Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection report Care homes for younger adults Ty Canol Neath Date of publication 30 th July 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: Ty Canol Contact telephone number: 01792 326820 Registered provider: Registered manager: The National Autistic Society Jacqueline Suzanne Booth Number of places: 3 Category: Care Home - Younger Adults Dates of this inspection from: 30 March 2011 to: 5 July 2011 Dates of other relevant contact since - last report: Date of previous report publication: November 2010 Inspected by: Olwen Davies Page 1
Introduction Ty Canol is a house providing care for three individuals, which is owned and operated by the National Autistic Society. The house had formerly been one large property and been converted into two homes to provide a more homely atmosphere. The house is on the outskirts of the town of Skewen and whilst on the edge of a residential area could not be seen from the main road. The manager of the home is Jacqueline Booth who has many years experience of working in the care sector and was qualified to NVQ level 4. In addition to Ty Canol, she was also the manager of another home, just a short walking distance away on the same area of Longford Court. Summary of inspection findings What does the service do well? Ty Canol provides a homely environment supported by a care team experienced in providing care for service users with complex needs. The team was focused on providing care for the service users as individuals, within a small group living setting. What has improved since the last inspection? The behaviour of the service users has been very settled in the past year, with no recorded incidents, confirming that the individuals are comfortable and settled in the home. What needs to be done to improve the service? a.) priorities There were no regulatory requirements made during this inspection visit. b.) other areas for improvement Should a new admission be made to the home the service user guide should be reviewed to provide a more succinct introduction. Inspection methods The inspection was carried out using the following methodologies: Two unannounced inspections. Page 1
Discussion with the registered manager, the senior practitioner and other target staff. Short conversation with one service user. 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: Ty Canol is registered by the Care and Social Services Inspectorate Wales (CSSIW) to provide care for a maximum of three male persons, between the ages of 18 and 64 years who have a learning disability. The home is part of the Neath service of the National Autistic Society and provides care and accommodation for three persons who have autistic spectrum disorder. The service users accommodated at Ty Canol at the time of inspection had been living there since it was first registered in October 2008. 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 Ty Canol was available to service users in an accessible format and copies were said by the manager to be held in the office for two of the residents in addition to one of the individuals holding their own copy. The manager said that this information was also available to service users families and their care managers. Whilst the 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 might be more appropriate for an individual to absorb in the event of any future admission to the home. This was discussed with the manager who had previously provided an additional adapted version appropriate for the individual being admitted to another 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. 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 3
Good practice recommendations: A more concise service user guide might be more appropriate for an individual to absorb in the event of any future admission to the home. Page 4
Individual needs and choices Inspector`s findings: At the time of inspection the three service users were male and aged between the early forties and fifties. They all had varying degree of need and ability to communicate with other people. On one day of inspection it was possible to speak to one of the service users who indicated that he enjoyed living in the home and on that day was looking forward to going to visit relatives and spending the rest of the day with them. The records of the resident spoken to were examined on the day of inspection. All records were securely stored in a locked cupboard under the stairs 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. This document was well constructed and gave details about the individual and could be taken to hospital in the event of emergency. The third file covered the essential lifestyle plan. This work was underway and not completed in the file examined. It was intended that this file once completed would avoid some of the duplication of information in other files. 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 user spoken to had attended and contributed to his review, as confirmed by the minutes. That had proven vital for his future as he had told the placing authority that he wished to remain in the home and did not wish to contemplate a move. 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. 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: At the time of inspection the service users had not indicated any religious preferences but it was said that they would be considered if requested. The manager said that they worked on the principle of the service users being encouraged to do things for themselves and getting involved in the operation of the home, rather than staff doing everything for them. This strong emphasis upon developing independence had resulted in the service users becoming far more settled in their home. The self assessment of service indicated that the service users were supported to shop in the community for clothing and other personal items. The staff supported these choices with picture cards for the service users with more limited verbal communication skills. Each service user had their own building society account for which the manager and senior staff member were appointees. Their weekly personal allowance and disability living allowance was paid directly into this account. The service users made decisions about how they spent their time in the home and each had a programme of activities. They all spent time in the day service attached to the Autistic Society. This was described by the manager as a college environment with small classrooms and vocational opportunities through gardening and making garden containers. When in the home there were occasions when the service users preferred to relax and not go out. There were activities planned daily and to support this they had additional staffing. On most occasions these activities were focussed on the individual and one service user enjoyed going to concerts. There were occasions when the three service users shared opportunities and they had a vehicle to transport them. The manager said that on a Saturday night they all shared a take-away meal and a few cans of beer usually watching television. The manager said that the service users had been offered holidays away but it was their preference to go on day trips and preferred not to stay away overnight. One of the service users had been asked if he wished to join the service users of another home on a holiday abroad, which he considered, but then stated that he had a fear of flying. One of the service users did stay with their relatives in the South of England a couple of times every year and the staff supported this by driving them halfway to meet them. The family of another family member spent their holidays in the locality of the home in order to spend time together. If they went out for meals staff would accompany them to provide additional support. One service user enjoyed listening to music and was able to do this in the former dining room used as a second lounge. He also had a cycle machine in this room which he used daily. The manager said that they try to introduce new activities for the service users but as they very much like to stick to their own routines there is limited success. The service users usually had their meals together in the large kitchen / dining room in the home. They operated a four week menu rota which was based on the known likes and dislikes of the individuals. One of the staff members completed the main grocery shopping weekly taking account of the menu. The service users were encouraged to help prepare drinks and meals and clear up after themselves. In the menu record book the staff also recorded fridge and freezer temperatures daily. Page 7
