Inspection on 20/11/07 for Whites

This is the latest available inspection report for this service, carried out on 20th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whites 10/04/06

Whites 28/11/05

Whites 04/05/05

Whites 19/06/04

Whites 13/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Whites Station Lane, Muller Road Horfield Bristol BS7 9NB Lead Inspector Nicky Grayburn Key Unannounced Inspection 22nd November 2007 09:30 Whites DS0000026557.V352356.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 Whites DS0000026557.V352356.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. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whites Address Station Lane, Muller Road Horfield Bristol BS7 9NB 0117 951 6407 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) Whites@freewaystrust.co.uk Freeways Trust Ltd Theresa Joan Robbins Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 11. 17th May 2007 Date of last inspection Brief Description of the Service: Whites House is operated by Freeways Trust Limited and is registered to provide accommodation and personal care for up to eleven people who have a learning difficulty. Primarily they accommodate people who have complex needs that can challenge the service provided. The home itself is situated in large grounds, which is set apart from a busy main road. This provides a secure area to which residents can have unlimited access. A cat also lives at the property. It is close to local amenities, including shops and public houses. It is also near to a main bus route. Whites benefit from having a van that is regularly used by residents to access community facilities. Freeways hold copies of all inspection reports, and Whites hold their individual reports. The home has an available Statement of Purpose and Service User Guide, which is user friendly. Freeways have a website which can be accessed to find out more information about the organisation as a whole. The day centre based at Leigh Court (head office of Freeways) also produces a newsletter for residents and their supporters. Freeways calculate their fees on a weekly basis. As of 1st October 2007, the range of fees is from £734.00 to £1255.00 per week. Additional charges apply to transport costs according to the resident’s mobility allowance. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Whites second Key inspection this year. It was unannounced and the inspector visited the home from 11.00am until 6.30pm. The inspector met with many of the residents, staff, and the Manager. The 2 deputy managers and senior support worker were also around during the inspection. There were 5 requirements and 2 recommendations to follow up from the previous visit in May 2007. Prior to the inspection, previous records and reports held at the Commission for Social Care Inspection were read, such as the home’s monthly reports carried out by the home’s Area Manager; incident reports, and the previous report. The Manager also completed the Commission’s ‘Annual Quality Assurance Assessment’ (AQAA), which is a self-assessment of the home, giving information regarding the service. It also includes details relating to each of the headings below with a description of ‘What we do well’; ‘What we could do better’; ‘How we have improved in the last 12 months’; and ‘Our plans for improvement in the next 12 months’. The inspector looked at key documents; talked with and observed residents, staff and the Manager on a one-to-one basis; and undertook a tour of the property. Surveys were sent out to the home for staff, relatives and professionals to complete if they wished. Surveys for the residents were sent out for the previous visit and were completed with the support from staff from the day centre. The inspector received 4 surveys from staff; 3 relative’s surveys; 2 General Practitioner’s surveys. 4 residents were case tracked and the inspector checked other residents’ records. Verbal feedback from the inspection was given to the Manager over the phone. The last key inspection was carried out in May 2007 and this report should be read in conjunction with previous report to gain a fuller picture. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There have been many improvements at Whites since Ms Robins started and since the previous visit. Ms Robins is now registered with the Commission for Social Care Inspection as the manager after a very successful interview with the Central Registration Team. A dietician has worked with staff to improve people’s diet and weight. Staff have found and are looking into more alternatives for daily activities and occupation for people who choose not to attend day centres. The staff team is becoming more stable to ensure a consistent approach is given. New furniture has been purchased in the lounges, which makes it look more homely and more cared for. 2 bathrooms have been refurbished which have proved popular with people. People are being supported with their health needs in a more respectful and dignified way. People have regular health appointments now. Some people’s health needs have been resolved and as a result this has had a big improvement on their own well being, as well as other people’ The home is employing external cleaners to come to the home regularly to carry out a deep clean. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 7 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. