Inspection on 07/07/09 for Church Street Short Breaks

This is the latest available inspection report for this service, carried out on 7th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Church Street Short Breaks 28/11/07

Church Street Short Breaks 09/11/06

Church Street Short Breaks 25/01/06

Church Street Short Breaks 23/05/05

Church Street Short Breaks 16/11/04

Church Street Short Breaks 22/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOME ADULTS 18-65 Church Street Short Breaks 88 Church Street Golborne Wigan Greater Manchester WA3 3TW Lead Inspector Sarah Tomlinson Key Unannounced Inspection 7th July 2009 09:30 Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church Street Short Breaks Address 88 Church Street Golborne Wigan Greater Manchester WA3 3TW 01942 765411 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) Wigan Council Social Services Department (vacant) Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 Date of last inspection 17th November 2008 Brief Description of the Service: 88 Church Street is a small local authority care home, run by Wigan Social Services. It is registered with us (the Care Quality Commission) to provide care for up to four people who have a learning disability. The home provides a short-term break (respite) service. Currently 35 people use it, usually staying several nights during the week or for a weekend. In addition to 88 Church Street, Wigan Social Services short break service also comprises a ‘sister’ home, 13a Green Lane; plus 4 ‘respite’, short stay places at The Pines care home. 88 Church Street is a purpose built bungalow in Golborne, close to local shops and amenities. It is on a main road, with a small, grassed front garden and an enclosed patio area to the rear. There is a small amount of parking at the back, reached by an un-adopted road. There are 4 single bedrooms, each with a wash hand basin (no en-suites are available). There is a small lounge/dining room, a kitchen, an assisted bathroom and an assisted shower room. During the week, the home is usually unoccupied between 10.30am and 3pm (as service users are out and staff are not working). The manager is based at a separate office. The current fees (at July 2009), range from £71.39 to £121.39 per night. Social trips out are extra. A copy of our latest inspection report and an easy read summary is kept in the home. Church Street Short Breaks DS0000005730.V376392.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 this service experience good quality outcomes. Our inspection visit, which the home was not told about beforehand, took place over 1 day (lasting 9.5 hours) and was done by 1 inspector. (References to we or our in this report mean the Care Quality Commission). During our visit we met the 4 people (service users) staying at the time. We spent time talking with one of them and watched how staff cared for all 4 service users. We talked with staff (5 carers, the manager and her manager). We also looked around the building and looked at some paperwork. A further 2 service users and their families returned surveys that we had sent out before our visit (to find out as much as possible about what it is like at the home). Their views are included in this report. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year. It includes information about what they think they do well, what they would like to do better and what they have improved upon since our last visit. What the service does well: The home took a lot of time to get to know a new service user. This included finding out about the help they needed and giving them plenty of time to try out the home before coming for their first overnight stay. Information given to service users was helpful and clear, with pictures and easy to read writing. The home looked carefully at who could stay at the same time, to make sure everybody enjoyed their visit. The home made sure there was always plenty of staff to look after everybody. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 6 The staff team was small. This meant service users, their families and staff all got to know each other very well. Staff were kind, warm and friendly. One relative said “staff were caring and attentive”. The home was attractive, safe, bright and clean. Service users (and their families) could get involved. They could talk about their own care. They could also join groups that looked at how the home was run and how it might work better in the future. What has improved since the last inspection? The management situation had been sorted out, with the new manager now staying as the home’s permanent manager. This helped everybody know things were staying the same (with no plans for another new manager). The new manager, her manager and the staff team had worked hard to make the following improvements. People thinking of staying at the home (and their families) were now told how much it might cost. This was written in a helpful and clear way (with pictures and easy to read writing). Ways of making sure service users got the care they needed and wanted were working better. This included a new way of making sure all staff knew about the help a new service user would need. The key worker system was working again, helping service users get the care they needed and do the things they wanted to do. Medicines were also being looked after and given out properly, helping service users stay healthy and safe. Ideas for new social activities were still being tried, helping service users enjoy their stay. A new sensory garden and vegetable patch were about to be made. This will make the back yard look more attractive and give people the chance to do some gardening when they stay. There had been extra training and better support for staff. This made sure they were getting the help they needed to do their jobs well. The home had been thinking about a new law and had changed some of its forms to make sure it was doing the right thing. The new law made sure service users were not stopped from doing things unless it is really important to keep them safe. The home was finding out what everybody thought about it. This included a new way to help service users have a say. Answers were taken notice of. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 7 Both staff and relatives felt the management of the home was much better. Staff said things were more organised and they were happier at work. One relative said since the running of the home had improved “there is nothing I dislike”. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Church Street Short Breaks DS0000005730.V376392.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 Church Street Short Breaks DS0000005730.V376392.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their families benefited from continued improvements in the information they received. In turn, the process of gathering information about prospective service users was now more formalised, ensuring their needs and aspirations would be well met. EVIDENCE: A brochure (Service User’s Guide) told prospective service users and their families about the home and the service it provided. Good practice was noted, as this continued to be in a format many people with learning difficulties would find helpful and easy to understand (with pictures, photographs and easy to read, large print text). Since our last inspection, the home had responded well in ensuring prospective service users and their families also had clearer fee information. The current range of fees (from the lowest to the highest) was now in the brochure. The individual cost of staying in the home, whilst provided by Wigan Social Services finance department, was also now in the service agreement (which was in a meaningful and easy to understand format). Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 10 At our previous two inspections, we had identified minor changes were required to the Statement of Purpose (the formal description of the homes service). These had now all been made, apart from including the Responsible Individual’s details (name, contact details, relevant qualifications and experience), which were still needed. We looked at how 88 Church Street found out about the help and support prospective service users needed. The home worked hard to ensure their specialised needs would be met via a thorough assessment and a considered introduction. This ‘getting to know you’ process was personalised and flexible. On receipt of comprehensive referral information from Wigan Social Services, staff from the home made a series of visits with the prospective service user and their family (e.g. to the family home and day centre and then several visits to 88 Church Street) before a first overnight stay. At our last inspection, we had advised better record keeping of this process would provide useful information for the staff team, and evidence of what work had been done (enabling any identified issues to be followed up). Although no new service users had started using the service since our last inspection, a new comprehensive assessment form had now been developed to record the information gathered during this process. Good practice was noted, as stays at the home continued to be made with reference to a compatibility matrix. This identified any issues between service users and so guided bookings. Further good practice was noted, as the matrix was now formally reviewed at the end of each 6 month booking period, with input requested from the staff team. Church Street Short Breaks DS0000005730.V376392.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in one to one working and in monitoring the changing needs of service users meant they received good, personalised care. EVIDENCE: We looked at the care files of four service users’ care in detail. Improvements noted at our last inspection had been built on and omissions remedied. Files were in good order, with individualised and helpful information. This ranged from a brief ‘personal plan’, providing staff with a quick reference tool, to in depth and detailed information within a ‘support plan’. This latter document contained comprehensive information, ranging from a service user’s ability to manage money, cross roads and their hobbies, to personal hygiene, sleep and health and mobility needs. Previous improvements in the recognition of risk issues had been maintained, with comprehensive, Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 12 meaningful service specific guidance in place. The content of care documents consistently reflected the participation of the service user and their family. Good practice was noted, as to ensure care records provided staff with accurate, up to date guidance, a courtesy telephone call was made to service users’ families prior to each stay (to confirm any changes in support needs). However, we discussed the need to ensure information received was properly recorded and acted on, as mobility changes recently raised by one service user’s parent had not been reflected in their risk assessment or support notes. This had potentially left staff without clear guidance about how to meet this service user’s mobility needs during their stay. The home was also working hard to improve communication with families at the end of a service user’s stay, with the recent introduction of diaries (particularly for service users with communication difficulties). These diaries were completed by staff, giving details about the service user’s stay and then returned with them to the family home. This initiative will hopefully address one comment we received from a relative regarding a request for more information about how a service user’s stay had gone (e.g. their eating and sleeping). Service users (and their families) ongoing formal involvement in how they were supported had been strengthened with the re-establishment of the home’s 6-monthly review system. At our last inspection, this had broken down. Since then, the home had worked hard to ensure all service users had received a review of their needs, aspirations and goals (in relation to their stay at 88 Church Street). Good practice was noted, as this continued to be produced in an easy read, pictorial format as standard. An additional, more