Inspection on 19/02/08 for Foxlydiate Mews, 1

This is the latest available inspection report for this service, carried out on 19th February 2008.

CSCI found this care home to be providing an Excellent 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

Foxlydiate Mews, 1 08/01/06

Foxlydiate Mews, 1 15/07/05

Foxlydiate Mews, 1 21/12/04

Foxlydiate Mews, 1 08/09/04

Foxlydiate Mews, 1 30/03/04

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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 Foxlydiate Mews, 1 1 Foxlydiate Mews, Lock Close Batchley Redditch Worcestershire B97 5LQ Lead Inspector Sue Davies Unannounced Inspection 19th February 2008 14:30 Foxlydiate Mews, 1 DS0000018489.V358857.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 Foxlydiate Mews, 1 DS0000018489.V358857.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. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foxlydiate Mews, 1 Address 1 Foxlydiate Mews, Lock Close Batchley Redditch Worcestershire B97 5LQ 01527 60482 01527 61840 julie.southern@nft.org.uk www.hft.org.uk Home Farm Trust 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) Mrs Gail Ann Beasley Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: learning disability (LD). The maximum number of service users to be accommodated is 5. 2. Date of last inspection 9th December 2006 Brief Description of the Service: 1 Foxlydiate Mews is a modern, purpose built establishment in a residential area of Redditch, Worcestershire. The property is close to the town centre. The home provides a respite care service for younger adults who have a learning disability and some of whom may have a physical disability. The main aim of the service is to offer planned respite care for up to five individuals at any one time between the ages of 18 - 65. The service offers planned short stays to a maximum of 5 people at one time out of a group of 40, and all the places are funded by Worcestershire Adult and Community Services. The service is open 51 weeks of the year closing only over the christmas period. The home aims to promote a philosophy of care that recognises and responds to the individual rights and needs of service users. The property is owned by Bourneville Village Trust, and is leased to Worcestershire County Council, who is responsible for maintenance. The registered providers of the service are Home Farm Trust Limited, (HFT), whose head office is in Bristol. The responsible individual is Mrs Mina Malpass. HFT provide care services nationally to individuals with learning disabilities and their families. The registered manager at the time of writing this report is Gail Beasley. Weekly fees for this service were unavailable at the time of this inspection Foxlydiate Mews, 1 DS0000018489.V358857.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 3 star. This means the people who use this service experience excellent quality outcomes. This was a routine, unannounced key inspection that took place through the afternoon and early evening on one day in late winter 2008. Time was spent preparing for the inspection by reading previous reports, the service history and record of contact with the Commission, and documentation provided by the service. Five hours were spent meeting the manager, staff and service users, viewing the home, observing the process of care, and looking at action to meet previous requirements and recommendations. Documentation at the home was sampled including care records, information about staffing including staff training, and policies and procedures relating to the maintenance, health and safety of the home. The hospitality, time and assistance offered by the manager, staff and service users during the inspection was welcomed and much appreciated. What the service does well: Guests have a welcoming, warm and comfortable house to stay in. The home is well looked after, pleasantly decorated, comfortable safe and clean. It has lots of space and things to do, and the right equipment for people who have special needs. There is lots of information to let new guests know what the service is like, so they can choose if they would like to stay. The information is written with pictures and symbols so guests can understand it. There are lots of pictures and symbols around the house so guests know what is going on each day of their visit. Staff have communication training so they can talk to guests and support them to make themselves understood in their own way. The manager and staff work hard to make sure guests enjoy short visits that suit them well. They ask guests what is important to them and help them plan their time. This is so they can enjoy doing new things if they want but so the visit also fits well with their regular lives. Guests can ask to visit at the same time their friends do and staff will arrange this if they can. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 6 There is a full staff team. Most staff have been working here a long time so everyone gets to know each other well. This means service users can trust staff to understand them well and how they want to be supported. The manager and staff are trained and experienced, and the home is well run. There are careful checks before new staff start work to make sure they are fit people to work here. Staff are properly trained and know what they must do to help people keep safe. Guests say they like the staff and trust them to support them well. Care records are very carefully written, with lots of important information. Guests’ plans and reviews are written with symbols and pictures they can understand more easily so they can really take part. Guests join with their link workers to write their plans. The plans say in their own words what is important to them. What has improved since the last inspection? The new manager is qualified and experienced. She has worked hard to put right all the things asked for at the last inspection, and then make things even better to make sure guests have a really good service. The providers have changed some things about the way they organise the service. This is making a big difference as these things make it easier for the manager to do her job well. One very important thing is that there are enough staff. Staff training is better managed to make sure all staff understand guests’ needs well and learn the special support skills to help them. Staff have training passports showing how well they are doing with their training. The service will soon have all its staff trained to the National Vocational Qualification in Care level 2. This is very commendable. The manager now has a clerical assistant to help with some of the work about organising how the home is run, especially records. This has given her more time for managing the way the service develops, and making sure staff have good supervision and support. This helps make sure staff know what is needed to do their job well and support service users in the best way. These are some of the things the manager has done : Information about the home and the complaints procedure have been brought up to date and written in a form guests can understand more easily for themselves. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 7 There are always enough support workers on duty to give guests individual time for the things they want to do. Each guest has a named link worker, to plan with them and make sure all staff know how they want to live their lives. Service user plans are written with the guests, and being reviewed about every six months. The way the plans are written has been changed so that they make good sense and are easier to read. All the information is up to date and much clearer. The service user plans include guests’ life plans written from their own point of view, in a style they can understand easily using symbols pictures and photos. The plans show how guests understand and deal with everyday risks. This helps them plan activities with their link worker, so everyone can help them manage the risks safely and be as independent as possible. Their link worker helps them manage reviews too to keep their support information up to date. Each review is now written in a person centred way too using symbols and signs the guests can understand, so they can see it for themselves. Staff are being trained in total communication and any special communication methods guests use, so that they can talk properly to each other and guests are not isolated when they visit. Staff use pictures and symbols guests can understand so they know what is going on, what to expect and what they can do when they visit. There are lots of key symbols used now to help guests say what matters to them and make decisions of their own. The way the service handles guests’ medication is now written in a medication policy. The policy shows what the Royal Pharmaceutical Society says is the right way to do things. Medication is properly stored and carefully managed. All this is properly recorded so no mistakes are made. The manager has shown families that staff need clear information about how medication is to be given, to make sure there are no mistakes. This means staff now have up to date clear written information every visit about each guest’s medication, so this has got much safer for all guests. An important step is that guests are assessed to see if they can understand about managing medication. This means some guests are being supported to manage their own medication now. Quality surveys have been sent to service users and their families to find out what they think of the service. These show most people are pleased with the service, and the replies also have some useful suggestions to make things even better. There is a report showing this. It would encourage everyone if the report included what the service is going to do about suggestions to keep on making things better. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 8 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. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 9 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 Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 10 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): 1, 2 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. There is helpful information about the home that new people can understand easily. The service has good ways to find out about what new guests need, so it can decide if it can support them properly. Everyone has a contract that tells people their rights and responsibilities when visiting. EVIDENCE: The service now has new and better ways of finding out what support new guests will need and what they like to do (their needs assessment), to make sure it can do the right things to make their stay a good one. People who are thinking of using the service now have good information about the home to help them decide if they want to visit. These things help everyone make the right decision about whether they can stay here. The statement of purpose, service users guide and contract have been changed so they say what the service is like now. They are written with pictures so guests can understand everything clearly. Guests can see the statement of purpose and service users guide in the hall when they come in, and they are given their own copy. They all have a copy in their records in the home too. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 11 The contract respects service users. This is because it says what the service will do for them when they come to visit and it shows they have responsibilities too. The service is thinking about other ways to help guests understand the users guide and contract better. The manager thinks one way might be for guests who stay here now to make a video saying what it’s like for them. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 12 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): 6, 7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Service users plans give good information about the support they need and the things they like. They are up to date and easy to use. They are written from the guest’s point of view. The plans help guests play a bigger part in decisions about their own lives on their visit. The plans help staff talk to guests’ other supporters about helping them live a good life. EVIDENCE: Service user plans have been redesigned and brought up to date. The record system is called the Support, Plan, Assessment and Recording system (SPARS), and staff are all being trained and supported to use it well. Guests work on their plans with their link workers. Plans are built up from the information about support guests need (their needs assessment) and written from their own point of view. They bring together information staff need to Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 13 know during their visit as well as important details about other areas of their life. The plans are easy