Inspection on 16/08/07 for 1 Middlefield Close

This inspection was carried out on 16th August 2007.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Middlefield Close 17/08/06

1 Middlefield Close 21/11/05

1 Middlefield Close 15/08/05

1 Middlefield Close 21/09/04

1 Middlefield Close 05/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Middlefield Close (1) 1 Middlefield Close Middlefield Farnham Surrey GU9 8RS Lead Inspector Suzanne Magnier Unannounced Inspection 16th August 2007 12:00 Middlefield Close (1) DS0000013438.V345445.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 Middlefield Close (1) DS0000013438.V345445.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. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middlefield Close (1) Address 1 Middlefield Close Middlefield Farnham Surrey GU9 8RS 01252 718479 F/P 01252 718479 alison.beverley@new-support.org.uk www.new-support.org.uk New Support Options Limited 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) Alison Deborah Beverley Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the adults with Learning Disabilities accommodated up to 4 may have additional Physical Disabilities. 17th August 2006 Date of last inspection Brief Description of the Service: 1 Middlefield Close is a purpose built, detached bungalow set in a private residential cul-de-sac, located close to the town of Farnham. London and Quadrant Housing Association own the home. New Support Options Limited manages and provides accommodation and care for up to five people with learning disabilities and/or physical disabilities. All areas of the home are easily accessible and the doors and hallways are wide enough for wheelchair access. Communal areas are arranged and furnished in a comfortable, homely way and there are ample toilet and bathing facilities. All bedrooms are single and of a good size, and all have a wash basin. No rooms have en-suite facilities. There is a garden to the rear of the property that is fully accessible to the supported people and there is parking for the homes adapted vehicle and cars to the front of the building. The current charges per week are £ 1,136.15 Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Some additional standards were assessed and have been included within the report. Following the previous key inspection in August 2006 the service has not met all the requirements made. Ms S Magnier Regulation Inspector carried out the inspection and requested attendance by the area manager to support the newly appointed homes manager who represented the service. For the purpose of the report the individuals using the service are referred to as supported people. The inspector arrived at the service at 12 midday and was in the home for five and a half hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The inspector spent time talking and observing people living at the home in order to seek their views about the home and the care they receive. Responses to telephone converstaions that the Commission received included ‘ I hope (my relative) can stay at Middlefields for the rest of his life. He chose the place himself when we took him to visit and he lingered about and made himself at home- he is very well looked after and likes his keyworker.’ ‘Couldn’t be happier everything is excellent I’m delighted’. ‘the lovely atmosphere has been restored , very pleased with the new manager’ ‘staff are very nice and they pick me up in the transport which I really apprciate.’ The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, the terms and conditions of residency in the home, care/person centred plans, risk assessments, medication procedures, staff files, a variety of training records, and several of the services policies and procedures. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, some details of which have been added to the report. From the evidence seen by the inspector and comments received, the inspector Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 6 considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the service does well: What has improved since the last inspection? What they could do better: Improvements to the homes Statement of Purpose and Service User Guide would more fully inform people about the services and accommodation offered by the home. It was evidenced that there remained a level of unmanageability regarding supported peoples the files which resulted in obtaining little evidence that improvements had been made to develop clear documented person centred plans and care plans for each supported person in the home as required at the previous inspection. All supported people’s risk assessments must be accessible and available and kept under review in order to prevent individuals being harmed or being placed at risk of harm or abuse. The homes complaints procedures must be improved to evidence that complaints received by the home are fully investigated. The home must ensure that person must ensure that the complaints procedure shall be appropriate to the needs of the supported people. Documentation (for example a checklist) regarding the selection, recruitment and safe vetting of staff must be available within the home evidence that safe vetting practices to ensure the safety and well being of supported people are being undertaken. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 7 The registered person must give notice to the CSCI without delay regarding any event, which affects the safety and welfare of the supported people. Timescale not met 17/08/06 The home must be kept in a good state of repair and the worn kitchen cabinets must be replaced due to the health and safety of the supported people. Timescale not met 17/11/06 Arrangements must be made for the prevention of spread of infection in the home and the Arjo bath chair cover must be deep cleaned or replaced to ensure robust infection control. The registered person must provide the CSCI with an improvement plan detailing how the home intends to improve the services provided in the home. 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. Middlefield Close (1) DS0000013438.V345445.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 Middlefield Close (1) DS0000013438.V345445.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): 1,2,3,5. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. People and their representatives have information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individual’s needs are appropriately identified and met. Terms and conditions/contracts of stay at the home are available to all individuals. EVIDENCE: The newly appointed manager advised the inspector that she had been in post about a month and during this time she had had the opportunity to look at the homes Statement of Purpose and Service User Guide. She advised that she will be reviewing the format of the documents which would include putting the information in a more easy to read and pictorial format including the use of CD’s (compact discs). The person newly admitted to the home told the inspector that they liked the home. The manager advised that the person’s representatives had visited the home and had chosen the service on behalf of their relative. The inspector sampled a reviewed needs assessment form, which had been more fully developed since the person had been admitted to the home. In response to Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 10 questions regarding new admissions to the home the manager was knowledgeable regarding the criteria and the importance of an individuals needs assessment prior to admission in order to ensure that the home could meet the needs and aspirations of supported people. The inspector sampled the licence agreement for the person newly admitted to the home and noted that it had been signed by them and was located in their personal file. Middlefield Close (1) DS0000013438.V345445.