A visitors book in the hallway and access to the home could only be made via the locked security gate. The service users were supported to have visitors to the home and there was sufficient space to support this. Additionally, the service users also visited friends in the community. 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 8
Personal and healthcare support Inspector`s findings: Staff had a good knowledge of the needs of the service users living at Ty Canol. Service plans were based on care management plans and the registered manager reported that these were reviewed annually by the staff at the home and once a year as part of the statutory care management review. Care management reviews were normally held at the home when possible. The manager had recently 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 health care plans drawn up for the service users and all were registered locally with the general practitioner, dentist and optician. A chiropodist also visited the home every six weeks. Additional support from a psychiatrist was provided for one service user. None of the service users at Ty Canol 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. 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: At the time of the inspection the staffing establishment for the home was four staff, including the registered manager. The registered manager and two staff members worked full-time. The other staff were contracted to work between 17 hours and 32 hours a week. Target staff (additional staff hours) are employed on an individual needs led basis to support individual service users to attend external activities/appointments. The manager said that staff generally had access to a wide range of training. 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). Three staff had achieved national vocational qualifications (NVQ), two at level 3 and one at level 2 who was enrolled to complete the new CQC Diploma level 3. The registered manager had achieved NVQ level 4 in management and was registered with the Care Council for Wales. The self assessment of service indicated that bank and target staff all received the same core training as permanent staff and also received specialist training. 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 are provided with a getting it right from the start induction handbook and the manager arranges for staff to shadow shifts and be allocated a mentor. The registered manager reported that all staff members working at Ty Canol 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. Page 10
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
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. 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 user. The quality assurance report of the home was provided, dated July 2010. The organisation undertakes an Annual Adult Residential Review of the Neath Residential Service, which includes Ty Canol. The Autism Accreditation Report is designed to provide a concise and focused insight into the organisation s performance against accreditation standards. The questionnaires distributed by CSSIW to obtain the views of service users and staff that were returned had positive responses. Bi- monthly Regulation 27 reports were examined on the day of inspection and found to monitor the quality of the service provided. Due to the global economic climate the Local Authorities had been looking at a reduction in costs and in order for two of the service users to remain at the home with reduced fees some of the target activities had been reduced. This had been achieved with the agreement of all concerned and also with the agreement that some non-negotiable activities which impacted upon behaviour were maintained. 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
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. 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
The environment Inspector`s findings: Ty Canol is a house providing care for three individuals. The house had formerly been one large property and been converted into two homes to provide a more homely atmosphere. The house is on the outskirts of the town of Skewen and whilst on the edge of a residential area could not be seen from the main road. There was some public transport to the home but there was more than sufficient car parking to enable visitors access. The home was accessed via the main door which led into a small hallway. From this there was a large kitchen/dining room on one side, a former dining room now used as a second lounge and additionally a large lounge. Also on the ground floor there was a laundry, staff toilet and shower and a staff sleeping in room / office, along with several storage cupboards. On the first floor there are three large bedrooms each of which has an en-suite, two with baths and showers and one with a shower. There are also several storage cupboards on the first floor. The home having been recently renovated was in good structural and decorative order with domestic furnishings. It was said that curtains were also to be purchased for the home in addition to the blinds. The home had impervious flooring throughout which gave the impression of solid wood flooring. During the unannounced inspection of the home it was found to be clean, tidy, safe and welcoming. There were policies in place to manage infection control. Externally the property had large well maintained gardens and had a boundary fence with security code and intercom system for entry. A person was employed by the organisation to attend to maintenance issues in any of the houses. Each of the bedrooms was seen to be personalised by the service users with furnishings and bedding of their own choice. Each of the bedrooms contained the furniture required by the National Minimum Standards. The choice of lounge area enabled the service users to choose whether to listen to music, or watch the television. The second lounge also offered the opportunity for visitors to have private space with service users which did not impinge upon the other service users. The large kitchen had new units and more than adequate storage space with a fridge/freezer and dishwasher for the service users. None of the service users living in the home at the time of inspection required any adaptations due to individual personal circumstances. It was said by the manager that specialist facilities would be provided if required. The self assessment of service indicated that they conducted annual health and safety audits which were forwarded to head office for any actions to be identified. To support this they had regular meetings in the home and each home had a nominated officer. They had rots for the regular cleaning of the home and they had a pandemic protocol in place in the event of an outbreak of e.g. swine flu or nora virus. The manager said that there was an emergency disaster plan in place but this was not examined during the inspection. Page 14
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 15
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 16
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 17
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