Inspection on 10/01/08 for Powys House

This is the latest available inspection report for this service, carried out on 10th January 2008.

CSCI 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

Powys House 12/10/05

Powys House 27/04/05

Powys House 05/11/04

Powys House 11/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Powys House 121 York Avenue East Cowes Isle of Wight PO32 6BB Lead Inspector Mark Sims Unannounced Inspection 10 January 2008 11:45 Powys House DS0000055743.V355851.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 Powys House DS0000055743.V355851.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. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Powys House Address 121 York Avenue East Cowes Isle of Wight PO32 6BB 01983 291983 F/P 01983 291983 powyshouse@harrisoncare.eclipse.co.uk 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) Harrison Care Enterprises Ltd Mrs Gillian Skeats Care Home 18 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (3), Mental disorder, excluding of places learning disability or dementia (6), Physical disability over 65 years of age (1) Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2006 Brief Description of the Service: Powys House is a large period building, which has been converted to provide residential care to a mixed client group, offering services to younger and older adults with learning disabilities. The premises is situated midway along York Avenue, East Cowes, which is the main thoroughfare into the town and provides service users with easy access to the facilities and amenities of East Cowes, including sources of transport. The building, as highlighted, is a period property, which has been extended and adapted to provide residential accommodation and includes a passenger lift, servicing all floors, portable ramped access, assisted bathrooms and single occupancy accommodation. Fees for accommodation at the home range from £425 - £450, although this depends on the care package required and/or negotiated by the placing authority. Powys House DS0000055743.V355851.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 stars. This means the people who use this service experience good quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit, the actual visit to the site of the home, was conducted over five and half hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met with service users and staff to see what it was like residing at the home and whether people’s needs were being meeting. The inspection process also involved far more pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database, Annual Quality Assurance Assessment information provided by the service provider/manager and linking with previous inspectors who have visited the home. Thirteen service user surveys, ten staff surveys, one General Practitioner survey and One Care Manager survey were returned to the Commission. What the service does well: What has improved since the last inspection? What they could do better: The manager could spend sometime, auditing the service users plans, to ensure a single process for communicating and recording information is used, Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 6 the files seen during the fieldwork visit containing several different care planning documents. The provider must ensure visits to the home are taken in accordance with Regulation 26 of the Care Home’s Regulations and that a report following each visit is produced and made available for inspection. 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. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 7 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 Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a well-structured and established admissions procedure, which ensures that the views, aspirations and needs of the prospective service user are appropriately identified and considered. EVIDENCE: One person has been admitted to the home within the last three months, records indicating that this process was well organised and structured and that prior to finalising their move to the home the person experienced two trial visits, the first a visit for tea and the second an overnight stay. The person’s records also document their arrival at the home and the initial settling in period, as well as containing a needs or support based assessment undertaken by the manager and a care summary supplied by the person’s previous service. During the fieldwork visit we met with the service users, including the person referred to above and whilst the person has restricted communication, they appeared happy and settled within Powys House. Information taken from the surveys, sent out by the Commission, as part of the inspection process, also indicate that the service has a well managed Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 9 admissions process, the comments from the service users supporting the fact that they were consulted about moving to the home before moving in, whilst the Care Manager survey establishes that clients routinely undergo assessments and that accurate information is gathered. A review of the Commissions database also established that the manager, historically, has applied to vary the home’s conditions of registration, where she has felt the service can meet the needs of a person or persons, who fall outside the home’s present categories of registration, which demonstrates an awareness of her legal duties and her need to ensure the home only provides a service to people whose needs they can meet. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service’s support plans are informative documents, however, they can be confusing at times, as there appears to be no single format in use and each of the three plans reviewed contained slightly different documentation. The service users are encouraged to make decisions for themselves and where appropriate risk assessments are provided to minimise the likelihood of injury or harm occurring. EVIDENCE: Three care or support plans were reviewed during the fieldwork visit, each containing a slightly different method or format for documenting information pertinent to the service user. The information contained within each plan was informative and provided details of the person’s health and social support requirements, information that Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 11 related to their personal relationships, contacts and communal or community based activities and professional contacts and support systems/structures. There were also clear connections between the pre-admission assessment documentation and the initial support plans, although the manager advised that she does not produce a detailed support plan