to use. Staff have been shown how to write the best kind of records for short visits. They are given enough time to make sure records are clear and kept up to date, and are well thought through. This means guests can be sure all staff working with them during a visit will have their most up to date information. The way the service helps guests deal with everyday risks has got much better. The plans have up to date information about how guests understand and deal with everyday risks. They are written to help guests plan with their link worker how to make more decisions for themselves and be more independent. Guests talk to their link worker about things they would like to do and any support they would need. This can include learning new skills they might need to keep themselves safe. The service is doing some very good work to help guests learn new things that help their regular lives. Plans show goals guests have agreed with link workers and work on during their visits. For example one guest wants to be more independent and is learning to cook. She was cooking the main meal for the other service users on the evening of the inspection. Another guest lived a long way away but needed his mother to take him to his day centre. This meant he could only stay overnight. Staff helped him learn how to get to his day centre by himself. This means now he can have longer visits. Another important thing staff do to help guests is about communication. Staff are being trained to help explain things in ways guests can manage and understand better. Better ways to help guests understand more about how things work means they can make more decisions for themselves. Foxlydiate Mews, 1 DS0000018489.V358857.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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Guests can choose from a variety of things to do at home and in the community. They are supported to keep up with their usual life if this is important to them, although they don’t usually have families visit as this is a respite time. Transport arrangements are getting much better so all guests can get out more than before, even if they need special transport. Guests are supported to choose and help with meals and healthy eating is encouraged. EVIDENCE: Guests can now enjoy more activities individually and with other people during their visit. This can be at home or out in the community, suited to their age and interests and giving them the chance to try new things. Link workers help them plan how they want to spend their time during each visit. An example of how they use community resources to do this is through St. Benedict’s, Where Next and Redditch day service social events. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 15 Guests enjoy meeting friends who are also visiting when they come to stay, and as far as possible they can choose visiting times when friends will be staying. Guests generally live with their families, so their visits do not usually involve family contact as the purpose of the visit is a respite break. During the inspection guests were busy doing different things, this included art with a visiting art therapist, shopping, cooking and listening to music. They also told of other activities they enjoy and are planning such as reading and watching DVDs, swimming, ten pin bowling, trips out such as to the Think Tank and Cadbury’s World, cinema, music therapy, making music, using the home’s sensory room, going out for meals and to the pub. Staff support them to keep up with regular activities, clubs and friends if they wish too. Going out is much easier now the service has better transport. It can borrow an adapted vehicle suitable for people who need mobility help, from another service that uses it less at weekends. The service hopes to purchase its own vehicle so as to extend weekday activities. This means previous transport difficulties for service users who use a wheelchair are being overcome, so they can get to a range of activities outside the service much more easily. The service is expanding ways of enabling service user choice and inclusion, and is considering how assistive technology may be used. Meals are planned with guests as much as possible although short stays can make it hard to plan far ahead. Meals are cooked at home from a wide range of healthy ingredients rather than ready meals. Staff encourage guests to be involved in planning shopping and preparing meals themselves each day, so they learn new skills and have as much choice as possible. There is good information in pictures and symbols to help everyone make their own choice. Foxlydiate Mews, 1 DS0000018489.V358857.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Guests have the support they need in the way that suits them. Good communication is valued and promoted, and staff take good care to make sure they understand and support guests’ physical and emotional needs well. There are sound and effective procedures for the safe handling of all aspects of medication, and where possible guests are supported to manage their own medication. EVIDENCE: There is a sound approach to personal and health care, and some excellent practice noted. Talking with staff shows the 37 people who use the service can be confident staff know and understand them well. Guests spoken to confirmed they feel staff listen to them and support them as they wish. Staff work with guests in a person centred way and recognise the need to involve not only families but also colleges, day services, and places of Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 17 employment when guests visit, to achieve a service that is right for the individual and has continuity with their regular lives. Guests need different levels of support, from help with all aspects of personal care to guidance and support towards independence. The service has aids and adaptations to meet the needs of people who require additional support to assist mobility or health related needs. Individual needs assessments make sure that equipment is suitable to meet the needs of users. This equipment is well maintained, monitored and reviewed through risk assessments involving community health professionals as necessary to ensure safety in use. Guests’ personal needs and wishes are carefully recorded in their plans. These show they are all treated with dignity and respect as individual people and this was observed in practice. Guests enjoy individually planned visits where they