Inspection on 11/05/06 for 1, 3, 5, 7 Exmoor Drive

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1, 3, 5, 7 Exmoor Drive 07/05/09

1, 3, 5, 7 Exmoor Drive 25/04/07

1, 3, 5, 7 Exmoor Drive 27/10/05

1, 3, 5, 7 Exmoor Drive 23/06/05

1, 3, 5, 7 Exmoor Drive 03/03/05

1, 3, 5, 7 Exmoor Drive 15/09/04

1, 3, 5, 7 Exmoor Drive 18/03/04

1, 3, 5, 7 Exmoor Drive 12/01/04

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

CARE HOME ADULTS 18-65 Exmoor Drive, 1 1 Exmoor Drive Bromsgrove Worcs B61 0TW Lead Inspector P Wells Unannounced Inspection 11 & 17th May 2006 10:00 th Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 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 Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 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. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Exmoor Drive, 1 Address 1 Exmoor Drive Bromsgrove Worcs B61 0TW 01527 576591 01527 871853 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) www.worcestershire.gov.uk Worcestershire County Council Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 4 persons may be accommodated in each unit. The home may accommodate people with a learning disability over 65 years of age. The home may accommodate existing service users who have an additional physical disability or mental disorder. 27th October 2005 Date of last inspection Brief Description of the Service: Exmoor Drive is operated by Worcestershire County Council Social Care Services. It is a care home for 12 adults with learning disabilities, some of whom may have additional physical disabilities or mental health problems. The responsible individual is Mrs Hayley Folley and the service manager is Mrs Amanda Nally. The home’s manager is Mrs Dee Edwins, who is about to be registered. The home is purpose built on one level and opened in 1992. It is located in a residential area approximately one mile from the centre of Bromsgrove, on a bus route and there is a range of community facilities within close proximity to the home. The accommodation consists of three, self-contained units. Each unit has four bedrooms, a bathroom, a separate toilet, and an open plan lounge/dining room/ kitchen. All of the service users’ bedrooms have a wash hand basin but no en-suites. Two of the units provide long-term care and one of the units provides respite care. Respite care is provided for 37 service users for varying periods. The staff also offer support to one service user now living in the community. The aim of the service is to provide appropriate support, advice and guidance in order to enable the service users to develop their individual potential and to participate as fully as possible within the community. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over two days. There were seven permanent service users and two users staying for short stays. To prepare for the inspection the pre inspection questionnaire, comment cards and incident reports were read. At the visit time was spent with service users, staff and the manager, viewing the premises and records, observing and following up on the previous requirements. The service has been through an unsettled period, see previous reports. Since the last full inspection (27.10.05) an additional visit has taken place on 25th January 2006. The home had a temporary manager and a new service manager, Mrs Nally had commenced in December 2005. In February 2006 a permanent manager, Mrs Edwins was appointed and a new responsible individual, Mrs Folley is now in post. The key standards were checked and discussed with the manager who has identified that the service needs to improve to meet National Minimum Standards and there was evidence that this had commenced. However as the manager has only been in post for three months, this process had only just begun. At the time of writing this report a new certificate of registration has been issued to include the registered manager. The co-operation and time the manager, service users and staff gave the inspector was appreciated. What the service does well: Maintaining a home for the existing permanent and respite service users, whom the staff have known for some years. The group know each other well and the atmosphere is relaxed, secure and safe with the service being run as a home for 12 (8 permanent and 4 respite service users at any one time) in a traditional way. The service users said they were contented with the service, found the staff helpful and the permanent service users considered it their home. The service was asked to give or send out comment cards to the 7 permanent service users, 23 respite service users and their relatives, the GPs and 10 health and social care professionals. 4 permanent service users, 9 respite service users and their relatives replied saying that overall they were happy with the service. In particular the families appreciated the respite service. Service users said ‘usually listened to’ (3 respite users), ‘usually make decisions about what we do each day’ (2), ‘usually the home is fresh and clean’ Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 6 (4) and ‘would like more activities’ (2 permanent service users). Relatives commented that they were not made aware of inspection and the reports, one was not consulted about the care provided and one considered there were not enough staff. A GP and a community nurse responded that the service was satisfactory. What has improved since the last inspection? What they could do better: The manager has identified that the home needs improving in all aspects for the service users to have a quality service and