report Care homes for younger adults Ty Coed Neath Abbey Date of publication- 28 January 2012 You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers

2 Care and Social Services Inspectorate Wales South West Wales Unit C, Phase 3, Tawe Business Village Phoenix Way Swansea Enterprise Park Swansea SA7 9LA Home: Ty Coed Contact telephone number: Registered provider: Registered manager: National Autistic Society Pauline Teressa Collins Number of places: 5 Category: Care Home - Younger Adults Dates of this inspection from: 31 October 2011 to: 28 January 2012 Dates of other relevant contact since last report: Date of previous report publication: Inspected by: None Olwen Davies Page 1

3 Introduction Ty Coed is a purpose built detached house providing care for five individuals which is owned and operated by the National Autistic Society. The house is on the edge of a residential area on the outskirts of the town of Skewen. The home is one of six homes operated in the area. The home had been registered since 2009 and the five residents had lived there since that time. The manager of the home is Pauline Collins who has many years experience of working in the care sector and was qualified to NVQ level 4. Summary of inspection findings The inspection findings were positive with five people cared for by a stable staff team. The service users had lived in the home for just over two years and were all well settled and saw Ty Coed as home They were allowed the opportunity to participate in the community with support and enjoy individual activities, in addition to some group outings. What does the service do well? The home provides care for service users with complex needs. The staff provide the individuals with the opportunity to make choices about their lifestyle and participate in a range of new experiences. What has improved since the last inspection? This is the first inspection of the home carried out by the inspector What needs to be done to improve the service? a.) priorities There were no regulatory requirements made b.) other areas for improvement Lighting could be improved externally Inspection methods The inspection visit to the home was in line with the Care and Social Services Inspectorate Wales (CSSIW) policy, based on a proportionate approach using the following methodologies: Page 1

4 One unannounced inspections. Discussion with the registered manager and other residential staff. Short introduction and observation of service users. Examination of information contained within the self assessment of service (SAS) and annual data collection form. Examination of some policies and procedures used in the home. Review of the returned questionnaires sent to service users and staff. Case tracking of one of the service users files. Inspection of the premises. All of the questionnaires returned by staff members were positive about their experience of working in the home. One of the questionnaires returned by a staff member stated I am very happy in my job; no two days are the same. Its very exciting to watch our individuals make progress they may sometimes be tiny steps, when put together they are huge. A detailed report about the findings of this inspection can be found below and will include any requirements and recommendations. It was not practically possible for every aspect of the operation of the home to be observed on each visit. The absence of reference to a particular fault or issue does not mean that such a fault does not exist. It was the responsibility of the registered persons to ensure that in all respects the home operates in accordance with the relevant Laws, Regulations and National Minimum Standards. Page 2

5 Choice of home Inspector`s findings: Ty Coed is registered by the Care and Social Services Inspectorate Wales (CSSIW) to provide care for a maximum of five persons, between the ages of 18 and 64 years who have a learning disability specifically autistic spectrum disorder. The home is part of the Neath service of the National Autistic Society which provides six homes in the area. Three male and two female service users were living at Ty Coed at the time of inspection, one of whom had a self contained flat. The Self Assessment of Service (SAS) confirmed that there was a Statement of Purpose and service user s guide for the home. The statement of purpose and service user guide were not seen, however the documents are standard throughout the organisation and provided detailed information, relative to the service provided, which enabled prospective service users and their relatives/representatives to make an informed choice as to whether the home was able to meet their individual needs. One service user s file was randomly selected and examined during the inspection. There was a comprehensive care plan and risk assessments on the file along with evidence of the ongoing involvement of health and social care managers who undertook reviews. The manager said that each of the service users had a contract but this process was managed by the office in Bristol. The National Autistic Society has a website which can be accessed by the public to gain more information about the services they provide. Staff members are also able to access the intranet for information. The self assessment of service also indicated that newsletters were circulated to service users families, care managers and the staff at the home. The National Autistic Society had a range of comprehensive assessment forms which were completed prior to any admission to the home. The assessment procedure involved the service user, their relatives and/or carers, specialist health care workers and managers. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 3