are supported to pursue goals planned with their link workers. For example one guest wanting to live independently is setting specific goals with support staff. Someone has learned to travel more independently. Another service user visiting at the time and anxious at a longer than usual stay away from family, was being treated with skilful, kind and patient understanding to allay these worries. Good care practice is supported by very sound records. They are well designed, for good communication between guests and staff and also between service staff and family carers. Staff know it is very important to communicate well with families about supporting guests in the best way for them. For example before a visit time is dedicated to capturing current information about guests’ health, well being and activities. Individual communication diaries support guests to share information with parents and day services about visits. It is particularly notable that staff time is specifically allocated during the day to recording, so all staff contribute to records, review and plan support together. Staff also telephone families to keep in touch, and encourage families to phone them too. These things really help good continuity of care and support. The careful approach to managing day to day risks and developing new skills is seen as essential to all areas of support, and benefits guests and also their family carers. Staff talked about how this is beginning to give families more confidence about helping guests take more responsibility for themselves. Guests’ communication needs have now been properly assessed so they can get the support they need to understand what is going on and make their own Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 18 views known. All staff are being trained in total communication, and they are already actively using these techniques throughout the home. For example, service users are expressing more choice and decisions for themselves using key cards illustrating key words and concepts. Photos are displayed everywhere, used to illustrate the many and varied activities guests take part in but also used as communication. This helps guests to know what is going on, which staff are on duty, meals of the day, and procedures they need to know about. When they know what to expect, guests have a better chance of choosing how to spend their own time. Positive feedback has been received from the NVQ assessor, who commented on the person centred nature of the service and high standard of communication between staff and service users. Guests’ health needs are assessed, and vital information about their health is kept up to date with information family carers supply at each stay. This is regularly reviewed. Although this service does not have the main responsibility for helping guests manage their health, this assures them their health care will be looked after and that the service can deal in the right way with health emergencies during a visit. Information about health that becomes apparent during a visit is shared with family carers. The government says in ‘Valuing People’ that people with learning disabilities should have more say in their health care. They want everyone to have a health action plan. Although health action plans help service users plan for their own health care and keep a health record, guests here do not always have them. The new manager thinks that as guests’ health care is shared with different carers, health action plans would help continuity and consistency. She brings valuable links with learning disability community nurses, and is already using these to strengthen liaison with healthcare professionals. This should help guests by improving the way everyone shares responsibility for their health care, and she hopes this would encourage more families to think about using health action plans. Requirements and recommendations were made at the last inspection to improve the way medication matters are managed. These have all been followed. Staff have up to date medication training. Medication information is shared and managed better so everyone knows quite clearly what the doctor expects to happen. Staff keep clear records to make sure they don’t make mistakes, and guests are supported to take medication safely. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 19 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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Guests know what to do to let someone know if they have any concerns, and feel staff listen to them. They can now rely on better procedures for responding to complaints, with picture information they can understand and use themselves. The service wants to do more to ensure all guests can understand the procedure. The service followed the right procedures when it responded to one complaint, but knows it needs to make sure all the details of an investigation are recorded fully, including outcomes. Sound procedures for protecting service users interests are in place, including robust staff recruitment procedures, and staff are trained in safeguarding people including local procedures for responding to allegations of abuse. EVIDENCE: The complaints procedure has been revised and updated. Information about how to make a complaint is in a pictorial format too so guests can understand and use it themselves. The complaints procedure is included in the service users guide, displayed in the entrance hall and guests have their own copy in each bedroom. Consideration is also being given to providing it as a video, made by guests themselves. Service user plans include information about the way guests indicate things are not right for them, so that staff can be attentive to their own individual ways of communicating concerns. Staff were familiar Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 20 with this, and during the inspection were taking particular care to support one guest so she felt able to talk about matters worrying her. The manager described action taken in one instance where a formal complaint was made, showing the system for responding to complaints was followed in a timely and constructive way. The complaint was substantiated but the area manager who conducted the investigation held the full record and we needed to follow this up after the inspection. Records seen were detailed and clear about the procedures followed, and showed appropriate action had been taken to put right identified