Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection report Care homes for younger adults Rhyd Hir Neath Date of publication 23 rd November 2011 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
Care and Social Services Inspectorate Wales South West Wales Unit C, Phase 3, Tawe Business Village Phoenix Way Swansea Enterprise Park Swansea SA7 9LA 01792 310420 01792 313038 Home: Rhyd Hir Contact telephone number: 01792 817736 Registered provider: Registered manager: The National Autistic Society Angharad Humphreys Number of places: 3 Category: Care Home - Younger Adults Dates of this inspection from: 21 June 2011 to: 20 October 2011 Dates of other relevant contact since - last report: Date of previous report publication: September 2010 Inspected by: Olwen Davies Page 1
Introduction Rhyd Hir is a semi-detached house providing care for three individuals which is owned and operated by the National Autistic Society. The house is on the outskirts of the town of Skewen and whilst within a residential road, could not be identified as anything other than a normal home. The home is one of six homes operated in the area. The home had been registered since 1992 and the three residents had lived there since that time. The manager of the home is Angharad Humphreys 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 three people cared for by a stable staff team. The service users had lived in the home for about eighteen years and were all well settled and saw Rhyd Hir as home They were allowed the opportunity to participate in the community and enjoy individual activities, in addition to some group outings. Clearly, the service users were able to be involved in decisions about their lives and encouraged to make choices. What does the service do well? Rhyd Hir provides a homely environment, supported by a care team experienced in providing care for service users with complex needs. The team were focused on providing care for the service users as individuals within a small group living setting. What has improved since the last inspection? This is the first inspection by the current inspector What needs to be done to improve the service? a.) priorities There were no regulatory requirements made during the inspection b.) other areas for improvement That the outside area to the laundry room be covered over as planned by the end of the year. The manager has reported that this work has been completed since the inspection. Inspection methods The inspection was carried out using the following methodologies: Page 1
Two unannounced inspections. Discussion with the registered manager and other residential staff. Short conversation with two 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. 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
Choice of home Inspector`s findings: Rhyd Hir is registered by the Care and Social Services Inspectorate Wales (CSSIW) to provide care for a maximum of three 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. Two male and one female service users were living at Rhydhir at the time of inspection and had been living there since it was first registered in 1992. The Statement of Purpose submitted had been reviewed and updated the previous year to reflect changes in the responsible individual for the National Autistic Society. The manager said that the document was updated to reflect any changes in the home, organisation or staffing. Information about Rhyd Hir was available to service users in an accessible format and copies were said by the manager to be held in the office. The manager said that this information was also available to service users families and their care managers. The original document was comprehensive and provided in a format that was user friendly for the residents, it was a very lengthy document and a more concise document had been developed following an inspection of another property earlier in the year. This new document was examined and it would allow the individual to absorb the information more easily in the event of any future admission to the home. 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. Page 3
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 4
Individual needs and choices Inspector`s findings: At the time of inspection the three service users were aged between their early forties and fifties. They all had varying degree of need and ability to communicate with other people. On the second day of inspection it was possible to observe all of the service users and communicate to a varying degree and they indicated that they enjoyed living in the home. The records of one of the residents were examined in full on the day of inspection. All records were securely stored in a locked cupboard in the office ensuring confidentiality. 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. An in-house review was being held on the second day of inspection for one service user which was observed. The staff from the home was present along with representatives from the two day services attended. The service user was encouraged and supported to make their views known and he was able to reorganise his schedule to spend three days in one setting and one in the other. The service user agreed to the decisions made and was able to express his views at all times. The manager said that the staff would support the service users to express their views if they felt unable to do this in a formal setting. Some staff were also able to communicate using British Sign language which was vital for one service user. There were also pictorial aids and a white board for using written communication. Some of the communication techniques had been shared with individuals working in the community facilities that the individuals used to support their independence. The staff also carried information cards to share with people in the community in the event of a service user having a difficult experience when out to fully inform them about autistic spectrum disorder and gave a contact number for the Society. 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. Page 5
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 6
Lifestyle Inspector`s findings: All of the service users living at Rhyd Hir at the time of the inspection were appropriately supported to go out independently. Some accessed the local shop independently and all had their own key to the home. Although service users attended specialist day services organised by the National Autistic Society, their individual involvement varied. They also chose to be involved in a range of different activities. It was also observed that staff members were encouraging the service users to try new activities. One of the service users was due to attend an award ceremony and had been involved in making all of the invitations to send out. While service users had programmes of activities, these were flexible and service users were able to make choices. Individuals made use of local facilities including the library, swimming pool and restaurants. Some of these activities could occur during the evening as well as the daytime. Observation on the day of inspection suggested that service users were relaxed, comfortable and confident within the home. One service user clearly had his own routines in which staff supported him to maintain. Staff took account of the varying needs of service users from different ethnic and cultural backgrounds. The families of service users visited regularly and the service users visited their families for overnight stays and holidays. The staff were observed to discuss arrangements for family visits with the service users who were all planning their Christmas breaks. Discussion with staff confirmed their understanding of how the different individuals responded to planned visits and how they had to manage them in the home. 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 7