6 Individual needs and choices Inspector`s findings: The inspection visit was undertaken in the afternoon to enable the inspector to meet with service users, as most of the service users attend the organisations day service unit during the day. Each of the service users had varied ability to communicate with PECs used to support verbal prompts. One of the service users had their board with an orange background to ensure consistency with the day service. The records of one of the residents were examined in full on the day of inspection. All confidential records were securely stored in a locked cupboard in the office. Other daily recording documents were kept on a shelf in the locked office for ease of access for staff. There was a main file for each service user which was split into the following sections:- a) personal information, b) Individual plan reviews, c) communication and social dictionary, d) behaviour, e) support guidelines & goal planning, f) risk assessment, g) health notes, h) assessments and i) miscellaneous. In addition to the main files for each service user they also had individual files with details about the individual, how they communicated, medication, health action plans, and a very important red, amber and green hospital traffic light system. Files were found to include details of important dates for individuals and emergency information in relation to hospital admission and persons going missing. Minutes of reviews were found on file along with assessment from the placing local authority. The service users had two reviews per year, one in-house and one annual. There were pictorial aids for each individual to support communication and choice making. Risk assessments were in place for individual service users and the activities planned for them. All documents were stored safely and the staff members were aware of the requirement to act confidentially as confirmed in the questionnaires returned. The National Autistic Society had commenced programmes which looked at family histories of the service users and looked forward to planning with a when I die document. Whilst some work had commenced on this the self assessment of service confirmed that this would be taken further in future years. The inspector visited the service users bedrooms and the self contained flat, which provided accommodation for one of the service users. The bedrooms and flat were personalised with the service users belongings and all had en suite facilities. Service users were encouraged and supported by staff to keep their rooms clean and tidy, do their own laundry, shop for food, prepare meals and wash the dishes. Service users in the main ate the same meals and were encouraged to sit together in the dining room. There was a programme of individual activities, including holidays, for each service user, which was tailored to meet their preferences and needs. Great care was taken to select locations that would meet the individuals needs and not place them in situations that they might find difficult to manage. Requirements made since the last inspection report which have been met: When completed

7 Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 5

8 Lifestyle Inspector`s findings: Examination of the service user s files and discussion with the registered manager identified that all of the service users were involved in a range of activities within the home and in the community. In discussion with staff and observation of service users it was evident that staff supported service users to achieve/maintain independence. The service users accessed the organisation s day centre where they participated in activities of their choice. The day centre has input from the local college to provide individual courses and support for the service users. All of the service users enjoyed visits to local facilities, including cafes, shopping trips, meals out, and spending time with their family. Within the home they had a WI-Fit and one resident had their own lap top to enable communication with their mother who lived in another country. Birthdays were celebrated along with any other festivals and all of the staff participated in dressing up for the parties. Service users were able to spend time alone or in the company of other service users as they so wished. The lounge was comfortably furnished with a flat screen television and there is a large dinning room which was also being used for board games at the time of inspection. Staff encouraged those service users who were able to prepare meals and share mealtimes together. The service user who occupied the flat was supported by staff to prepare snacks in the kitchen of the flat, which was fully equipped; however, he joined the other service users for main meals. This decision had been made following assessment of the needs of the individual. The service user spent time in the flat or used the communal facilities in the house. Observation on the day of inspection suggested that service users were relaxed, comfortable and confident within the home. The service users clearly had their own routines in which staff supported them. The organisation advocated an open door policy with regard to visitors to the home. Service users were encouraged to maintain contact with relatives and friends. The inspector was informed that the service users maintained contact with those they wished to, and were assisted to visit those they chose to. There was a visitor s book in the entrance to the home, which staff encouraged visitors to sign when entering and leaving the home. Staff all asked for identification before allowing entry to the home. Requirements made since the last inspection report which have been met: When completed Page 6

