Inspection on 20/03/08 for 2 Littlefield Gardens

This is the latest available inspection report for this service, carried out on 20th March 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

2 Littlefield Gardens 20/06/06

2 Littlefield Gardens 15/06/05

2 Littlefield Gardens 14/12/04

2 Littlefield Gardens 02/08/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Littlefield Gardens (2) 2 Littlefield Gardens Ash Guildford Surrey GU12 6LN Lead Inspector Christine Bowman Unannounced Inspection 20th March 2008 10:30 Littlefield Gardens (2) DS0000013462.V359518.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 Littlefield Gardens (2) DS0000013462.V359518.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. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littlefield Gardens (2) Address 2 Littlefield Gardens Ash Guildford Surrey GU12 6LN 01252 318968 01252 330869 N/A 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) Atlas Project Team Ltd Post Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be 30 - 50 years 17th November 2006 Date of last inspection Brief Description of the Service: Littlefield Gardens is a small care home accommodating three service users who have learning disabilities and whose behaviour is challenging, and are aged between 30 and 50 years. The home is situated in quiet residential cul-de-sac in Ash, near Guildford. It is managed and staffed by Atlas Project Team. T.A.C.T. (Thames and Chiltern Housing Association owns and manages the property). The building is single storey and comprises a communal lounge, dining area, kitchen and bathroom. There are three single bedrooms, one with an en-suite bathroom and a Snoozelam, relaxation room. Externally there is an enclosed rear garden with small patio and a garage to the front, which is used mainly for storage. A limited amount of parking space is available on the driveway and to the front of the property. The home is close to local amenities, including shops, library and pub and is well served by public transport. The fees at the home range from £1733.90 per week to £2728.63 per week. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over five and a half hours and was undertaken by Ms Christine Bowman, regulation inspector. The appointed manager, who was in the process of applying to be the registered manager for the home, was present all day to assist with the inspection process. The regional manager for the home was interviewed and kindly made herself available to ensure the smooth running of the home whist the manager was engaged. Another regional manger visited the home during the course of the morning and three staff were observed as they interacted with the clients and supported them in their routines and activities throughout the day. The Annual Quality Assurance Assessment (AQAA) had been completed by the manager and sent to the Commission for Social Care Inspection (CSCI) to show how the service had improved over the previous year and how the clients’ views were incorporated into all aspects of the running of the home including plans for the future. Other information recorded on the inspection record since the previous site visit was also taken into consideration. The Annual Quality Assurance Assessment (AQAA) recorded that, ‘we provide specialist care to people with complex needs and associated challenging behaviour. All the clients have more profound learning disabilities with little or no means of communicating verbally. The staff are trained to support the clients to live as ‘normal a life as possible’ and the service is designed and shaped by each individual person and tailored to them.’ Observations confirmed that the staff understood the clients’ needs very well and interactions were respectful and considered. The organisation took great care to ensure the consistency of familiar staff and care was also taken to ensure a visiting stranger did not upset the clients. A partial tour of the premises was conducted and a client allowed their bedroom to be viewed. Outcomes for clients in respect of the key inspection standards for Care Homes for Younger Adults were assessed and records were sampled including care plans, staff personnel files, medication administration records, maintenance certificates and accident/ incident and complaints/compliments files to confirm the welfare and safety of the clients was promoted. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 6 Thanks are offered to the management and staff of 2 Littlefield Gardens for their assistance and hospitality during the visit and to all those who completed surveys. What the service does well: What has improved since the last inspection? A requirement made at the previous site visit that the service review the practice of secondary dispensing of medication for planned and adhoc external activities was no longer relevant as the practise had ceased and all medication was administered at the home. Staff supervision sessions had been formalised and records were viewed in their personnel files to confirm this. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 7 New furniture had been purchased for communal areas including comfortable sofas and a dining table and chairs to enhance the environment for the clients and an individual’s bedroom had been refurbished according to their choices, which they had been supported to make Views of external stakeholders involved in the care of the clients and the clients’ relatives and representatives were gathered at formal review meetings and records were kept. These had been taken into consideration in the development of the service. What they could do better: 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. Littlefield Gardens (2) DS0000013462.V359518.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 Littlefield Gardens (2) DS0000013462.V359518.