until the person has had time to settle into the home and become familiar with their surroundings, new housemates and staff, as often new support needs develop with time. During the fieldwork visit the staff were observed using the support plans to document and record information. One person in particular experiencing a health related problem, which required significant health and social care support, all contacts relating to this person’s needs immediately documented within the running records and health contact records. The professional surveys, support the fact that the staff are prompt to update the client’s support records, the General Practitioner stating that ‘specific and/or specialist advice is incorporated into the service user plans’, whilst the Care Manager documented that ‘the care team have good care plans, which are working documents’. Included within the service users plans are risk assessments, which focus largely on practical activities such as moving and handling and which could be extended to include other activities such as self-medication, unaccompanied activities outside the premise and the use of equipment like that located within the laundry and kitchen. The promotion of independent activities were observed throughout the fieldwork visit, with people involved in laundering their clothes, setting up and clearing the dining room tables, making choices over meals, participating in communal activities or independent activities within their rooms. People also spoke of the various activities and day centres they attended; and over the Christmas period the huge number of parties they were invited too, which they clearly appreciated and enjoyed. In addition to observing or discussing with people the independent activities they undertake, information was also taken from the service user surveys, which indicate that people feel they are encouraged to make decisions independently by the staff, that the staff listen to their requests and that they can do what they wish, as demonstrated by a client who during lunch asked to have his diner in the back lounge and not the dining room with the other clients. It was also noted, whilst reading through people’s support plans that advocacy services had been involved in the home until recently but that the service had been withdrawn. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 12 In discussion with the manager it was stated that the number of client attending the advocacy meetings had dwindled and that the advocacy providers fees had increased, which meant the service was no longer cost effective. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service supports the resident’s to maintain community links and contacts and to attend day service, which provide vocational, educational and social opportunities for people. EVIDENCE: The service user plans contain weekly schedules, which identify the day services each person is involved with and the number of days per week that the person attends the centre. More generic schedules are maintained with the service users medication records, the staff advising that these acts as quick reference guides, which prompt them providing people with their medication when setting out to the various services. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 14 Running records are use to capture or record information that relates to people’s experiences when undertaking activities, recent entries including details of people’s attendance of Christmas parties and trips out to see the Christmas Lights. Throughout the fieldwork visit residents were observed returning from various day services and centres and during group discussions described the activities they had been involved in and the people they had meet during the day. They were also able to discuss the activities they participated within when not attending the day services, which included both internal and external activities/entertainments, some of which have been mentioned but include: attendance of clubs, shopping trips, pub outings and walks. Feedback obtained from the Care Manager survey, indicates that service users are considered to enjoy a varied and fulfilling life that reflects their choices. The service user surveys establish they too are satisfied with their lifestyle and that they feel they have choice and control over their day-to-day activities. As mentioned early the risk assessment process could be extended to consider a variety of additional factors, including people’s safety when outside or away from the home. People described how when the weather is warmer they like to sit outside and watch the world pass by, whilst other people discussed walking into the town without an escort, both actions, which potentially could incorporate a degree of risk, as people are not directly or easily observed. Generally however, people’s involvement with the local community includes staff support, attendance of a local club, visits to public houses, shopping trips, walks and visit to facilities such as the health centre, as mentioned. The amount of support varies depending on the person and details of how people, wish to be supported, especially when accessing health and social care services are clearly documented within the service user plans. Each resident is registered with the local community health centre and assigned a General Practitioner, who does visit the home when people are unable to attend the surgery Additional community based events, theatre trips, bowling, meals, etc are often arranged and supported by the day services people attend, as reflected via the running records and individual comments. Relationships within the service user group were observed to be good during the fieldwork visit, people interacting and discussing a number of topic’s, which Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 15 included, attendance of clubs, day service, holidays, television programme’s, roles and responsibilities and relations with staff. An example of the friendship that exist came during a group session, when one person described how they had supported a new resident at an evening club they attended, this person involving a second service user in the conversation and reliving the experience in a light and jovial manner. On speaking with the staff, they were able to confirm the information received via the Annual Quality Assurance Assessment (AQAA), which indicated that the core client group have lived together for over five years, with the exception of one recently admitted client, mentioned earlier within the report. This person’s admission information identified that they were known to many of the home’s current client group, via their involvement with day services and that the