shortcomings. However, the service is aware some aspects of the procedure need further attention. This includes making sure there is a complete in-house record of all complaints showing how they have been responded to and the outcome, so guests can be confident their concerns are listened to and acted upon. The manager had concerns about confidentiality, it is good practice in such circumstances to cross reference to service users’ personal records or other confidential records where sensitive or detailed information may be more appropriately located. It would also be good practice to consider follow up with the complainant. These matters have all been included in the development plans for the service over the next twelve months. This should enable more effective monitoring of the way the service responds to concerns raised so guests know it remains attentive to any concerns they may have. Staffing records kept at the service confirm sound recruitment procedures for protecting service users interests are in place and used. Staff have all received appropriate training including understanding of local procedures for responding to allegations of abuse, and discussion with staff showed a clear understanding of safeguarding responsibilities. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 21 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): 24 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The environment is spacious, suitably equipped and well suited to service users’ varied needs. Although the service is used currently by a total of up to 37 people, the 5 people staying at any time have comfortable, inviting accommodation where they have had a say in the décor furnishings and equipment, are offered a choice every stay about the room they wish to use, and encouraged to bring personal items for use during their visit. There are facilities for a variety of activities in different rooms so service users can choose how they want to spend their time. The accommodation is well maintained, clean and fresh. EVIDENCE: The service is located near to the town centre. Shops and facilities can be reached on foot and by public transport, and there is specialist transport suited to people with mobility problems. The accommodation has been redecorated Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 22 since the last inspection, and is bright, comfortable and well decorated in a modern style that is colourful and includes a variety of stimulating artwork. There are plans to redecorate and refurbish the spacious sitting room soon. Although it is not possible for service users to have their ‘own’ room each stay they are offered a choice so can use the same room if possible. Their name and photo are displayed on the room they are staying in and they are encouraged to bring personal possessions. They took part in choosing the décor and artwork for each room so each bedroom has a distinctive style that is warm and welcoming. The excellent facilities in the sensory room have been further added to, and service users spoken to were keen to have more musical instruments such as a keyboard. A resource room previously used by another linked service is being incorporated into the service facilities. For example, during the inspection service users were enjoying an art therapy session there. All visitors can see relevant information about the service displayed in the welcoming entrance hall, including the service users’ guide and newsletters. Photographs are on display throughout the building, showing guests’ activities and personal achievements such as learning cooking and travel skills, and providing service users with information about the service for example names of staff, who is on duty, who is visiting, the day’s activities and meals. A variety of tools are on display and used to help staff and service users talk to each other, such as photographs and key symbols to help service users who communicate in other ways to express choices and make decisions themselves. The accommodation is well maintained in good order, clean and fresh. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 23 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): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a committed, stable group of staff working effectively as a team, in sufficient numbers and well deployed to provide individual support for personal needs, fulfilling activities and skills development, and to manage the infrastructure of the service, maintenance of the home and sound and effective records. Robust recruitment procedures safeguard service users well being by making thorough checks to avoid the appointment of unsuitable staff. There is a sound approach overall to managing staff training. Good progress is being made to ensure all staff are developing sound practice skills and will soon have all mandatory and core training. EVIDENCE: Guests have good levels of staffing that means they each have their own link worker and enough opportunities for 1:1 support, so they have real choice about planning their activities during their visit. They are very enthusiastic about the things staff now have time to do with them. The regular staff team provide a minimum three staff on duty when guests are at home. Regular relief staff support the team, so guests with special needs know they will have Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 24 enough staff to support them without the need for agency staff. During the inspection there were three guests staying and 3 staff on duty. Guests had enough staff to support someone preparing the evening meal, while another guest was able to go out shopping with a staff member allowing time to talk. Guests benefit from staff time being well managed, because there is a good balance between supporting them and maintaining the service. While supporting them comes first, enough time is allowed for record keeping, liaison with family carers and other agencies, training, staff development and support. Staff spoken to felt very positive about this. They feel the service is well managed, and that they have the support they need to do their job well with six weekly personal supervision and regular staff meetings, and an effective training programme. Staff recruitment has improved and there is now a stable group of staff working here, so guests know people they know who understand them well will support them. Records of staff recently appointed show robust recruitment procedures