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Quality in this outcome area is good. Prospective residents will have an up-to-date Statement of Purpose and an easier to read Service User Guide to make an informed decision. People’s needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made at the previous visit for the home’s Statement of Purpose to be updated fully to reflect the home’s service and facilities. This had been partly met. More information is to be included to ensure that it fully complies with Schedule 1 of The Care Standards Act as stated in the previous report (how the home respects the privacy and dignity of the residents; fire precautions; size of rooms, and the complaints procedure). It was discussed with the manager and agreed that she will send it to the Commission for Social Care Inspection by 14th December 2007. There is also a Service User Guide, which is pictorial with some text which has also been updated. This guide would be more appropriate for potential people moving into the home, whereas the Statement of Purpose would be given to their supporters as it is not user friendly and all in text. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 10 Comments and answers from the relatives’ surveys suggested that they would like some more information about the home and it would be good practice for the Statement of Purpose be sent to the relatives. No new people have moved into Whites for the past few years. Some people still have their original assessment prior to moving into Whites in their file. Whites can be a noisy lively home. Some residents enjoy this level of commotion. Whereas others prefer a quieter life. The appropriateness of placements was discussed with the manager and should be discussed further with senior management. There is a list of people and their care plan review dates so that everybody has a formal annual review. Sometimes, the person’s Social Worker leads this review and people’s supporters are invited to the review. For some people, where no social worker is available or assigned to that person, the home carries out their own review. The person’s key worker is also involved in this process. These reviews ensure that people’s needs are recognised and actions are written to make sure that they are met. The admissions procedure in the Statement of Purpose states visits and overnight stays are arranged if appropriate and necessary. Freeways Trust recently held a ‘Professionals Open Day’ and included a play performed by residents of Freeways homes. It was called ‘Moving into a Home’ and the actors showed what happens: - go for tea - stay over night - asked what colour they would like their room to be painted - get new towels; bedding; clothes; and bedding - are told that they can bring their own furniture, and staff will record what they bring so it doesn’t get lost. Contracts were not inspected during this visit. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. People have care plans but could be improved to ensure that people’s needs are fully met. People are able to make decisions about their lives and are supported to do so. People are supported to take risks as part of their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 4 people’s files were read during the visit, and others were spot-checked. Generally, people have annual care plan reviews. From these, numerous documents are written, such as risk assessments, proactive strategies, and monthly key worker reports. All files contained a care plan assessment. Some had been reviewed recently with the person’s social worker which highlighted changes. Some people are in need of a formal review as they haven’t had one since 2005. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 12 People have ‘Essential Lifestyle Plans’ which are person centred and give information to staff as to how to support the person. Included in the plan is ‘How I communicate’; ‘Things that keep me calm’; ‘Morning and Evening routines’, and ‘Support I need from staff’. Key workers have the responsibility to write monthly reports regarding the person’s needs and care. Some are written with good detail, some give just basic detail about the months activities, and others are incomplete. Some people did not have reports since July or September 2007. The monthly reports were discussed with the manager, as they are not directly linked to the care plans. Actions from the reports and care plans are not clearly being actioned. It was pointed out to the manger that some sections of the monthly reports had been photocopied from previous months and attached. The AQAA stated that in-house training has been set up for staff on key working so that it becomes more meaningful, which was explained during the visit. The manager said that she will be discussing this with staff and senior management to improve the records. 3 of the 4 staff surveys stated that they are ‘always’ given up to date information about the needs of the people they support. 1 survey ticked ‘usually’. 2 of the 3 relatives surveys stated that the home ‘always’ gives the support and care to their relative that they expect. It has been observed over the last few visits how people living at Whites make decisions. Staff are aware of how people communicate in their individual styles and know what certain signs and noises mean. Decisions made still need to be recorded and this will also tie into the recording of people’s complaints. The ways in which people communicate is recorded in their personal files. Risk assessments are written with the input from the management and staff. New assessments are read by staff and signed accordingly. It was clear that after incidents, risk assessments are reviewed and updated to ensure peoples safety. Despite risks posed, people remain to be well supported during activities and out in the community. Gaining advocacy has been a long-standing goal for Whites and has now been achieved. It was important to seek this service for some people living at the home as some do not have much contact with family members. Staff from Freeways Leigh Court day centre were originally being used, then an exemployee, and now an ex-Freeways Manager is supporting people. Her role is still being developed and she is also helping the home with various aspects of training. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 13 Whites DS0000026557.V352356.