detailed and comprehensive format was also being trialled. Although these reviews could be combined with service users’ wider annual reviews with Wigan Social Services, they were usually held separately - allowing the focus to be on the service user’s stays at 88 Church Street. In addition, rather than a rolling programme, reviews were now held to coincide with the booking cycle. This allowed any issues to be acted upon quickly (e.g. future stays needing to take account of a compatibility issue or meeting a friendship group request). We discussed how goals identified by the service user during their 6 month review would be acted on and tracked over time (particularly when the person stayed infrequently). We advised some form of monitoring system was required to ensure they were realised (or attempted). The re-establishment of the review process reflected in part, the success of an active key worker system, as it was the key worker’s responsibility to organise. This system had also been in difficulty at our last inspection. Since then, the home had worked hard to re-establish staff members’ commitment and understanding of their role. This had included repeating an induction into the Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 13 home’s general policies and procedures, plus further team building and training days. We observed service users in control of their time at 88 Church Street making day to day decisions, and with staff support, carrying these out (e.g. going to bed early, choosing to lie in the floor). Staff had an excellent understanding of the help and support service users needed, and most importantly how they liked this to be provided. With regard to service users participating and influencing the running of 88 Church Street, the home worked hard to ensure a range of opportunities existed. These varied from the re-introduced six monthly internal review system (enabling input on an individual and personal level); to regular group meetings for service users; plus the service user and family/stakeholder consultation groups that had been introduced at our last inspection. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were enthusiastic and motivated, with service users benefiting from an improving range and frequency of social activities. EVIDENCE: During the week, service users spent their day away from the home, attending day centres, colleges and other social, educational and therapeutic activities. Service users left after breakfast and returned late afternoon. (As noted, the home was usually unoccupied and not staffed between 10.30am and 3pm). Good practice was noted, as staff were expected to support service users to pursue hobbies and interests, and also take part in ordinary leisure activities outside the home (which usually happened at weekends). Improvements noted at the last inspection, with regard to an increase in social activities, had been maintained, and were continuing. Staff were taking the initiative to plan Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 15 future activities. Recent activities included trips to Southport and a safari, plus more local bus trips. A lot of time and effort had recently gone into having an ‘Elvis’ theme birthday party for a service user, with themed décor, karaoke music and a staff member dressing up as the ‘king’ himself. The limited amount of communal space, with one small lounge/dining room shared by up to 4 service users and 4 staff members, continued to limit the type of social activities that could be provided in the home. The compatibility matrix, which considered the impact service users had on each other (including physical space required), helped alleviate this impact. Families and friends continued to be welcomed. Daily routines were flexible, particularly at the weekend. As noted, service users were encouraged and supported to make decisions, e.g. what time to get up and go to bed. Where able, service users were given a key to their bedroom and encouraged and supported to use it during their stay. With regard to meals, shopping and food preparation was the responsibility of staff, who had all received food hygiene training. There was no fixed menu, as staff prepared meals based on the preferences of the service users staying at the time (with often up to four different meals provided at one sitting). Good practice was noted, as staff supported service users to eat in a discreet, individual and patient manner. Meals were a social occasion, with staff eating with service users. Although a lack of space prevented this at times. In line with the National Patient Safety Agency’s recent guidance asking all care homes to ensure staff can deliver effective first aid, in particular the management of choking; Church Street staff confirmed they had completed appropriate training. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support was provided in a caring, respectful and individualised manner. Improvements in medication record keeping and staff training, plus flexible support packages, ensured healthcare needs were well met. EVIDENCE: Due to their complex and specialised needs, most service users were unable to tell us what it was like to stay at the home. Consequently we spent time watching how staff spoke to and cared for service users. Staff were warm, considerate, patient and respectful. Staff also actively listened to service users and responded to those who used non-verbal communication. We received feedback from two relatives, who both felt people who stayed at the home received a good service. One person wrote “staff were caring and attentive”. The second person said “everything was done well…nothing needed improving”. Seven compliments had been made by relatives since our last inspection. These included comments about how much service users had Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 17 enjoyed their stays; how one person could not stop talking about their stay and how service users were asking to come back. The home also received formal feedback about staff support through surveys sent to relatives. Fourteen had recently been returned, with