9 Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 7

10 Personal and healthcare support Inspector`s findings: The service user s files identified that their individual health and social care needs were met by a range of visiting professionals with the support of staff. Staff accompanied service users to their healthcare appointments when necessary and kept families informed of any issues. There were individual pictorial health care action plans drawn up for the service users and all were registered locally with the general practitioner, dentist, chiropodist and optician. These had been reviewed in the past year and were said to be more person centred and easier to monitor and review. The self assessment of service confirmed that healthy eating plans were encouraged along with regular exercise. Staff encouraged service users to maintain their skills in personal care and hygiene. None of the service users at Ty Coed stored or managed their own medicines. Medication was stored in a locked metal cabinet in the office or for one service user in a locked cabinet in his own flat and provided in blister packs by Boots the Chemist monthly. The self assessment of service confirmed that the staff received training in the administration of medicine and only qualified staff would be allowed to administer medication. Audits were carried out by the pharmacist every three months but these were not examined during the inspection. All of the service users had their own building society accounts and the manager said that there was recording of expenditure maintained. The staff used petty cash for expenditure and receipts were kept and monthly they were balanced. There were monthly print outs for the expenditure for each individual and accounts were audited annually in addition to the manager carrying out spot checks. The Registered Manager was an appointee and the two senior staff were signatories. The staff withdrew money from the building society accounts to reimburse the NAS for petty cash expenditure. The inspector observed staff interacting with the service users. Staff demonstrated understanding of the service users needs. The registered manager and staff were seen to be respectful towards the service users and communicated with service users in a meaningful and sensitive way. The staff also planned how they would manage breaking news to one service user that their father had passed away. Staff demonstrated a great understanding of how the individual functioned and the best approach to deliver the information in a planned way. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion

11 New requirements from this inspection: Timescale for completion Good practice recommendations: Page 9

12 Staffing Inspector`s findings: On the day of the inspection there was sufficient staffing to meet the needs of the service users. Target support staff (additional staff hours) are employed on an individual needs led basis to support individual service users to attend external activities/appointments and support with activities within the home. The registered manager, senior practitioner and three other practitioners were present during the inspection visit. The rotas demonstrated that there was an adequate number of staff employed with the appropriate skills to care for the service users and manage the home. The registered manager had achieved NVQ level 4 in management and in the past year had gained the Advanced Positive Behaviour Support Diploma. On appointment all new staff members undertake an induction and the manager had an in-house induction file which was signed at all stages. All of the staff had received training such as, infection control, food hygiene, health & safety, fire safety, adult protection, first aid, Deprivation of Liberty Safeguards (DoLS). Having completed the Positive Behaviour Diploma the manager was able to give input into plans and support staff in their implementation. It was planned that the two senior staff would be enrolled on the Diploma in the next year. Staff files were not examined during this inspection. The SAS identified that there was a stable workforce. The inspector was informed that Criminal Records Bureau (CRB) monitoring sheets were compiled by the organisation, which identified that all of the staff employed had current CRB s. The registered manager said that she undertook bi-monthly supervision of staff and an annual appraisal of all staff. There was a disciplinary policy and procedure for staff with a process for implementing staff disciplinary measures. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 10

13 Conduct and management of the home Inspector`s findings: The registered manager had many years of experience in the care of service users with autism/complex needs, and had achieved NVQ level 4 in care management. The registered manager was supported in her role by the service manager who is responsible for the registered manager. The service manager visited on a regular basis. During the inspection visit staff were observed to be relaxed and open in the presence of the inspector and the service users. The organisation undertakes an Annual Adult Residential Review of the Neath Residential Service, which includes Ty Coed. The Autism Accreditation Report is designed to provide a concise and focused insight into the organisation s performance against accreditation standards. The service user questionnaires used by the organisation to inform the Annual Quality Assurance Report are specifically designed for this client group. This SAS indicated that all of the equipment was tested according to manufacturers instructions and assessments had all been carried out accordingly. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 11

14 Concerns, complaints and protection Inspector`s findings: The self assessment of service form (SAS) identified that there had been no concerns or complaints received by the service in the last 12 months. The registered manager confirmed this. CSSIW had not received any concerns or complaints in relation to the home. There was a complaints policy and procedure. The information provided within the complaints policy was in accordance with The Care Homes (Wales) Regulations There was a Protection of Vulnerable Adults (POVA), policy and procedure in place for staff to refer to. No POVA referrals had been made. The inspector was informed that none of the service users were subject to a DoLS authorisation and an assessment was placed on the individual service user s files. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Page 12