pre-admission process provided them with the opportunity to cement or reinforce these friendships, with at least two visits made to the home prior to admission. Resident and staff relations were also observed to be good, with interactions noted to be friendly, warm and supportive, the staff and residents addressing each other by their first names, staff listened and responded appropriately to people’s statements or comments and staff and service users sitting together within the lounges discussing day-to-day events. The service user plans provided detailed accounts of people’s family dynamics/contacts and social histories, whilst the running records are used to document contacts between the service users and family members. The service user surveys indicate that people are generally satisfied with the support provided in maintaining appropriate contact with friends and relatives. Within the lounge is a schedule, which lists and shares out the various roles and responsibilities for the service users, these roles basically involving the setting of the dining room tables, assisting staff to clear away following meals and assisting the staff with the washing up and tidying of the kitchen. The schedule appears to share the tasks fairly between those clients most able to undertake the tasks, some people’s physical wellbeing precluding them from certain elements of the process. During the fieldwork visit people were overheard asking if they could lay up the tables, the task having to be shared between several people eventually. Service users were also observed in the laundry checking their washing, which they are able to assist with should they wish. Risk assessments were not seen Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 16 during the visit, around using the equipment or chemicals found within this area and the manager should consider producing these documents. The service users are also encouraged to use their home days to keep their bedrooms clean and tidy, one service user keen to show their keyworker their bedroom, which they had tidied throughout the day. The service user plans seen during the fieldwork visit make little reference to these activities or people’s involvement in tidying the home/their rooms. However, the daily schedule and people’s willingness to be involved in the process of tidying and setting up the dining room, etc, indicate that routines within the home are kept to a minimum, not oppressive and shared fairly between people, a view supported by the service user surveys, which talk about choice and independent decision making. Diner and tea were observed being taken during the fieldwork visit, the food was served by staff onto the individuals plates and staff were mindful of whom they served and sizes of meals provided. Staff were also observed asking people what they would like on their plates, which enable people to make decisions on portion size and the make up of their meals. In discussion with service users it was ascertained that the food provided was considered to be good and to provide choice and variety. Within the front room it was noticed that a bowl of fresh fruit, a water cooler, glasses and squash are made available to people, the water cooler observed being used by several people throughout the visit. Staff also offered people hot drinks and snacks throughout the day and the stores of food observed appeared adequate, containing a variety of snack and main meal foods. The service user plans contain information about any specialised diets people are on and provided guidance to staff on how to support people with food choices, fresh fruit instead of biscuits/crisps, etc. In discussion with the cook, it was evident that she appreciated and understood the varying dietary needs of the clients, the cook having cooked additional low sugar puddings for people known to suffer from diabetes. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care and support provided to the service users meets both their social, personal and health care needs. Medications are routinely managed by the staff, without reference to a self-medication assessment. EVIDENCE: The service users surveys indicate that people feel they are treated well within Powys House, which has an impact upon both people’s health and personal care. In discussions with service users it was evident that they are encouraged, where possible towards remaining independent for their personal care and that the staff are largely involved in supporting them achieve the goal of maintaining good levels of personal hygiene. Records demonstrate that staff are heavily involved in supporting people with bathing, etc, due to the risks associated with independent bathing and physical restrictions, which lead to people being unable to access certain areas of their bodies. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 18 During the fieldwork visit we overheard a discussion between a service user and a member of the staff team, when the service user was concerned that they had dripped tomato juice onto their jumper. The staff member, provided reassurance to the resident instantaneously and then went and sponged the affected area, returning with the jumper and showing the resident that the stain had been removed. The tour of the premise provided us with an opportunity to check on the communal bathrooms and toilets, which are clean and tidy. During the tour the manager discussed securing additional funding, which would enable her to upgrade one of the bathrooms and rearrange the layout slightly so as to create an en-suite facility for one of the service users. The tour also enabled us to ascertain that there were no shared toiletries and that each person has their own individual toiletries, which they are able to take back and forth when using the communal facilities. The service users health and personal welfare is considered by both the Care Manager and the General Practitioner, who responded via the survey process, to be well managed, with appropriate referrals for consultation and monitoring of peoples wellbeing mentioned. The service users plans contained both Health Action Plans (HAP) and Health Information Learning Disability Assessments (HILDA), which are documents designed to promote easier access to health care services and improve the experience of people with learning disabilities when involved with health professionals. The service users plans, also identify, historically, people’s varying physical and emotional/psychological health care needs, whilst their running records contain more detailed accounts of their current contacts with health and social care professionals. During the fieldwork visit two health care professionals were observed working with the staff to support a client with an acute health problem. This person’s records demonstrated that the staff had become concerned following a deterioration in the clients health after a they had received a blow to their leg. The person’s mobility had changed dramatically and the person complained of pain in their hip and/or pelvis. The records also demonstrate that the General Practitioner had been called and arranged for X-rays, and that following additional support had been sought from physiotherapy services and psychiatric services, the latter being the visit professionals. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 19 A diagnosis was achieved during the fieldwork visit and the client was prepared for an admission to hospital, the service users family were also kept informed of the events unfolding and plan to admit the client for further treatment. Policies and Procedures are in place, according to the Dataset documentation, which is a form completed by the service, as part of the inspection process, which direct staff to safely and appropriately handle, administer and store people’s medicines. Medication Administration Records (MAR) seen during the fieldwork visit were appropriately and accurately maintained, although the records for documenting the temperature of the medication fridge were not as well maintained, with several entries missing. Storage facilities are satisfactory and medications are transported around the home via a specific medications trolley. None of the care plans reviewed contained any form of medication selfadministration assessment, which might have been used to determine if any of the clients could be supported to manage any aspect of their own medications. Staff spoke of having completed a BTEC medications course at the Isle of Wight College, statements supported by the training records and certificates seen whilst checking staff files. The manager also discussed an agreement the service has entered into with a mainland based training provider, who is to undertake or provide large parts of the staffs ongoing training, which will include medication training. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are confident that any complaints raised will be appropriately handled and address, whilst the safeguarding and complaints procedures provide staff with details of how to manage any concerns raised or identified. EVIDENCE: The service users surveys indicate that the service users would be happy to raise concerns with the staff and that they are confident that the staff would listen and act upon whatever they said. The Dataset establishes that the home possess a complaints procedure, which is made accessible to people, however, as the service users have varying communication skills and abilities, people’s confidence in raising and having their concerns listen to are perhaps more important than their ability to comprehend the process. Information provided by both professional sources indicate that no complaints about the service have been received by them, the Care Manager adding that they have confidence in the manager and the care staff in the home to provide a good service to the residents. The staff surveys also indicate that the staff are happy with their role in supporting people raise or make complaints, whilst in conversations with the Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 21 service users it was made clear that people had no concerns about the care or service provided at Powys House. A similar picture is painted with the safeguarding process, with the Dataset establishing that policies and procedures exist, although this time for the purposes of directing and informing staff practice. Training records evidence that safeguarding training has been provided to staff and the manager discussed having recently completed the Local Authority (LA) safeguarding training that enables her to become an in house instructor, although she currently awaiting the delivery of the LA training packages. The Commissions database establishes that over the last year both the LA and the home’s manager, via regulation 37 reports, have brought several safeguarding alerts to the Commissions attention. These have all been investigated and satisfactorily concluded with plans to support the service user agreed between all parties involved. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premise was in a good state of repair, clean and tidy throughout. EVIDENCE: A tour of the premise was undertaken in the company of the manager with the home appearing to be in good structural and decorative condition throughout, with the lounge/diner being the last area of the home redecorated. During the tour the manager, as previously mentioned, discussed having secured additional funding for the redecoration and refurbishment of the first floor bathroom and the creation of an en-suite facility for one of the clients. Several service users bedroom were visited during the tour, with each of the rooms seen personalised by its occupant and decorated individually. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 23 A maintenance person is employed by the home on a part-time basis and records are available of the work they have undertaken, these jobs identified and reported by the staff via the maintenance log. Domestic staff are also employed on a part-time basis, although this would appear to be sufficient, as the home was clean and tidy throughout, with no unpleasant odours or dust build noted anywhere around the home. Cleaning materials were noted to be appropriately stored during the fieldwork visit and environmental risk assessments take into account the Control Of Substances Hazardous to Health (COSHH) and the need to obtain and use datasheets. The Dataset establishes that staff have access to guidance on the management of infectious outbreaks and the prevention of cross-contamination of materials. The staffing files contain certificates that evidence the infection control training completed by the majority of the staff employed. In conversation and via the service user surveys, people were able to confirm their belief that the home is fresh and clean. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff trained, skilled and support both the people who use the service and the manager with the smooth running of the service and people’s day-to-day lives. EVIDENCE: The manager was able to provided us with sight of certificates, awarded to staff for courses they have attended and completed and the training matrix, which is used to document and track staff training achievement. The certificates evidence that the staff have access to both mandatory and more specialised training events, such as the Learning Disabilities Award Framework (LDAF), National Vocational Qualifications (NVQ’s) and the BTEC medications training. Surveys returned by the staff indicate that they believe working at the home provides them with the opportunities to develop the necessary skills to care for and support the service users, new staff confirming that they had also completed induction training. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 25 In conversations with some of the staff on duty it was clear that they too appreciate the opportunities to complete and undertake additional training, one employee (deputy manager) discussing how she is working her way through her Registered Managers Award (RMA). The dataset establishes that a recruitment and selection procedure exists to support the manager when employing new staff and that an induction based on the ‘Skills for Care’ induction standards is in place, staff as mentioned above confirmed completion of the home’s induction on employment. It also indicates that all of the people who worked in the home over the last twelve months had undergone satisfactory pre-employment checks. On reviewing the files of three newly recruited staff all of the required checks were in place, Criminal Records Bureau (CRB) checks, Protection Of Vulnerable Adults (POVA) checks and two references. The files also contained completed application forms, health declarations, photographic identification, interview summaries, personal information and information used to support the CRB application process. Powys House DS0000055743.V355851.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the manager has introduced systems that ensure the views of the service users are considered when making decisions about the day-to-day operation of the service. EVIDENCE: The manager is an experienced person who has worked at the home for a number of years in the position of manager and who has undertaken both the Registered Managers Award and NVQ Level 4 in care, as established at previous inspection visits. Statements taken from both professional sources establish that the manager is considered to be somebody who will take decisions appropriate to the needs of the service, the Care Manager, as mentioned stating: ‘I have confidence in the manager and the care staff’, whilst the General Practitioner indicated that they Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 27 felt the management took appropriate decisions when they could no longer manage the care needs of the service user. The views of the staff were generally supportive of the way the manager operates the service, with comments such as ‘I fill it is a very homely atmosphere and the clients appear happy and Powys House is lucky that it has a very good manager, who ensures that the home has high standards of care for the clients and also good support to both clients and staff’. However, one person felt that issues affecting the night staff ‘were not always given the attention they merit and sometimes this lead to people feeling undervalued’. A solution put forward to address this issue, was to arrange more frequent night staff meetings, however, records demonstrate that the manager already arranges regular staff meetings, which night staff not on duty are welcome to attend. Conversations with the service users indicate or establish that they are happy with the running of the home and have good relations with all staff, including the proprietor and the manager. In addition to the staff meetings, mentioned above, the manager also arranges regular service users meetings, minutes of which are available, as are the minutes of staff meetings. The minutes of the service users meetings indicate that they are well attended and that people are encouraged to discuss a range of topics, which concern or interest them. Until recently the service users also had regular group meetings with members of an advocacy service, however, as numbers dwindled and a fee was introduced this service has been stopped. At the last inspection the need for the proprietor to ensure he is undertaking visits to the home in accordance with Regulation 26 of the Care Homes Regulations, to monitor the conduct of the manager and running of the service, was raised. At this visit the Regulation 26 report file was scrutinised and found to contain no recent visit reports. This statement is not intended to suggest that the provider is not visit the home regularly, as this is not the case, with the service users discussing Mr Harrison visited with us and telephone calls to the home establishing his presents within the building. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 28 However, there continues to be a lack of reports following these visits, which as discussed was a requirement of the last inspection and must therefore be consider not to have been addressed. The tour of the premise raised no immediate health and safety concerns and basic environmental risk assessments were noted to be in place. The Annual Quality Assurance Assessment and Dataset establishes that full health and safety policies/guidance documents are made available to the staff and that equipment is regularly maintained and serviced, gas, electrical installations, portable electrical appliances, hoists, baths, etc. Health and safety training is made available to staff, with the training matrix and certificates providing evidencing of the health and safety training being completed by the staff, moving and handling, first aid, fire safety and health and hygiene. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 29 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 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 2 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 3 3 3 X 3 X 2 X X 3 x Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 30 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 YA39 Regulation Requirement Timescale for action 22/02/08 Regulation This requirement was raised 26 at the last inspection 11th September 2006 and has yet to be complied with. A copy of the monthly Regulation 26 reports must be available in the home. 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. 2. Refer to Standard YA6 YA6 Good Practice Recommendations The manager should review the support planning process and settle on one form for presenting and documenting information. The manager should review the risk assessment process to ensure all personal activities undertaken by the service users are considered and addressed. Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Kent ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Powys House DS0000055743.V355851.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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