individual lifestyles. The assessment, admission and care planning must be developed. A programme of daily activities for the service users must be introduced. The upgrading work to the home needs to be completed including cleaning, decorating and carpeting. Also the home should have equipment to assist service users who have physical disabilities. The staffing arrangements need reviewing so that there are more staff on duty when all the service users are at home and less when service users are at day centres. Provide staff with further training and guidance. Introduce a quality assurance system. Improve aspects of health and safety. Please contact the provider for advice of actions taken in response to this Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 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 Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is adequate information about the home and prospective service users are assessed and have opportunities to visit the home. The information needs to be updated, in suitable formats for the service users and circulated to them and their families. The assessment and admission process needs to developed and recorded in detail. EVIDENCE: Both the home’s manager and service manager had separately amended the statement of purpose. To ensure everyone is made aware of what the service provides, a final and updated statement needs to be agreed, with copies available in the home and a copy sent to CSCI. The manager gave an assurance that this would be done by 30.06.06. The manager advised the service user guide had been reviewed and a copy placed in each bungalow. However this was not evident, nor was it in suitable formats for the service users. A member of staff had previously produced a guide in a different format but this was not available. The guide should be in suitable formats and include details of activities, the agreement/contract and the complaints procedure and a copy given to each service user and their family (permanent and respite service users). Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 10 The service was continuing to rely on assessments being carried out by social workers for new service users. The manager agreed that the home should carry out it’s own assessment to ascertain whether the service could meet the needs of the person and whether they would be compatible with the other service users. There was an assessment form for respite admissions but it needed developing for both permanent and respite admissions. Two prospective service users had been assessed recently but for one, staff had not started to complete this assessment form or record the outcome of the person’s initial visit to the home. The manager advised that she had assessed the other prospective service user. For respite users a useful admission form had been introduced to ensure that the service had up to date information about the service user. The form was not always sent in by families or completed by staff on admission and discharge. This needs to be followed up. An agreement/contract was in place for each permanent service user and kept on their file in the home. Another home had amended the agreement for short stays and this needs to be introduced for the respite service users. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The new care planning process needs to be comprehensive, up to date, person centred and regularly reviewed for each service user, including the respite users. EVIDENCE: New service user plans were in place for permanent service users and some of the respite users. A sample were viewed. One plan was detailed as this service user had been admitted last year with a full service user plan form her previous home. The format was suitable but as yet the plans were not comprehensive with detailed information about each persons’ needs, lifestyle, healthcare, goals and how staff would support the service user. For example the following needed to be included: The service user’s daily and weekly activities and routines. The service user’s goals and aspirations Nutritional assessments and guidance for service users with eating and drinking problems. Assessment and guidance for service users with a known sight loss. Records to indicate how service users with weight gain or loss were being supported and monitored. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 12 Details of the wishes of service users regarding faith, in the event of serious illness and dying. Additional details of how to assist service users with personal care needs – continence, bathing, dressing and menstruation. There were guidelines for supporting a service user who occasionally has challenging behaviour but not for another service user. Up to date descriptions of health care needs and medication. Reviews – monthly (a monthly review form was in one file but not completed) six monthly or when needs changed were not evident. In contrast the staff spoken with all had a good understanding of the needs of each service user. The service users were aware that records were kept about them in the office but vague about having been involved in setting up the new plans. It was unclear whether families and day centres had been involved in the process. The service user plans were being kept in the office, not by service users and there was no indication why this was the situation. The plans were not in suitable formats for the service users. Consideration was being given to relocating the service user files to the bungalows in a secure cupboard, which would be preferable. However service users would not be able to have easy access