15 The environment Inspector`s findings: Ty Coed is situated on the edge of a quiet residential area on the outskirts of Skewen. Some of the service users would require transport to access local facilities and public transport routes; however some service users enjoyed walking to a local shop with the support of staff. Transport is provided by the organisation. The home is a large detached residential house with accommodation over two floors. There is a large entrance hall with a lounge, a well-fitted kitchen, large dining room, communal toilet, laundry room, and two bedrooms on the ground floor. The registered managers office and staff sleep in room with en suite facilities; two bedrooms and a self contained flat with lounge, bedroom, kitchen and bathroom are on the first floor. The four bedrooms had en suite bathrooms with a bath or shower. There were well maintained areas to the front, sides and rear of the property, with lawns and paved areas. There were sufficient parking areas close to the property. Due to the large trees on the perimeter the lighting could be improved as it is quite dark. The home was purposed built in 2009 and had been completed to a high standard. The home both internally and externally was well maintained. Service users rooms seen during the inspection were personalised and appropriately and individually furnished. At the time of inspection there were plans to redecorate some of the communal areas. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for completion New requirements from this inspection: Timescale for completion Good practice recommendations: Due to the large trees on the perimeter the lighting could be improved as it is quite dark. Page 13

16 A note on CSSIW s inspection and report process This report has been compiled following an inspection of the service undertaken by Care and Social Services Inspectorate for Wales (CSSIW) under the provisions of the Care Standards Act 2000 and associated Regulations. The primary focus of the report is to comment on the quality of life and quality of care experienced by service users. The report contains information on how we inspect and what we find. It is divided into distinct parts mirroring the broad areas of the National Minimum Standards. CSSIW`s inspectors are authorised to enter and inspect regulated services at any time. Inspection enables CSSIW to satisfy itself that continued registration is justified. It also ensures compliance with: Care Standards Act 2000 and associated Regulations whilst taking into account the National Minimum Standards. The service`s own statement of purpose. At each inspection episode or period there are visit/s to the service during which CSSIW may adopt a range of different methods in its attempt to capture service users` and their relatives`/representatives` experiences. Such methods may for example include selfassessment, discussion groups, and the use of questionnaires. At any other time throughout the year visits may also be made to the service to investigate complaints and to respond to any changes in the service. Readers must be aware that a CSSIW report is intended to reflect the findings of the inspector at a specific period in time. Readers should not conclude that the circumstances of the service will be the same at all times. The registered person(s) is responsible for ensuring that the service operates in a way which complies with the regulations. CSSIW will comment in the general text of the inspection report on their compliance. Those Regulations which CSSIW believes to be key in bringing about change in the particular service will be separately and clearly identified in the requirement section. As well as listing these key requirements from the current inspection, requirements made by CSSIW during the year, since the last inspection, which have been met and those which remain outstanding are included in this report. The reader should note that requirements made in last year`s report which are not listed as outstanding have been appropriately complied with. Where key requirements have been identified, the provider is required under Regulation 25B (Compliance Notification) to advise CSSIW of the completion of any action that they have been required to take in order to remedy a breach of the regulations. The regulated service is also responsible for having in place a clear, effective and fair complaints procedure which promotes local resolution between the parties in a swift and satisfactory manner, wherever possible. The annual inspection report will include a summary of the numbers of complaints dealt with locally and their outcome. Page 14

17 CSSIW may also be involved in the investigation of a complaint. Where this is the case CSSIW makes publicly available a summary of that complaint. CSSIW will also include within the annual inspection report a summary of any matters it has been involved in together with any action taken by CSSIW. Should you have concerns about anything arising from the inspector`s findings, you may discuss these with CSSIW or with the registered person. Care and Social Services Inspectorate Wales is required to make reports on regulated services available to the public. The reports are public documents and will be available on the CSSIW web site: Page 15

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