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): Standards 1,2 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Sufficient information is available for an informed decision about the suitability of the home with respect to the needs of prospective clients can be made. A full assessment of the clients’ needs and aspirations is carried out to ascertain the ability of the home to fulfil those needs. EVIDENCE: The three clients living at 2 Littlefield Gardens had resided there together since the home was opened, the appointed manager stated. There had, therefore, been no new admissions. Full information was available to prospective clients, their relatives/representatives and commissioners in the Statement of Purpose and the Service User Guide, which were viewed. Both these documents had been kept under review and contained all the information about the home necessary to enable a decision to be made about its suitability for prospective clients and as required under the Care Homes Regulations. Client files sampled included comprehensive needs assessments and it was clear from the documentation that the home carried out a process of continuous assessment to ensure that up-to-date information with respect to clients was available. Assessment formats in place for collecting information Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 10 from prospective clients included the recording of their ethnicity and religious belief in the personal information section to enable the home to be aware of any special needs arising from this information. The detailed assessment covered forty-one areas of behaviours in the residential setting and in the community, which were rated according to the level of independence of the prospective client. Areas included independent functioning with respect to selfcare and choice, sensory and motor development, money handling and shopping, language development, domestic activity, leisure interests and socialisation. The socialisation section highlighted areas of risk in interpersonal interaction. The admissions policy included assessment by a qualified member of the management team, visits to the home to ensure compatibility with existing clients, an overnight stay before moving in to confirm the clients’ care and support needs could be met at the home and for the client to be introduced to the staff and clients and to find out what it would be like to live there. Littlefield Gardens (2) DS0000013462.V359518.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): Standards 6,7,9 People who use the service experience excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Clients assessed needs and personal goals are reflected in their individual plans. Clients are enabled to make decisions about their lives with assistance as required and supported to take risks as part of an independent lifestyle. EVIDENCE: Care plans sampled had been reviewed regularly. Records confirmed that a review report had been completed prior to the review meeting to share with care management, relatives/representatives and professional. The report included the activities in which the client had participated over the previous six months and an update on the client’s health, educational and social achievements, which had been analysed on a weekly basis to ascertain the client’s level of participation in activities offered. One client had enjoyed a holiday in Blackpool and the appointed manager stated they, ‘had particularly Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 12 enjoyed riding on the trams.’ A photograph showed the client smiling as they stood beside a tram. Minutes of a review meeting of one client showed that the care manager, the regional manager for the company, the home manager and a clinical behaviour specialist had attended in addition to the client and a member of their family. The two client files inspected contained detailed care plans, which were individual and included self-help programmes. The care plans were written in a person-centred way and included the likes, dislikes and preferences of the clients with respect to their personal care and support. Levels of achievement were recorded, goals set and support was given to enable clients to reach their full potential. Behaviour guidelines included clear instructions to the staff of actions to take to avoid issues, which could potentially trigger undesired or anti-social behaviours. The three staff who completed surveys confirmed they were always given up-to-date information about the needs of the people they support and one commented, ‘I am always given up to date information at handover meetings and care plans are kept up to date. Communication support was in the form of a communication board for each client designed at their level of understanding and objects of reference enabled clients to make decisions by selecting words or objects to indicate their needs and wishes. Clients’ care plans included a ‘passport to communication,’ which gave important information to those working with them about their relationships, how they express themselves, and how they could be supported and enabled to understand. The staff, observed working with the clients on the day of the site visit, were very patient and kind in their interactions with the clients and supported them in a professional, sensitive and respectful manner giving encouragement and positive support. One client had been supplied with their own touch-screen computer. The AQAA recorded that, ‘one client showed an interest in using a touch screen computer at adult education class and in Dec 07 one was purchased for them and appropriate programmes had been acquired based on the individual’s ability’. The manager stated that the client had very limited access to the touch screen computer at the class they attended and it was clear from their response that it was something they really enjoyed. The computer was set up for the client in the dining room and photographs of the client had been downloaded and a video clip of the client’s mother reading poetry. Comprehensive risk assessments were viewed on clients’ files covering all areas of client involvement including personal care, self-medication, travel, epilepsy, holidays abroad and were individual to each client and signed by the staff to acknowledge their understanding. Risk assessments recorded potentially harmful occurrences and their likelihood and level of risk. Positive outcomes of taking the risk with benefits to be achieved for the clients were balanced with the negative outcome and risk probability. A risk response strategy was recorded for each potentially hazardous situation. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,15,16,17 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Clients are involved in the community, take part in appropriate activities, have their important relationships promoted, their rights and responsibilities in daily life recognised and enjoy a healthy diet. EVIDENCE: All the clients had their own ‘weekly planners’ showing their daily activities from getting up to going to bed. The AQAA recorded, ‘Set activities such as art class are included, as are general day to day activities which occur within the home to develop, promote and maintain life skills and also home entertainment such as games or crafts.’ Activity schedules identified three diverse individuals whose needs and interests covered a wide range involvement in the community, in the home and the ability to carry out selfhelp tasks. Community access include some adult education courses such as Art Venture, Line Dancing and computer lessons and sessions at the local Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 14 leisure centre for swimming. Throughout the home, artwork created at adult education sessions was displayed, enhancing the sense of self-esteem of the clients and valuing their creative endeavours. There were two large sculptures in the dining room, a ceramic name plaque on the outside wall of the home and framed pictures displayed on the interior walls. Activities in the home included cookery, aromatherapy and massage and completing tasks such as making a drink, tidying bedroom, loading the dishwasher, watering the plants, hovering and dusting. Other activities recorded included ‘girlie shopping and pampering’, walks, dives, bus rides, food shopping, train journeys, social evenings, visits to other homes and family, cinema, exercise and relaxation. The manager stated that there was flexibility in daily plans and that they were subject to change should the client wish to do so. Throughout the day of the site visit, one client was observed enjoyed having their nails painted by a staff member, another was playing a game and a third watched a film with familiar songs, which made them smile. Two of the clients had been out in the morning swimming and taking a trip to town. The home provided transport in the form of two hire cars to enable flexible access to the community. Family contact was promoted and one client was taken regularly to meet their mother for a meal out accompanied by a member of staff. When the client’s mother, who has mobility disabilities, expressed an aspiration to spend a day at the seaside with the client, a trip was arranged and a van hired to transport everyone including the necessary mobility aids for a day at the coast. The menu showed that the clients receive a nutritious and healthy diet, which is varied and appropriate to them. Pictures were used to support the clients in their choice of food. Records confirmed that one client does not eat solid food and a dietician had assessed their diet. Good records were kept of weight gain and loss and of the taking of food supplements. Fresh fruit was available in the kitchen and staff records confirmed they had received training in food hygiene. Care plans recorded the need for specialised eating equipment and the dining room provided a pleasant and comfortable place to eat with a large solid dining table, comfortable dining chairs and a view of the well-kept garden. The room was tastefully furnished well maintained and homely with potted plants and artwork displayed. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 15 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): Standards 18,19,20 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Clients receive personal support in the way they prefer and require, their physical and emotional health needs are met and safe systems are in place with respect to the administration of medication in order to protect them. EVIDENCE: Care plans gave clear information on how the clients preferred their personal support to be given. ‘This knowledge’, the regional director stated, ‘had been gathered through continuous assessment and the knowledge and experience of the staff working with the clients over the years and it provided an in-depth understanding of each individual’. A key worker system was in place to provide consistency and continuity, however, the manager stated that with such a small client group the staff were very much involved with all the clients. Clients’ preferences with respect to the gender of staff for support with intimate care were recorded and how the clients could be supported to make personal choices about what to wear. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 16 Records of appointments with healthcare professionals including General Practitioners, psychiatrists, speech and language therapists and routine appointments with dentists, chiropodists and opticians were viewed. The manager wrote in the AQAA that ‘any signs of ailments or distress were immediately acted upon and the relevant medical intervention was sought.’ A visiting aroma therapist had a regular appointment slot with two of the clients and they also benefited from a massage session each week. The manager pointed out that the sensory room offered ideal environment for relaxation and was used for therapy sessions. A good example of very effective healthcare was described in the AQAA involving the implementation of a support plan for a client in conjunction with a number of health and social care professionals including a dietician, a care manager, a psychiatrist and the organisation’s own behaviour therapists. Staff input was increased to enable the support plan to be carried out and the client’s physical and emotional health improved over a period of time and was reflected in their capacity for improved interaction with others. A requirement made at the previous site visit that the service review the practice of secondary dispensing of medication for planned and adhoc external activities was no longer relevant as the practise had ceased and all medication was administered at the home. The medication administration records of two clients were sampled. Records included a photograph of the client, a sample of the staff signatures and details of drugs returned to the pharmacy with the pharmacist signature to confirm receipt. All medication administered to clients had been double-signed to protect the clients. ‘The administration of medication is only carried out by staff after training and competency checks,’ the manager wrote in the AQAA. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 17 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): Standards 22,23 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home endeavours to ensure that the staff have a comprehensive knowledge of the clients and promotes their communication needs to enable them to make their feelings, wishes and views know so they may be acted upon. Complaints are dealt with promptly and systems are in place to protect the service users from the possibility of abuse, neglect and self-harm. EVIDENCE: Since the previous site visit one complaint had been received by the home and the Commission for Social Care Inspection had received no complaints on behalf of this home. The complaint, which was regarding the parking of cars in the private road in which the home is situated had been upheld and resolved well within the allotted timescale. The manager stated that he was in the process of developing relationships with the neighbours and there had been no new complaints for a long time. A complaints procedure was in place and a client friendly version with smiley and sad faces had been produced. However the AQAA recorded, ‘the clients are unlikely to be able to use the formal complaints procedures, therefore handover meetings are used to report any sign of client displeasure. Due to the staff knowledge of the clients, any problem, which cannot be communicated verbally, will be recognised in the clients’ reactions and dealt with in a prompt and appropriate Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 18 manner’. The three staff members who completed surveys confirmed they knew what to do if a service user /relative/representative had concerns about the home. The regional manager stated that, ‘an open culture exists at the home whereby the staff feel comfortable to raise concerns they may have’. The home held a copy of the most recent local authority guidance on Safeguarding Adults and staff records confirmed that the ‘protection of vulnerable adults’ training had been accessed within the first six months of employment. The manager stated he had been unable to secure a place on the Surrey local authority Safeguarding training but would persist in his efforts; however, he had attended the training provided by an adjacent local authority. Safeguarding Adults Alert information with details of how and to whom a referral should be made, including a direct contact number for Surrey was available to the staff in the form of a laminated card and also pinned on the staff notice board enabling staff to take direct action should they need to do so. The home’s local policy reflecting the local authority policy and procedures was not available for inspection and should be available to the staff informing them that if abuse is suspected, the authorities must be informed immediately and not, ‘at a suitably early stage’ as recorded in the AQAA. One safeguarding referral had been made by the home with respect to an allegation of theft from a client by a staff member. The staff member was suspended to protect the clients and left the company without notice. A referral was made to the Protection of Vulnerable Adults list but was declined due to the low value of the items. One client’s money was checked and the balance agreed with the record kept. Storage was safe and all transactions had been recorded and receipts retained to provide an audit trail and to safeguard the client’s interests. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 19 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): Standards 24,26,28,30 People who use the service experience excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Clients live a comfortable, homely and safe environment, which is clean and hygienic. EVIDENCE: The AQAA recorded that, ‘Littlefields is a three bed roomed bungalow, positioned in attractive surroundings and located in a quiet cul-de-sac’. The home was in keeping with the local environment and the style and ambiance of the home reflected its purpose, which was to provide a home for three individuals and enable them to access the local community and live as normal a life as possible. Parking was limited, but the manager stated that the staff park their cars in another road nearby when staff meetings are organised. A pottery name plaque on the wall of the house had been designed and executed by one of the residents, the manager stated, and pots of colourful plants by the front door gave the bungalow a well-cared for and homely feel. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 20 A partial tour of the home revealed that it was well maintained both externally and internally and that the shared accommodation consisted of a large sitting room equipped with three comfortable sofas, which had been purchased since the previous site visit, a wide screen television, DVD and video player and a selection of films and games. Plants, framed pictures, occasional tables, a fish tank with a variety of exotic fish provided interest and there was a pet cat in addition to the fish for the clients to care for. The lighting was domestic and consisted of attractive wall lights and a standard lamp. French windows led into the well-kept and colourful garden containing flowerbeds, a lawn and garden furniture including a hammock swing seat. The manager stated that the garden was well used in the summer months, that the clients enjoyed bar-b-cues and one of the clients enjoyed helping to maintain the garden. The dining room was accessed through an archway from the sitting room and also had a view of the garden and contained a music system with a choice of compact discs. A new dining table and chairs had been purchased since the previous site visit, the manager stated. Two of the clients’ communication boards were located on one of the walls, Easter pigs were displayed on the window ledge in various stages of preparation for the weekend celebrations and two large sculptures created by the clients at Adult Education courses stood on the floor. A client’s touch-screen computer was set up in this room and showed photographs of the client on holiday, involved in activities and on a day trip to the zoo. The kitchen was quite small but provided sufficient space and facilities to enable a client to be supported in the preparation of their meals. The manager stated that one client particularly enjoys cooking, that another client likes to make their own breakfast and that the clients had unrestricted access to the area. The kitchen was clean and well equipped. An environment health inspection carried out since the previous site visit had made no requirements and noted they, ‘were pleased to see up-to-date records of food safety checks.’ Shared accommodation also included a sensory room in which there were sensory objects, coloured lights, bubble tubes, a waterbed, music and mobiles for the clients’ enjoyment and to promote relaxation. One client allowed their room to be viewed. A new bed and bedroom furniture had been provided since the previous site visit and the client had been supported to make the choices, the manager stated. The bedroom was personalised, reflecting the client’s interest in transport and contained a collection of miniature vehicles, posters of trains and a bedside light in the form of a football. Photographs were displayed both of the client’s family and of a 70’s party, which had been arranged for them on their birthday. Photographs showed the guests and staff dressed in 70’s fashions. A digital photo frame, which automatically gave a slide show of photographs of the client’s family and of themselves to music, had been purchased for them. The manager stated that people from other homes had been invited to the party, that the gathering was between 20/30 people and that the client had smiled all day. It was clear from the photographs the client had enjoyed their special day. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 21 The home had an infection control policy and staff training logs confirmed they had received training in the prevention and management of infection. The position of the laundry facilities ensured that soiled linen would not pass through areas where food was stored or prepared and the clients’ weekly planners confirmed their involvement in the laundering of their own soiled linen. The home was clean and fresh. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 22 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): Standards 32,34,35,36 People who use the service experience excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Safe recruitment, excellent induction, training and staff support ensure that competent and qualified staff support the clients. EVIDENCE: The AQAA confirmed that 50 of the staff team had either achieved a National Vocational Training Qualification at Level 2 or above or were working towards one although five full-time staff had left the home’s employment over the previous twelve months. Three staff members, who completed surveys, thought there were always enough staff to meet the individual needs of all the people who use the service, and one commented, ‘ due to the nature of the needs of our clients, our managers ensure we always have sufficient staff on each shift to meet the clients’ needs’. All confirmed they always had the right support, experience and knowledge to meet the different needs of the service users with respect to equality and diversity. From observations made on the day of the site visit, the staff were accessible to and approachable by the clients, they treated them with respect and the Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 23 clients’ facial expressions confirmed they were comfortable with the staff. The regional manager stated that the senior management team were ‘hands on’ and available for support, but would also work alongside staff on shifts should this be needed. The personnel files of two staff employed since the previous site visit were sampled, confirming robust recruitment checks had been completed prior to their employment to safeguard the clients. The application form did not require gaps in employment to be explained, however, the manager stated that this was something that would be picked up at interview and that administration staff at the regional office also checked the authenticity of referees although this was not recorded. The organisation’s senior management supported with the