are followed, to check before staff start work that they are fit to work with this service. There has been a commendable improvement in meeting training needs so guests can be sure they are supported at all times by skilled and knowledgeable staff. Staff training is managed centrally for the organisation. All staff have a training passport that identifies their training needs, agreed training path and achievements. The central service training record shows forward planning to 2011, but although it records mandatory safe working practice training it is unclear from this record whether it kept up to date, booked or planned for each person. The manager is confident the system is working well to ensure staff get the training they need in a timely way, but an accurate record is essential. The record shows all current staff have completed their induction and Learning Disability Award Framework (LDAF) linked foundation training, and that most now have or are working towards National Vocational Qualification level 2 (NVQ2), with some progressing to NVQ3. The aim is to achieve 100 NVQ2 for all staff. Additional training includes for example person centred planning, communication skills, eating and drinking support, epilepsy, dementia, challenging behaviour, bereavement, sexuality and health awareness and record keeping. Staff development is clearly valued and encouraged. Staff are enthusiastic and committed with a professional approach, and making real progress in training and skills. The NVQ assessor spoken to praised highly the quality of staff training and support here. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 25 Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 26 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): 37, 39 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The service is ably and effectively managed. It is well run with the interests of the service users the foremost priority. Service users and key people are actively encouraged to contribute their views and with support have a role in planning and developing the service. Management responsibilities are carried out sensitively and fulfilled effectively, and enhance the well being of everyone living and working in the home. EVIDENCE: A skilled and experienced registered manager is in post and has been working hard on all aspects of the service to establish sound principles procedures and practice. This has brought significant improvements throughout all areas so that the service users can now enjoy very positive and successful visits, with a better fit within the pattern of their regular day to day lives. Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 27 On taking up her post the manager reviewed all requirements from the previous inspection and addressed them energetically, so these have now been well met to ensure provision of a sound service. Most recommendations have been followed or are in progress. The manager is providing valued support to staff through regular personal supervision, staff meetings and informal support, and inspiration through her own good practice, enthusiasm and commitment. Resources are managed creatively and an inclusive enabling approach promoted so that staff, guests and their family supporters all benefit from being listened to and have the opportunity to be involved in service development. A sound approach is being taken to quality assurance. Surveys have obtained views on service quality in preparation for a report on how the service will respond with future development. Safe working practice training is now up to date or training planned for most staff. There is a sound approach to risk management, and sample checks on safety procedures show these are up to date and being carefully followed. It is noted that the policy on 1st aid training is for most staff to attend an appointed persons course, updated 3-yearly. This may not be sufficient to make sure staff have the specialist skill needed to respond to an emergency. The providers’ attention is drawn to the commission’s 1st aid guidance on its website, highlighting the need to carry out a risk assessment to determine the first aid requirements for the service, and sources of appropriate training. The provider’s updated policies and procedures are now in place and staff are familiar with these. There is a sound approach to record keeping, with welldesigned up to date records that ensure information is both managed and used in an integrated way. The manager recognises the importance of allocating sufficient staff time to record keeping, particularly significant for the busy turnover of guests using this service. Staff have time set aside for maintaining records, so guests and their families can be confident of consistency in both information and support. Records to support service administration are also in good order and where some aspects need attention this has been clarified in relevant sections. Foxlydiate Mews, 1 DS0000018489.V358857.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 x 2 4 3 X 4 X 5 3 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 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 4 3 3 x 4 X 3 X X 3 x Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 29 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. 1. Standard YA42 Regulation 13, 18 Requirement All staff must be suitably trained so someone qualified to administer first aid is available on every shift and able to keep guests safe in the event of any incident requiring medical attention. A risk assessment must be done to decide what level of first aid training the manager and staff need to meet the identified needs of guests. Timescale for action 31/05/08 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 YA19 Good Practice Recommendations Respite service users would benefit from having health action plans. 2. YA42 Staff training records should be clarified to distinguish between details of training done, booked and planned, to verify when mandatory training has been completed and DS0000018489.V358857.R01.S.doc Version 5.2 Page 30 Foxlydiate Mews, 1 3. YA39 aid forward planning to keep this training up to date A report provided to guests on results of surveys to obtain their views of the service, should also show how the service proposes improvements that take these into account Foxlydiate Mews, 1 DS0000018489.V358857.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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