to their individual plan without staff input, therefore discussions should take place about the service users retaining their own plans. If it is agreed with the individual that this is not suitable, the reasons should be recorded in the plan. The home does have a key worker system for the permanent service users – each person has two co-ordinators. The service users and staff were aware of how this worked. Through observations and discussions it was apparent that service user do make decisions about their lives and are supported by staff. However this could be developed further rather than the service users fitting in with the established routines of the home. Advocacy services were not being promoted nor information available about activities in the community (see next section of the report, lifestyles) Risk assessments were included in the service user’s file and most had been reviewed. However the assessments were brief and similar. Service user’s risk assessments should be tailored to each individual’s needs. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users need more opportunities for personal development and with activities in and out of the home. Efforts were being made to provide the service users with a more nutritious, varied and balanced diet. EVIDENCE: A few of the permanent service users and all the respite service users attend day placements some days during the week. Service users enjoyed these regular activities and one was upset that due to a dispute about transport costs the days attended was one rather than three. Other service users did not have regular activities in or out of the home. These service users were choosing when they got up and had breakfast, also free to sit and move about the home. At the first visit the seven permanent service users were at home and it was very disappointing to observe that the only activity provided was the television on in the communal lounge. Service users Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 14 were not watching a specific programme and some were dozing. It was a warm, sunny day and no opportunities were being arranged for the service users to go out, even into the garden. One service user was able to take himself out into town and another was happy to do tracing. It had been planned that a service user would be taken out by his co-ordinator but as this member of staff was not on duty, this did not take place. Service users spoke of enjoying the occasional outings to the pub and cinema. A service user persuaded a member of staff to go to the local pub at the end of the shift. However other service users were not invited, nor was this outing offered during the day. Staff explained that if there were only three staff on duty it was difficult to cover the home and go out with service users. However on this day there were four staff on duty and the manager for seven service users. The manager was most aware that this was unsatisfactory and at the second visit there were more opportunities for the few service users, who were at home, to go out. One service user was taken into town by taxi and another was taken out by staff (in a staff car) to a garden centre. Two service users were looking forward to going to Worcester the next day with staff. There needs to be a programme of activities and outings for service to choose from on a daily basis, including promoting individual living skills. The service needs an activities co-ordinator (or designated staff given time to undertake this task) to gather information, in suitable formats, for the service users to discuss and plan their activities. Consideration should be given to using local community resources such as the college, leisure centre, library, park, bus passes (the home is on a bus route), theatre and cinema. Also other easily accessible facilities in Worcestershire and Birmingham. A record of the daily activities chosen by each individual needs to be kept. The home is now using County Council mini buses for transporting service users to day placements so perhaps these vehicles could be used for other social outings. Most of the permanent service users have family and friends but it was said by a member of staff that visitors rarely stay for a meal. The visitor’s book indicated that family and friends visit infrequently. Both these aspects should be actively promoted. The service users do have their own routines in some aspects but have become accustomed to the established group routines of the service. Staff need to be more proactive in assisting service users in running their own bungalows rather than the focal point of the home being the office and communal lounge (this would lend itself to being an activities room). Only one service user had a key to the bedroom and none had front door keys to their bungalows. Mail was Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 15 opened by service users but was delivered to the office rather than post being delivered directly to the bungalows. Menu plans were being agreed with the service users on a weekly basis in each bungalow, mainly for the evening meal. The food cupboards in the bungalows did have some stock. Individual records of food provided were being kept for mealtimes but no indication of snacks offered at other times if a service user declined food at mealtimes. The manager advised that service users were being involved in food shopping for each bungalow. However it was observed that a member of staff went to do communal shopping and that snacks at lunchtime were prepared and served in the communal kitchen by staff, also teatime drinks and snacks. The communal lounge does not have a dining table so this is not ideal. A service user whose eating and drinking assessment indicated that the person should sit at a table for meals was served food whilst sitting in an armchair and a snack that was not recommended in the assessment. Another service user was not given the choice of a healthy eating snack, which the care plan indicated was to be encouraged. A service user advised that her favourite meals were served and that there was a choice. The respite service users said that they liked the food. Fruit was available in some of the lounges. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users’ personal and healthcare needs must be kept up to date, in detail, in the care plans and health action plans. Any follow up on healthcare matters needs to be acted upon swiftly. The medication system was suitable. Service users wishes in respect of serious illness and dying need to be ascertained and recorded. EVIDENCE: It was apparent from observation and discussions with staff, the manager and service users that their individual personal and health care needs were being met. However the care plans did not indicate this in detail and were not always up to date (see page 11 of this report). Service users were being supported in attending routine check ups. The request of a GP to meet and discuss a health management plan for a service user had not been acted upon swiftly and this needs to be agreed between the home and health care professionals as a priority. Health Action plans had been completed for the permanent service users and retained by them. A copy for reference was in their service user plan. However the plans were not taken to appointments and records kept up to date. It Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 17 would be helpful if respite service users who have health action plans bring the plans with them. The medication system had improved and was now based in the three bungalows where there was a locked medicines cupboard. The administration records were kept with the medicines. There was a separate cupboard in one bungalow for the safekeeping of controlled drugs and a small, separate fridge for storing medicines, if needed, in the office. The manager had a copy of the County Council’s revised medication policy and this needed to be shared with staff. The senior support worker had a good understanding of the medication system. The administration records were being kept appropriately, although in a few instances a record had not been made to indicate that incoming medicines had been checked. A virtually, empty, sticky medicine bottle was observed out of the cupboard. Stains on the carpets were said to be from liquid medication. The medicines and cupboards need to be regularly checked and cleaned. There were three tubes of cream opened in one bungalow and this needs to be addressed so that one tube is used at a time and dated when opened. The majority of permanent service users were regularly taking laxatives and this should be reviewed, recorded, to include looking at the person’s diet and exercise. All the permanent service users have medication but none self medicate. This should be reviewed. It was said that some of the respite service users do and that this was risk assessed. Some of the staff have experience of caring and supporting service users with ageing and illness. This was currently the situation. However the service users plans did not include the wishes of the service users and their relatives in respect of illness and death. As some of the service users are getting older, this is essential and staff may well benefit from training, as previously recommended. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are systems in place to protect the service users. The service users feel that they are usually listened to. EVIDENCE: The home has a complaints procedure which is different formats (CD Rom, video and tape) for the service users and advises them who to go to in the service if they have a concern. It was unclear how accessible this was for the service users but there was a brief procedure in the bungalows. The complaints log indicated that there had been none recorded since 2004, yet there had been some complaints in-house during the last year. The manager advised that there had been no complaints since her arrival but she was monitoring a difficult situation. The County Council’s policies and procedures were in the home relating to protecting vulnerable adults. There was guidance for staff in a service user’s plan in the event of challenging behaviour. The County Council had carried out an audited of the home’s arrangements for finances in October 2006 and many concerns were raised which the service manager had followed up. There was an implementation review in March 2006 and one of the deputies had been involved. The home no longer retains personal monies for respite users and arrangements are being made for all the permanent service users to have their own bank/building society accounts to access their own monies. Three permanent service users still use the joint welfare account and arrangements need to be concluded so that each person Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 19 has their monies transferred to individual accounts. Each service user had a lockable cash tin in their bedroom for the safekeeping of personal monies. If staff are assisting a service user with their monies, a record is kept in the cash tin. Two of the service users showed me how this worked and were delighted that they now had their own personal monies and accounts. Where staff are involved and keeping records, these records must be kept up to date with the balance tallying with the monies in the cash tin. This arrangement should be audited on a regular basis in-house. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises are suitable for groups of service users to live separately in the bungalows. The premises will be homely and safe once the building work has been completed. Equipment needs to be provided to assist service users who have physical disabilities. Aspects of cleanliness and hygiene need improving. EVIDENCE: The premises were purpose built fourteen years ago with all the accommodation provided on the ground floor. The home consists of three selfcontained units/bungalows (3,5, & 7 Exmoor Drive), accommodating 4 service users in each unit. The home also has communal facilities - kitchen, lounge, laundry, toilet, two offices, staff sleeping room with en suite shower and toilet. The home is in keeping with the local community and close to local amenities and a bus route into Bromsgrove town. The furnishings are homely and comfortable. The home has an enclosed garden and patio area. Each bungalow is self-contained, with own front door, an open plan lounge/dining room/kitchen, a bathroom, a separate toilet and 4 bedrooms. There are 12 single bedrooms, on the small side, especially if a service user has mobility problems or a lot of personal equipment and belongings. However Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 21 it is accepted as a pre-existing home as at 31st March 2002. Service users with mobility problems reside in bungalow 7 where the rooms are slightly larger. The bedrooms have a wash hand basin but not en-suites. The bedrooms did not have all the furniture outlined in NMS 26.2, a previous requirement. At this visit work had begun in two of the bungalows to install shower rooms, improve the bathroom and toilet facilities, which will be beneficial to the service users when completed. However at the time of the visit two of the bungalows were affected by the work in progress. Some of the service users showed the inspector their bedrooms, which were personalised and suitably furnished. A permanent service user had changed bedrooms and was pleased. A respite service user said the bed was comfortable and he slept well. The bedroom doors have been fitted with single action locks but only one service user has been given a key to lock their room. A review of the equipment in the home still needed to be undertaken. This is considered necessary with service users who have additional physical disabilities and sensory impairment being accommodated, and with some of the service users ageing and becoming frailer. The following was still awaited: An assessment from an occupational therapist for a service user’s mobility aids. An epilepsy monitor was awaited. A hoist for assisting service users who have falls. A call bell system Aspects of hygiene and infection control need to be reviewed to protect service users and staff: Bungalow 7 does not have a washing machine whilst the other two bungalows do have washing machines in the kitchens. There is also a communal laundry serving all three bungalows. Consideration should be given to installing domestic dishwashers in the bungalows in place of the washing machines, which could be re-sited in the laundry (there is not space for both in the bungalow, open plan kitchens). This would be preferable from a hygiene perspective and it is anticipated that that the environmental health officer would welcome this proposal. This should not prevent the service users from washing their own clothes in the laundry. A few service users now have commodes and procedures need to be in place for the emptying and cleaning of the buckets, which was taking place in the laundry. Manual sluicing should also be avoided and items placed in disposable bags used so that soiled items can be placed in the washing machine on the sluicing cycle. There was a supply of protective clothing in the home but staff indicated no wipes, anti bacterial gel or tissues (a service user was sneezing and it was suggested that the person was given toilet paper) were available. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 22 Staff would benefit from training in infection control. The service needs to obtain a copy of the Worcestershire Infection Control policy. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a stable, experienced staff group who need to be supported and trained to implement the changes to the service and offer the service users a quality service. EVIDENCE: The staffing situation has improved this year and the service has an experienced, trained staff group of permanent workers and relief workers; all of whom know the service users well. The home has the luxury of two deputies and two senior support workers, so with the new manager, should be able to improve the quality of the service for the users and implement the principles of Valuing People. However they need to be working with service users and staff on shifts and proactive regarding activities rather than being office based as observed at the visits (see pages 13 &14). Rotas indicated that there were a minimum of three staff on duty during the day and two at night – one sleeping in and one awake. On weekdays there were often more staff on duty including two senior members of staff, and the manager. On these days some of the service user attend day placements so this would be an ideal opportunity for other service users to be taken out. However in the evening and weekends, when all the service users are at home, there were shifts without a senior member of staff. This imbalance needs addressing. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 24 Staff spoken with were clear about their roles and committed to supporting the service users. Senior staff were pleased to have a manager. A cleaner had just been appointed and the service also has a clerk, gardener/maintenance person. The manager advised that she was preparing a training programme for the year and had identified training that staff had undertaken. It would appear from this training matrix that many staff need to attend refresher courses in safe working practices and care practices. Only 2 of the 14 staff have an NVQ in care. 50 of the staff should have had an NVQ in care by 31.12.05. Many of the staff have undertaken other training, which may well assist them in obtaining an NVQ in Care. Three staff were on a Learning Disability Award Framework (LDAF) course. The manager had established staff records in the home and the sample viewed indicated that a thorough recruitment process had been followed. Evidence of full employment history and previous training should be obtained. CRB checks should not be retained or photocopied. Also there were no records to indicate that an in-house induction programme had been completed for permanent, relief or agency staff. The manager advised that arrangements had been made by the acting manager for staff to have regular supervisions but this was not yet established. Dates were now planned for all staff to receive regular supervision from a senior member of staff and this needs to happen to support staff with the changes to the service. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is good that a manager is in post. However a quality assurance system must be introduced and some aspects of health and safety improved. EVIDENCE: The appointment of a permanent manager who is experienced and trained is welcomed. Mrs Edwins has been a registered manager for various care services for the last fifteen years. This has included care homes for younger adults with learning disabilities. The County Council have not yet introduced a quality assurance programme. The service manager has proposed monthly audits, which would be beneficial. Also of reports of her monthly visits to the home this year are awaited. An annual development plan was not available. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 26 The manager had reviewed the policies and procedures, obtaining the County Council’s policies and procedures. These will need to be introduced to the staff and in some instances personalised for the service. The standard of safe working practices was assessed and it was apparent that there were systems in place to ensure the health and safety of the service users and staff. Gas and electrical services were being checked regularly. The certificate of electrical safety could not be located but a copy had been requested from the County Council. Also the risk assessments for safe working practices and service records for equipment could not be found. The manager was planning to review and develop COSHH records. The accident book and Riddor reports to the County Council were in place but not all accidents/near misses had been recorded in both places. Staff need refresher courses in safe working practices. 9 of the staff had undertaken first aid training. The home should aim at a member of staff trained in first aid being on duty at all times, preferably a first aider; or a risk assessment carried out. The fire precautions were being regularly checked except for the smoke detectors. This appeared to have been lost in the new recording system and the maintenance person gave an assurance that this check would be reinstated. The fire risk assessment had been reviewed on 18.01.06. The manager agreed to follow up on the recommendations in the assessment. Staff had received some fire awareness training in-house, including fire drills, but the manager’s new record indicated that not all staff had received quarterly fire awareness training. Senior staff covering day and night shifts need to undertake training in fire safety management. The daily check of fire precautions and security needed to be expanded to indicate what was being checked. Also there should be a daily check of the bungalows after the workmen have left to ensure that the areas are safe for the service users and risk assessed, if necessary. A smoke detector had been removed for an alteration to start and the loft hatch left open even though no work was currently taking place in this area. Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 1 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 2 3 X 1 2 X 2 X Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 3 Requirement A contract/statement of terms and conditions, that includes all of the information detailed in Standard 5.2 and in a format appropriate to the service users’ needs, must be provided for respite service users. The rules on smoking, alcohol and drugs must be clearly stated in the service users’ contract. (timescales of 31.08.05, 31.01.06 & 28.02.06 not met) For permanent service users: Service user plans must be comprehensive, person centred, cover all of care and support as set out in Standards 2.3,6-21 and Schedule 3, in particular personal and health care. Health action plans must be kept up to date. All service user plans must be signed, dated, maintained and reviewed with the service users when needs change, at the request of the service user or at least once every six months. Timescale for action 31/07/06 2. YA6 15,13 31/07/06 Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 