consistent views regarding the good quality care provided. Residents’ health was promoted and maintained, with improvements in medication practices. The majority of staff had completed additional medication training; handwritten medication administration records (MARs) were now being checked and countersigned; and the design of the MARs had been changed to create more space (all reducing the risk of error). At our last inspection, we had also advised designated space was created on the MARs to record the balance of medicines on admission and discharge. This had not yet been done. We were told a major redesign of the MARs was due (for all Wigan Social Services learning disability services) which planned to take account of this recommendation. We also discussed the new practice of storing service users’ money in individual medication cupboards. The management team was aware this should not occur and explained it was temporary whilst awaiting new separate lockable space (e.g. lockable drawer). Good practice was noted, as the home had recently taken a responsive and innovative approach to meet the changing health care needs of one service user. Through good partnership working with a day centre, a new physical condition had been supported and managed by the home providing temporary day care (plus additional overnight stays). We discussed the information kept by the home about service users’ epilepsy. This was generally comprehensive and helpful. Although for one service user who had a regular pattern of seizures, there was no record of whether any had occurred when they were at the home (and not been referred to in their six month review). Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for protecting service users from abuse or harm were in place. A proactive approach ensured new legislation had been acted on, further strengthening this system. Improved confidence in the (new) management team meant relatives felt concerns would be taken seriously. EVIDENCE: Information about how to make a complaint was in the home’s brochure. This was provided in an appropriate easy read, pictorial format, enabling as many service users as possible to understand it. The complaints procedure was not displayed around the home, in order to promote a more homely and domestic setting. Service users’ awareness of how to complain (and whether they had any complaints) was confirmed during their six monthly reviews and also in service user surveys (conducted by an independent advocate). At our last inspection we had been concerned to find complaints were not being properly recorded, with any clear indication they had been properly investigated, acted upon and learnt from. The service’s own survey had also found relatives either had not or did not feel they would be listened to if they raised queries or concerns. At this inspection, results from the recent relative survey showed greater confidence in the (new) management team. In contrast to last year’s survey, no negative comments were made regarding a lack of response from the manager or staff. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 19 No complaints had been received by either us or the home since our last inspection. The home had kept a record of a booking error. This had been quickly corrected, with an apology made to the family concerned. Steps had been taken to ensure this situation did not happen again. No safeguarding alerts had been made since our last inspection. The home confirmed all staff were trained in abuse awareness, whistle blowing and safeguarding adults. With regard to money held on service users’ behalf, this was being stored safely and securely (although as noted, it should not be held with medicines). Appropriate records were kept. Good practice was noted, as the manager audited these before they were archived. We checked one cash balance at random and found this to be correct. We discussed the recent introduction (from the 1st April 2009), of the Deprivation of Liberty Safeguards (DOLs), which include a new specific legal role and responsibilities for managers of care homes. Good practice was noted, as the service had recognised the importance and impact of this new legislation and had responded proactively. The manager and her line manager had both attended formal DOLs training, with the staff team receiving informal local training (with further formal training planned). Care documents had been revised to have regard of the new legislation (e.g. assessment and review forms). These now considered whether there were any restrictions placed on the service user’s choice and freedom. The home confirmed no service users currently experienced a deprivation of liberty. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements and imminent changes ensured the home continued to provide an attractive, comfortable and safe place to stay. EVIDENCE: The home was attractive, bright and welcoming. There was a good standard of décor and furnishings, which were domestic and ordinary in style. Although the kitchen was not designed for wheelchair users, there was a range of adaptations in the rest of the home, including lowered light switches, raised sockets, an assisted bathroom and an assisted shower room. Two bedrooms had rise and fall beds, the third had a double bed and the fourth a large padded headboard. There was level access to both the front and rear of the home. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 21 Since our last inspection bedroom furniture had been repaired. Its appearance and usability had improved, with numerous missing handles replaced. Wigan Social Services had just released budgets for this financial year, with agreed funds to replace bedroom furniture; a much worn vanity unit in one bedroom; and provide flat screen televisions in bedrooms (the latter at the request of service users). Bedrooms were going to be further improved, with their layout and design reviewed. With regard to communal space, as noted at previous inspections, the lounge/dining room was quite small. Although the compatibility matrix considered the spatial needs of service users, this area could become cramped (with four service users, some of who may be wheelchair users, and up to four staff present). Regarding outside communal space, significant improvements were about to take place. Staff had organised for the Probation service to create a new sensory garden and vegetable plot. These will be attractive and useable resources. Requests had also been made to local garden centres and shops to provide appropriate plants. We discussed how wheelchair users could enjoy the new garden space (e.g. having an accessible work bench and adapting the current garden table to allow wheelchair users to sit at it). The home was clean, tidy and smelt fresh. Care staff had some domestic duties, with a cleaner also working 2 hours each weekday evening. Church Street Short Breaks DS0000005730.V376392.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good staffing levels protected service users. Improvements in staff training and support systems further strengthened this (and also benefited staff). EVIDENCE: The home had plenty of staff available at all times to support individual service users. There was a minimum of 2 staff during the day and night. This regularly rose to 3 or 4 during the day as some service users’ required 1 to 1 support. During the night there was a minimum of 1 waking night staff and 1 sleeping day staff. This regularly increased to 2 waking night staff for those service users who required 1 to 1 support at night. Good practice was noted, as shift patterns supported staff communication, with a paid handover between day and night staff. Since our last inspection, to make best use of staff time, this handover had been reduced to 30 minutes (from 1 hour). Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 23 Service users continued to benefit from a small staff team of 7 day staff and 3 night staff, plus 1 additional bank staff. After a period of considerable change noted at our last inspection, the staff team had now remained stable. At our last inspection, we had concerns about inadequate staff training and staff support. At this inspection, we found the management team had worked hard to address these shortfalls, fostering a supportive and competent staff team. As noted, all staff had taken part in several training sessions/away days. The aim was to re-establish commitment and understanding of their individual and team roles. This had included training on the disabilities and specific conditions of service users; key working; and a re-induction to the home’s main policies and procedures. An up to date staff matrix now identified staff had also completed their annual moving and handling and safe working (including fire safety) refresher training. This also showed staff had completed medication training and had been nominated for refresher training in autism awareness; epilepsy; and in challenging behaviour. One staff member had also had the opportunity to shadow the manager; gaining insight and experience of a more senior role. Staff were now receiving regular individual formal supervision and team meetings were regularly held, including some with an evening start time to help night staff to attend. The re-establishment of these support and communication systems were of particular importance for staff who worked without direct supervision, supporting people with complex and specialised needs. Staff felt the team was now working well together, one person commented it was like one team now, rather than ‘us’ and ‘them’. The format of annual appraisals had also improved. In addition to personal goals, performance was also now reviewed against service specific targets (e.g. key working). These targets linked with those set for the management team, helping to ensure planned improvements were realised (e.g. the reestablishment of six month review system). With regard to NVQ training, the home had improved upon previous good practice. Apart from the bank staff member, all the other 10 members of staff had now attained at least an NVQ level 2 care award, with 3 also having now attained the level 3 award. Wigan Social Services commitment to achieving training above our minimum standards remained evident with a further staff member now accepted onto the NVQ level 3 award and another staff member nominated for it. The NVQ level 3 award, rather than the level 2, is more suited to the work and responsibilities of the home’s staff team. Staff recruitment records were held centrally at Wigan Social Services’ head office. A sample of these was looked at during a visit by two of our inspectors in August 2008. These were in good order and in the main, evidenced that the appropriate checks and information had been gathered prior to new staff starting work. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 24 The new bank staff member was completing their formal induction. This had included Wigan Social Services formal induction course, plus shadowing staff at the home and working through the home’s policies and procedures with the manager. Once completed, the manager planned to review the success of this induction with the new bank staff member. We again advised the home to consider introducing a more structured induction programme to make best use of the shadowing period provided. This would be particularly helpful due to the specialised and often complex needs of the home’s service users, many of whom had communication difficulties. Church Street Short Breaks DS0000005730.V376392.