Personal and healthcare support Inspector`s findings: Staff had a good knowledge of the needs of the service users living at Rhyd Hir. Service plans were based on care management plans and the registered manager reported that these were reviewed internally on an annual basis by the staff at the home as observed during the inspection. Additionally they were reviewed annually as part of the statutory care management review. Care management reviews were normally held at the home when possible. The manager had completed a BTec Diploma in Positive Behaviour Support and was able to use this knowledge in the behavioural support plans for the individual service users. There was also the assistance of the positive behaviour Support Team available should the staff team require additional support. 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 manager said that all service users had an annual health care check. The self assessment of service confirmed that healthy eating plans were encouraged along with regular exercise. For one service user Zumba classes had been sourced to address a need to lose weight, along with attending a slimming club. None of the service users at Rhyd Hir stored or managed their own medicines. Medication was stored in a locked metal cabinet in the office 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. Staff encouraged service users to maintain their skills in personal care and hygiene. Visual communication was used in the home to advise the service user who was not able to hear. All of the service users had their own bank accounts and the manager said that they managed their own money but there was recording of expenditure maintained. This was not examined during the inspection. All of the service users carried out their own weekly goods shopping and had individual reward cards for the supermarkets locally. Page 8
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 9
Staffing Inspector`s findings: The core staff group for the home consisted of the registered manager and four practitioners. However, at the time of the inspection one of the staff was on long term sick leave. This post was being covered by the staff in the home and the use of some flexi bank staff. The bank staff who are employed at Rhyd Hir, were generally limited to three members of staff. All were known to service users and were familiar with the home. On the day of inspection there was an opportunity to have some discussion with one of the staff members who was on duty. The staff reported that they had good access to training and they were appropriately supported by the registered manager and management of the NAS. At induction all staff cover policies and procedures for the home including POVA, whistle blowing, fire safety, code of practice, introduction to Autism, local protocols, missing person protocol, personnel, health and safety, infection control and a three day Studio 3 managing challenging behaviour course. The registered provider arranges for some of this training to be refreshed at set intervals. All of the staff working at the home had received refresher training in infection control, food hygiene, health & safety, fire safety, adult protection, first aid, Deprivation of Liberty Safeguards (DoLS). New staff would not commence work until they had received a CRB check, three references, a full work history and contact made with former care employers. The staff were provided with a getting it right from the start induction handbook and the manager arranged for staff to shadow shifts and be allocated a mentor. The registered manager reported that all staff members working at Rhyd Hir were supervised at the required frequency bi-monthly and that she had oversight of their work within the home. She also completed annual appraisals with the staff. No new staff had been recruited since the last inspection; therefore, staff files were not inspected on this occasion. Staff were nominated as key-workers for the individual service users. 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 Page 10
Good practice recommendations: Conduct and management of the home Inspector`s findings: The registered manager had achieved NVQ level 4 in care management, and was very experienced in the care of service users with autism/complex needs. She had completed her registration with the care Council for Wales. On the day of the inspection staff were observed and seen to be relaxed and open in the presence of the inspector and the service users. The questionnaires distributed by CSSIW to obtain the views of service users and staff that were returned had positive responses. A quality assurance report of the home was provided annually. The organisation undertakes an Annual Adult Residential Review of the Neath Residential Service, which includes Rhyd Hir. The Autism Accreditation Report is designed to provide a concise and focused insight into the organisation s performance against accreditation standards. Bi- monthly Regulation 27 reports were not examined on the day of inspection although one visit was being undertaken on a day of inspection which allowed the inspector to meet the visiting officer. 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
Concerns, complaints and protection Inspector`s findings: The registered manager said that there had been no concerns or complaints received by the service in the last 12 months. There was a comprehensive complaints policy and procedure in place. The information provided within the complaints policy was in accordance with The Care Homes (Wales) Regulations 2002. There was a comprehensive protection of vulnerable adults (POVA), policy and procedure in place for staff to refer to. No POVA referrals had been made in the last twelve months and the registered manager said that all staff were aware of the policy and their role in protecting vulnerable adults. The NAS trained staff with regard to their responsibilities under the South Wales Procedure for the Protection of Vulnerable Adults. This training was refreshed on a regular basis. There were no issues to suggest that any service user was being deprived of their liberty. Service users had a great deal of involvement from their families. Where service users are supported in the community there is evidence to show that they have requested staff support rather than doing things independently. Furthermore, each service user had a deprivation of liberty checklist. This helps staff to assess what was happening in each service user. It asked questions about the nature and number of restrictions placed on each service user. 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
The environment Inspector`s findings: Rhyd Hir is a semi-detached home run by the National Autistic Society located in a quiet residential estate on the outskirts of Neath. It is registered to accommodate up to three people who have a learning disability, specifically autistic spectrum disorder. The home is situated within easy reach of community facilities such as local shops, pubs, places of worship and is close to public transport routes. Service users living at Rhyd Hir were accommodated in individual bedrooms. These bedrooms were individualised and reflected the service users likes, dislikes and interests. All bedroom doors are fitted with a suitable lock and service users had keys. One bedroom is below the national minimum standard of 9.3 square metres. The service user only uses this room as a bedroom, preferring to spend leisure time in the lounge or other areas of the home. Under current guidelines for homes in existence prior to 01/04/2002 this room could not be reoccupied if the current service user leaves the home. The décor of the home was domestic and communal areas had been redecorated in the previous year. New kitchen flooring had been requested and the kitchen would benefit from redecoration. The bathroom tiling was re-grouted between inspection visits to address the small build up of mould. The laundry was in an outbuilding a few paces from the back door. It was recommended that consideration be given to covering the walkway to allow the service users some protection from the weather. The manager said that she had spoken to the maintenance officer to attend to this before the end of the year and an e-mail has been received to confirm that the work has been completed. 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 13
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
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: www.cssiw.org.uk Page 15
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