29 For respite service users, prior to their next admission, the requirement above applies. (timescales of 31.12.05 & 31.03.06 partially met) 3. YA6 15,13 The form introduced for each respite admission detailing the service users’ current situation must be implemented. (timescale of 01.03.06 partially met) All service users must be supported in managing their own finances. (timescales of 30.09.05 & 31.12.05 partially met) For all service users risk assessments, where needed, must be individualized and detailed. (timescales of 31.12.05 & 31.03.06 partially met) There must be a programme of activities implemented for the service users. The record of the food provided for individual service users must be developed and maintained in sufficient detail to enable any person inspecting the record to determine whether the diet is nutritious, healthy and satisfactory. (timescales of 30.09.05 & 30.11.05 partially met) An audit of bedroom furniture and facilities must be carried out as listed in Standard 26. If the provision of any item poses an unacceptable risk to the service user or they decline the provision, details of the DS0000037488.V289643.R01.S.doc 18/05/06 4. YA7 20 30/06/06 5. YA9 15,13 31/07/06 6. YA12 16 31/07/06 7. YA17 17 30/06/06 8. YA26 16 31/07/06 Exmoor Drive, 1 Version 5.1 Page 30 discussions and decision about this should be recorded in the service user’s plan. (timescales of 31.08.05 & 31.12.05 not met) 9. YA26 16,13 The service users must be given 31/07/06 bedroom door keys or the reason why this would not be appropriate recorded A review of the equipment in the home must take place to ensure that the service users needs can be safely met and any necessary equipment installed, including a call bell system, a monitor and hoist. (timescales of 31.07.05 & 31/01/06 not met) A walking frame in use must be repaired or reviewed by an occupational therapist. (timescales of 30.11.05 & 28.02.06 not met) Improvements for hygiene and the control of infection must be improved. The home must be suitable staffed at peak times when all the service users are at home so that service users can be supported at home and to go out. A record must be kept of the introduction and induction training given to all new staff, including relief and agency staff. (timescales of 31.08.05 & 31.12.05 not met) A training needs assessment must be carried out for the staff team as a whole and for individual members of staff. DS0000037488.V289643.R01.S.doc 10. YA29 13,23 31/07/06 11. YA29 13,23 31/07/06 12. YA30 13,23 31/07/06 13. YA32 18 31/07/06 14. YA35 13,18 31/07/06 15. YA35 18,13 31/07/06 Exmoor Drive, 1 Version 5.1 Page 31 (timescales of 31.08.05 & 31.01.06 not met) 16. YA39 24 A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and all of the aspects of Standard 39. (timescales of 30.09.05 & 31/01/06 not met) An annual development plan for the home based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users must be provided. (timescales of 31.09.05 & 31.01.06 not met) The remedial work listed in the fire risk assessment must be undertaken. Staff must receive fire awareness training quarterly. 31/07/06 17. YA43 24 31/07/06 18. YA42 23,13 31/07/06 19. YA42 23,13 30/06/06 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 YA2 Good Practice Recommendations The home should carry out and record it’s own assessment on a prospective service user. Service user plans should be in a format, which the service user can understand and be held by the service user unless there are, clear (and recorded) reasons not to do so. 2. YA6 Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 32 3. YA9 The staff should have training in care planning and risk assessing. Service users should have opportunities to participate in activities that enable them to influence key decisions in the home as outlined in Standard 8.3. There needs to be a review as to whether this is a care home for 12 service users or a service being provided in three self contained bungalows. There should be a review of the permanent and respite services being provided in the same home, particularly with the admission of new, permanent service users with high dependency needs. The home’s statement on confidentiality setting out the principles governing the sharing of information should be issued to partner agencies. Opportunities for the service users’ personal development should be provided based on care planning and assessment, covering NMS 11-17. The staff should have training in caring for service users who have increased personal and health care needs The staff should have training in dealing with ageing, illness and death. A policy regarding managing service users’ monies should be introduced. A review should be undertaken to ascertain whether service users could be involved in domestic tasks in their bungalows. All staff should receive training in equality and diversity. DS0000037488.V289643.R01.S.doc Version 5.1 Page 33 4. YA8 5. YA1 6. YA3 7. YA10 8. YA11 9. YA18 10. YA21 11. 12. YA23 YA31 13. YA35 Exmoor Drive, 1 14. YA40 All of the home’s documents including the policies and procedures should be signed and dated by the manager of the home and written evidence provided to show that all of the staff have read and understood them. Consideration should be given to installing dishwashers in the bungalows and relocating the washing machines to the laundry. 15. YA30 Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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 Exmoor Drive, 1 DS0000037488.V289643.R01.S.doc Version 5.1 Page 35 - 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!