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, 17 Quality in this outcome area is good. People living at the home have lifestyles which suit their needs. More choices and alternatives regarding daily activities and occupation will enhance people’s lives. People’s daily routines are respected. People are offered a healthy and balanced diet. People are supported to maintain relationships. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to people’s needs, some people have very specific lifestyles which suits them. The AQAA stated that they are “trying to engage and occupy service users with alternatives to activities load on according to preferred choices.” Freeways run a day centre called Leigh Court, and many people from Whites go there during the week. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 15 However, some people don’t like going there and the home is finding other options. This will be followed at the next inspection, but it was clear that the manager is working towards people having more choice regarding their lifestyles. During the inspection, a dance and voice therapist came to the home and it was observed how all of the residents at home that day participated with staff’s support. It was evident that it was enjoyed by all and more of this input would be beneficial. Everyone has a life skills day when they are supported by staff to undertake and develop daily living tasks such as their washing and cleaning their room. These days also give an opportunity for people to spend time with their key worker on a one-to-one basis. Key worker reports state that people go out and about in the community for shopping trips and going out to cafes and pubs. Whites has their own transport which they use daily. The manager explained how they are trying to start and maintain relaxation sessions for residents, such as using foot spas; hand massages, with music. These sessions used to happen and were enjoyed by those residents who prefer a quieter life. The manager is trying to introduce more sensory items to give more stimulation to residents. The AQAA stated “All residents are supported with a life skills programme; are offered and supported with a day service; are offered alternative outings in the community; regular weekend outings are organised such as trips to the country, Long Leat, the Zoo” The AQAA stated that “5 residents have been on short breaks away”. Some people do not like staying away from their home so go on day trips and records are kept in the person’s file. Recent trips included Cardiff and Exeter, and a bowling trip and train rides. Some people go and stay with their families and staff drive them to the location, which has been much appreciated by the relatives. The manager and some residents told the inspector about their Bonfire Night and Halloween events, which seemed to be really enjoyed by all. Other people from other homes came for the party too. Many people do not have any contact with their family relatives. Those who do are well supported to maintain contact. Over the past year, some relatives have made contact with the home. These contacts have been sensitively dealt with to ensure that people are protected. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 16 The home has implemented a smoking ban within the home. The people who do smoke go outside now. There is a ‘make-shift’ smoking shelter at the side of the house, which the manager said will be replaced with something more permanent. Where appropriate, some people have keys to their bedrooms. It was observed that people can choose whether to spend time on their own in their bedrooms or with the other residents in the lounges. It has also been observed over the last few visits that people can access the grounds at any time. It was pleasing to observe that staff were interacting with the residents more than on previous visits. Some people in the home are over weight and have certain obsessions concerning food. Recommendations have been made over the past few years for the home to refer some people to a dietician and to ensure that healthy meals are provided. The home now has a dietician who has visited Whites; reviewed their menus; made recommendations regarding recipes, intake of fibre, and suggested tasty healthy choices. This is good practice. The menu was viewed for the week and shows healthy choices. Even though facilities to make drinks are kept locked in the smaller kitchen, people can have drinks when they want. Some people’s care plans stated that they have to be encouraged to drink due to specific health needs. This is monitored by staff. It was observed how some people help with the preparation of meals. Whites DS0000026557.V352356.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): 18, 19, 20 Quality in this outcome area is good. People are supported with their physical and emotional health needs in a way they require. People’s needs are generally met. People are protected by a robust medication system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home have complex physical and emotional health needs. There have been improvements in people’s health and as a result, people’s well-being and welfare has improved. Behaviour which has challenged staff and other people living in the home has also reduced because of this. The manager kept the inspector informed of the progress with specific individuals. The surveys from General Practitioners ticked ‘yes’ that the home communicates clearly and works in partnership with them; there is always a senior member of staff to confer with; specialist advice is incorporated into the care plans, and that they are satisfied with the overall care provided to people within the home. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 18 The AQAA stated “everyone has a health action plan”. These were read at the inspection. These are being completed mainly by the person’s key worker. Information regarding the person’s health is currently written in the monthly reports and other records kept. Due to some people’s emotional needs, mood charts are used. This helps staff to monitor people’s moods and can inform the relevant health care professional of any changes. Some people have epilepsy and information is recorded regarding the type; history; recovery; medication, and what staff should expect. A requirement was made at the last visit to ensure that people have regular health care appointments and for referrals to be followed up. From the records looked at, it was clear that improvements have been made and some identified needs had been followed up. Health checks are recorded and people are supported to attend regular appointments (dentist; optician; chiropody; GP). Some people have a lot of anxieties about seeing some health professionals. The manager has made people aware of the importance of oral hygiene, and this has improved people’s health. It was clear from some people’s notes that relevant professionals are contacted when specific health problems arise. A requirement was made at the last inspection regarding people receiving care and support from staff with dignity and respect. Observations during the inspection, supervision notes and discussions with the manager confirmed that this has been met. It was pleasing to note that certain areas of support have changed. The medication cupboard was checked with the manager. The home has changed their pharmacy with no problems. The manager confirmed that they have had a ‘technical’ check last year and are due to have one in the near future. There are no controlled drugs kept in the home. No medication is needed to be kept in the fridge. No one looks after his or her own medication. Medication Administration Record sheets were signed. Nearly each person has a ‘profile’, which outlines the individual’s medication details, possible side effects and interactions. It would be good practice for the manager to ensure that every person has one of these and that they are updated according to current medication. The home keeps some ‘homely remedies’ according to Freeways policy. The manager confirmed that the General Practitioner has agreed to these. Some people have medication to be used ‘as and when’ (PRN). These were checked and the amounts corresponded to the stock control sheets. This medication is given for specific situations, such as for health appointments which people may get anxious about. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 19 Staff are undertake a one-day training course at Freeways head office and are then observed by an experienced member of staff within the home. The Commission for Social Care Inspection has not received any notification of medication errors since August 2007. Previous errors were dealt with correctly. The surveys from General Practitioners confirmed that medication is appropriately managed. The AQAA stated that medication reviews are being held within the next 12 months. Whites DS0000026557.V352356.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): 22, 23 Quality in this outcome area is good. People’s communication regarding complaints is understood but is not recorded as effectively as it could be. People are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation was made from the last visit for complaints to be effectively recorded. Many of the people living at the home do not communicate verbally but express themselves in other ways when they are unhappy. It was observed, and during previous visits, that some staff understand the way people communicate. The AQAA stated the home ‘recognises the need to develop a more comprehensive way of interpreting the complaints procedure. This involved reviewing behaviours that are recorded.’ They plan to do this over the next 12 months with the support from the home’s advocate. This will be followed up at the next visit. 4 out of the 4 staff surveys stated that they know what to do if someone has a concern about the home. The relatives’ surveys all had different answers as to whether they know how to make complaint (yes, no, can’t remember). It was discussed with the manager that when the Statement of Purpose is sent out, relatives will then receive the procedure. 2 relatives wrote that the home has ‘always’ responded well to concerns raised, 1 ticked ‘usually’. Both General Practitioners’ surveys stated that they had not received any complaints about the service. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 21 Staff undertake training in ‘Understanding Abuse’ and the ‘Protection of Vulnerable Adults’ to ensure that they are aware of what constitutes abuse and how to report any suspicion of abuse. Staff do this through their Learning Disabilities Assessment Framework. Since the last visit, staff have had inhouse training from another of Freeways’ managers. Staff are also trained in ‘Studio III’ which teaches staff how to safely ‘break away’ and restrain people when necessary. Records are kept for when this happens and reported to The Commission. When necessary, referrals are made to the Bristol Adult Community Care (Care Direct) team in line with ‘No Secrets’ for the Protection of Vulnerable Adults and are dealt with effectively. Some people who had displayed behaviour, which challenged staff and placed other people at risk has decreased significantly which is a great improvement for the home and the people living there. Prior to starting work at the home, staff have a Criminal Records Bureau check. At the last visit, it was noted that some staff’s checks were from 2002. A recommendation made and from a recent visit to Freeways head office has been actioned. Some staff are re-doing their checks in accordance to the guidance from the bureau to have them renewed every 3 years. This is very good practice. The home keeps some monies for people in the safe. It was observed that a member of staff checks the amounts on a daily basis. The monthly report from September stated that a full financial check took place in August and the next one will be done in February 2008. Whites DS0000026557.V352356.