recruitment process, but the home’s manager stated he was involved at the stage of short listing and interviewing prospective staff. Interview questionnaires with remarks were also included on personnel files and equal opportunities checklists had been completed. Three staff, who completed surveys, confirmed the employer had carried out checks, such as Criminal Record Bureau and references, before they started work and that their recruitment had been carried out fairly. The manager stated that after interview and before confirmation in post, prospective staff were introduced to the clients whose reactions were noted and that at one time an applicant was taken to the door by a client in a very decisive way. The staff induction programme was comprehensive and based on the Common Induction Standards and The Learning Disability Award Framework. The full programme covered the first working year and included ‘the caring role’, ‘meeting employer’s objectives’, ‘the care environment’, ‘professional’ and ‘individual development’ and led into an appraisal interview at the end of the first year. A record of the progress of the staff member was kept and signed off by the supervisor and the employee. Three staff, who completed surveys, thought the induction covered everything they needed to know about the job before they started very well and that they were given training which was relevant to their role. The three staff who completed surveys also confirmed the training given was relevant to their role, helped them understand and meet the individual needs of the clients and kept them up to date with new ways of working. The staff training matrix showed that fire training, first aid, health and safety, food hygiene, epilepsy management and awareness, autism, the protection of vulnerable adults, strategy in crisis intervention and prevention, the administration of medication, communication passport and Maketon had been undertaken by the staff. Many other areas significant to those working with clients with complex needs and associated challenging behaviour were included in the induction programme including behaviour management, assessment, report writing and equality and diversity. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 24 The three staff who completed surveys stated they met regularly with their manager for support and to discuss how they are working. One commented, ‘My manager meets with me every three months and we discuss the clients as well as my performance/ any problems I am facing and I am well supported.’ Records of staff supervision were viewed confirming the meetings had been formalised. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 25 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): Standards 37,39,42 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Clients benefit from living in a well run home where their needs and wishes are taken into consideration and where they are protected by safe working practises. EVIDENCE: Since the previous site visit, the registered manager and the deputy had both resigned and the present appointed manager had been transferred from one of the organisation’s other homes where he had been in post as deputy manager. He had been acting manager of 2 Littlefield Gardens from January 2007 until his official appointment in November and was in the process of applying to be registered with the Commission for Social Care Inspection. In addition to having extensive experience in the care and support of people with profound Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 26 learning disabilities and challenging behaviour, he had achieved a National Vocational Qualification at level 4 in Care and completed the Registered Manager’s Award (RMA). The regional manager explained the support system for the home, which ensured that a senior manager was always on call and could be on the premises within fifteen minutes. The manager stated that the organisation actively promoted the acquisition of appropriate qualifications to enhance career development for the staff. He stated that senior managers had accessed courses in ‘Applied Psychology in Challenging Behaviour and Learning Disabilities.’ The presence of a regional ‘hands on’ manager throughout the site visit ensured that not only were clients well supported at all times but the appointed manager was able to be directly involved in the inspection process. Regional managers had undertaken monthly quality monitoring visits and findings, including any required actions, were documented. In addition to this the manager confirmed that the views of clients, their relatives and external stakeholders were routinely sought as part of the regular review meetings. Positive comments recorded from a recent meeting indicated a high level of satisfaction with the home, the staff and the services provided. One relative stated, ‘my daughter has not been this well all round since she was a child. I am very grateful for the amount of effort the staff have put in due to her complex needs.’ The completed AQAA recorded the most recent maintenance dates for the testing/servicing of equipment and a random check on certificates confirmed safety in this area. Policies with respect to health and safety had been kept under review and records confirmed that the staff had accessed mandatory training. Accidents and incidents had been responded to and recorded appropriately. Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 27 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 X 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 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard YA22 Good Practice Recommendations Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Littlefield Gardens (2) DS0000013462.V359518.R01.S.doc Version 5.2 Page 30 - 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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