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new management team had consolidated and built on previous improvements. Service users and staff now benefited from clear, positive leadership and a home that was now well managed. This will be strengthened by more consistent fire safety checks. EVIDENCE: The Registered Manager post at the home has been vacant for over 2 years (since 2/1/07). A new permanent manager had been appointed in December 2007, but had not worked in the home since June 2008. Mrs Jennifer Mills was now the manager. Mrs Mills had managed the home since 7th July 2008. She had initially retained responsibility for its ‘sister service’, 13a Green Lane, Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 26 where she was the Registered Manager. This was relinquished on 25th August 2008, enabling her to focus solely on 88 Church Street. Mrs Mills had since been confirmed as 88 Church Street’s permanent manager. She was currently in the process of submitting her application to us to be the Registered Manager. This was received shortly after this inspection, but returned as some required information was missing. Mrs Mills has extensive experience in the learning disability field and had been involved (as manager of 13a Green Lane) in originally setting up the short break service 10 years ago. Mrs Mills has an NVQ level 4 in management and the Registered Managers Award (NVQ level 4). At our last inspection, previous concerns we had about a lack of clear, positive leadership had started to be addressed. With the new manager, Mrs Mills, and her new line manger, Ms Michelle Campbell, improvements were being made and service users and staff were starting to benefit from a better run home. At this inspection we found further considerable improvement in how the home was being run. There were notable achievements from the management and staff team (e.g. the re-establishment of the 6 month review system for all service users; completion of a new training schedule to help build skills and confidence). Serious incidents were now being reported to us. There was also a warm and positive atmosphere. Staff motivation had improved. We received consistent feedback from staff that things were better; more organised. One staff member commented there was now a sense of direction. A second staff member said the home was a happier place to be. A third person commented how things were fairer (regarding how overtime was offered and how it was decided who supported service users on weekend social trips). A fourth staff member explained they now had confidence in the management (which they had not in the previous team) and felt able to approach them if necessary. As noted, confirmation of a general improvement had been shown in the home’s own recent relatives’ surveys. In comparison to last year, no concerns were raised about poor management or organisation. One relative had written “the administration of the service has improved therefore there is nothing I dislike”. At previous inspections we had discussed the need for the manager (who was not based at the home) to have more of a presence, in order to provide day to day support and monitor care practices. Although managers would visit the home on a daily basis, they did not regularly work alongside staff during weekday evenings and at weekends. At this inspection, we found Mrs Mills was now regularly working a weekly evening shift, enabling her to observe care practices and provide a more hands on, supportive and coaching role. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 27 We were impressed with how the home had developed its quality monitoring systems. As noted, surveys were now being regularly sent to relatives; the new wider ‘Short Break Service’ relative and service users consultation groups were continuing to meet; and service users meetings were held. A senior manager carried out formal monthly unannounced quality monitoring visits. Further good practice was noted, with regard to gaining feedback from service users (in addition to 6-monthly reviews and group meetings). Since our last inspection, the home had organised for a paid independent advocate to carry out 1 to 1 surveys with service users. The advocate was a user of other Wigan Social Services learning disabilities services and carried out the surveys away from 88 Church Street. This person was paid for their work. The results of these surveys were currently being compiled. The manager confirmed initial feedback seemed positive. Further good practice was noted, as the views of stakeholders were also now being formally sought. Eighteen different in house and external agencies and groups had recently been contacted. Again initial feedback seemed positive, with one comment about good partnership working. A concern about some difficulties in contacting managers was to be addressed by internet and email access installed at the home. Further stakeholder feedback was going to be sought on an ongoing basis; after each interaction. At previous inspections, we had concerns about required records not being on site, plus 3 missing service users’ confidential files. At this inspection, records were correctly held at the home. As noted, they were in good order. With regard to safe working practices, prior to our inspection, the home had provided details (in the AQAA) showing all safety and maintenance checks were up to date. During our inspection we looked at records about accidents; maintenance of the hoists; and about fire safety. These were generally satisfactory. At previous inspections, we had serious concerns about weekly fire safety checks not being carried out and fire drills not being held. These omissions had been rectified at our last inspection and had generally been maintained at this inspection. However, we found the frequency of weekly fire safety checks was inconsistent (with only monthly checks in 12/08, 1/09, 3/09 and 4/09). To ensure the safety of service users, staff and visitors, these must be carried out on weekly basis. Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 28 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 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 4 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 4 4 X 3 2 X Version 5.2 Page 29 Church Street Short Breaks DS0000005730.V376392.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation 23 (4) (c) (iii) (v) Requirement To ensure the safety of service users, staff and visitors - the fire alarm and means of escape must continue to be checked each week. Timescale for action 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Church Street Short Breaks DS0000005730.V376392.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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