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): 24, 27, 28, 30 Quality in this outcome area is good. Residents live in a home which has been improved and provides comfort and security. People have sufficient toilets and bathrooms which provide choice and ensures privacy. The home is clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A short tour of the property was taken with the manager. The AQAA stated that the home carries out an annual maintenance review of the home. There are on-going repairs and re-decoration plans, and systems in place for emergency maintenance. The home has a gardener who maintains the large garden which is used mainly in the warmer months. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 23 There has been much improvement within the home since the last visit. The downstairs bathroom is now a ‘walk-in’ shower room. The manager said that this is now very popular with people. The upstairs bathroom has been refurbished and is cleaner and more inviting. The lounges/dining areas have had new flooring put in, and there are new tables and chairs, and sofas which all make it look more homely. The manager sought specific sofas so that the covers can be easily washed. Bedrooms were not inspected during this visit, but were in May and were found to be personalised according to the person’s choice and personality. The AQAA stated that most bedrooms have been re-decorated. A requirement was made at the last visit for the house to be kept clean. This has been a long-standing problem and the manager has worked hard to enforce this. People are supported to clean their own rooms on their life skills day. The manager said that they are employing cleaners from an outside agency to come every few months to do a deep clean in the home. This is good practice. It was evident that the manager and staff are working hard to ensure that the home becomes a home for the people living there. Whites DS0000026557.V352356.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): 32, 33, 34, 35, 36 Quality in this outcome area is good. People living at the home are supported by a well trained staff team, but could be better qualified. People are protected by the home’s recruitment practices. Staff are supported by the management team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home are supported by a large staff team. Since February, Ms Robins has worked hard to try and collaborate the team. 4 staff returned the surveys. All 4 stated that they ‘usually’ have the right support, experience, and knowledge to meet the different needs of the residents. There have been a few new members of staff. 4 staff files were read. These contained their application form; details of their Criminal Record Bureau checks, and 3 references from previous employers. This is good practice. The manager has signed a record in approval of the references. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 25 It was evident that staff had undergone their induction over a period of a few days rather than all in one day. Some of the newer members of staff are in still in the process of their induction, whereas others were totally complete. From the surveys, staff had a mixed response to the induction to the home, and generally felt that they would need to know more about the job before starting. Someone added, “A further and broader explanation of the type of support work to the particular house is needed.” Staff’s files also contain their training records. The staff surveys stated that they are given training relevant to their role; helps understand and meet the individual needs of the service users, and keeps them up-to-date with new ways of working. Some people added “They have very good training schedules and are adaptable to difference service users needs”. Some staff are in need of training in mandatory subjects. The manager was aware of this and said that staff are waiting for dates to complete the courses. Staff undertake their Learning Disability Assessment Framework (LDAF) once they have completed their probationary period. Once they have completed this, they start the National Vocational Qualification (NVQ) in care. Out of the 25 staff only 2 have at least their NVQ level 2, and 2 are working towards it. The manager confirmed that all the other staff are doing their LDAF. However, this can often take longer than expected and staff need encouragement to complete these courses. People living at the home would benefit from having more staff who are qualified. This will be followed up at the next inspection. The surveys from General Practitioners ticked ‘yes’, staff demonstrate a clear understanding of the care needs of the service users. The AQAA confirmed that staff receive supervision every 6 weeks. 3 of the 4 surveys stated they ‘regularly’ meet with their supervisor to give support and discuss their work. 1 survey said ‘sometimes’. An added comment was that it “could be more often”. Staff files included notes taken during the meetings and has a set agenda including training; key working; workload; progress, and ‘how are you’. The manager and the 2 assistant managers carry out these meetings. Along with the supervision meetings, there are staff team meetings, which occur nearly on a monthly basis. Minutes from the past 4 meetings were read and covered issues regarding the running of the home and also any residents’ issues. If staff are unable to attend, they have to sign to state that they have read them to ensure communication is maintained. Added comments from both staff and relatives’ surveys referred to the levels of pay staff receive in terms of increasing the salaries in order to maintain a stable staff team for the people living at Whites. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 26 This was discussed with the manager during the inspection. The manager does not have control over staff’s salaries. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 27 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, 40, 41, 42 Quality in this outcome area is good. People living at the home can be assured that the home is well run. Procedures and policies ensure that people are kept safe and can live a life as they wish. People in the home are protected by the home’s health and safety checks. People can be assured that they views on their home are being sought. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ms Robins has been working at Whites since February 2007 and has made significant improvements within the home. Her application for Registered Manager with the Commission for Social Care Inspection was approved in August 2007. Ms Robins has achieved her NVQ level 4 in Care; NVQ Assessor Award; Registered Manager Award; Cert. Counselling Skills, and C & G 325/3 Management Cert. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 28 The AQAA was completed and returned, but not within the timescale. Ms Robins has also complied with the requirements set from the last 2 visits. Since starting at Whites, Ms Robins has dealt with issues such as low levels of staff; team dynamics; institutional practices; poor environment and noncompliance with notifying The Commission regarding incidents. However, as stated in the registration report ‘the applicant has responded to these issues by meeting with staff, line managers, and developing new systems and processes to ensure the home is operated in compliance with regulations.’ A relative added in their survey that “I am pleased that the managers are so good, knowledgeable and caring. I have been very impressed at all the meetings I’ve attended. My **** is very happy at whites and I hope [he/she] always will be.” From this visit, it is evident that Ms Robins and her staff team have worked hard to improve the home. As written within this report, improvements have been made to the environment of the home; people’s daily activities, and staffing. The home is still developing their quality assurance system but has improved over the past few years. The AQAA recognised that it is an area, which they could do better in, in terms of gaining residents’ views of their home. The Area Manager visits the home on a monthly basis to support the manager as well as carrying out an inspection of the home. These are duly sent to the Commission and contain a lot of detail about the running of the home. There is a policy folder for staff’s reference containing the ‘10 most important things you must know’, such as ‘Missing Persons’ procedure; ‘No Secrets’; ‘Infection Control’, and ‘Moving and Handling’. Freeways Trust facilitates a group called ‘Our Project’. This is a group of residents who have learnt about policies. It has been running for 4 years, initially Lottery funded. The money has now run out now but Freeways have continued funding the group. The reason the group was formed was so that policies are easier for residents and staff to understand. The group asked residents in every home and the people who attend the day centre for their suggestions and opinions. New policies include ‘Advocacy’; ‘Holidays’; ‘Transport’, and ‘Relationships’. Records are kept in the two offices within the home. The doors are kept locked at all times. Medication records are kept within the locked cabinet. Generally, records are kept up-to-date and reviewed regularly. Where possible, people should be involved in their support plans. The wording of some reports needs to be more sensitive and written with more respect and dignity towards the person. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 29 Some daily notes do not give sufficient detail about the behaviour the person was displaying. This was highlighted to the manager and she said that she would raise this issue at the next staff meeting and during supervisions. The fire safety folder was read. Records indicated that regular fire checks are carried out on fire fighting equipment, emergency lighting and the alarm test. The home also carries out fire drills to ensure that people know what to do in the event of a fire. There is an old fire risk assessment from 2005, which does not reflect current good practices or detail problems faced for those people with hearing impairments or mobility problems. Some individuals have specific risk assessments in their files relating to leaving the building. This was discussed with the manager and the house assessment must be updated. Health and safety checks are carried out by external contractors, such as the Gas Safety Landlord Certificate; Portable Appliance Testing, and Periodic Electric Installation. These are all up-to-date. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 3 3 3 X Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 31 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 YA6 Regulation 14(2) 15(2b) 13(4) Requirement Care plan assessments to be reviewed and to be clearly linked to the monthly reports ensuring that actions are followed up. The home’s fire risk assessment must be reviewed and updated. Timescale for action 28/02/08 2. YA42 31/01/08 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 YA22 Good Practice Recommendations The manager to ensure that complaints are effectively recorded from residents to evidence the home’s practice of dealing with complaints and to also provide information for the home’s quality assurance system. Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Whites DS0000026557.V352356.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!