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, 8, 9. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. Improved documentation and management of supported peoples care plans and risk assessments must be implemented to clearly demonstrate that their health, personal care and safety are being met. Supported people are encouraged to make decisions about their lives both inside and outside of the home. EVIDENCE: Some comments received by the inspector from relatives stated ‘ I speak with (my relative) on the phone and he is getting his memory back and is more himself’. The inspector sampled a newly updated person centred plan and care plan related to the individual newly admitted to the home. The person centred plan had been developed with the person and included a variety of aspects of their life including their dreams and aspirations, likes and dislikes, social and cultural history and fears and anxieties. The documents were thoughtfully Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 12 presented including pictures and photographs and offered the reader an insight into the individual’s life. The care plan sampled had also been developed with the supported person and included their everyday life for example a 24 - hour breakdown of their day and their support needs. It also included how they wished to be addressed, whether they preferred gender specific care, and how they preferred to receive care and support from staff. The care plan included agreed working practices to support the individual and guidelines were in place if the individual should become distressed and what actions staff should take to reduce the distress or anxiety. During the previous inspection in August 2006 the inspector noted that the general state of the homes documentation with regard to the care plans and person centred plans was unmanageable. There were various systems in place which included a large double file which contained care plans, risk assessments and an assortment of care related documents, a pen picture file to assist new staff to the home to support a person and an informal person centred plan for example a photo album. It was concluded with the area manager and the newly appointed manager that there was little evidence that improvements had been made to develop clear documented person centred plans and care plans for each supported person in the home as required at the previous inspection. Whilst information may be available in the home it was difficult to locate and was not readily accessible during the inspection. It has been further required that each supported person in the home has a clear documented care plan to ensure their health and care needs are clearly documented and met and that the plan must be kept under review and made available to the supported person and their representative. The inspector observed several supported people moving freely around their home and staff were seen to be attentive and on hand if the supported person needed them. During the lunchtime the inspector noted that one supported person took their meal to their bedroom and later returned to the kitchen/dining area having eaten their meal. Other people moved freely from the lounge or went to their bedroom or spent time lying on the sofa in the hallway. Throughout the home the inspector noted that there were colourful posters which, included supported peoples photos and pictures from magazines which had been used to express peoples opinions and choices about their new kitchen, a holiday to Disneyland Paris and a poster with pictures of people’s individual dreams and aspirations. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 13 The manager explained that one supported person was holding a photographic exhibition in the coming months and had adopted an elephant since the previous inspection. The inspector sampled a variety of risk assessments in place for the person newly admitted to the home for example, health care emergencies, support regarding epileptic seizures in the community, moving and handling, use of bed rails. All the risk assessments had been signed and were current documents. It was evidenced that there remained a level of document unmanageability regarding other supported peoples risk assessments. For example it took both the managers and a care staff member a considerable time to locate a risk assessment regarding the use of a lap strap, which was viewed as a current working practice to support a person in the home. The inspector confirmed that the documentation of the practice of using the lap strap had been required as a result of the previous inspection in August 2006. It has been required that all risk assessments are accessible, available and kept under review in order to prevent supported people being harmed or being placed at risk of harm or abuse. Middlefield Close (1) DS0000013438.V345445.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. This judgement has been made using a range of evidence including a visit to this service. The home promotes and maintains the supported person’s involvement in their local community offers opportunities for personal development, appropriate activities and assists in maintaining and supporting friendships. The supported person is encouraged to be involved in the running of the home and maintaining their daily living skills. A choice of a healthy diet is provided. EVIDENCE: On arrival at the inspection the inspector noted a staff member was supporting an individual into the home having been out for a drive in a car. It was evident during the inspection that the supported people were comfortable and happy in their surroundings and the manager was aware of a low stimulus environment for one person. Colourful activity boards were displayed in the kitchen with photos of the supported people and pictures to identify what activities, hobbies and interests Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 15 were taking place that day and also during the week. One individual signed to the inspector that they were going to be making cakes and do some cooking and at the end of the inspection the manager was given some chocolate fairy cakes. The staff on duty were observed as attentive and engaged with the supported people throughout the inspection. One person in the kitchen enjoyed singing along to their 60s music and another staff member was observed building Lego with a supported person in the lounge. It was agreed at a recent meeting that the home would have the addition of a rabbit who is called Cinnamon and who the manager advised has a risk assessment and with support from staff people in the home will help to feed and care for him. The manager explained that the home are looking at implementing a more active support programme which would include building on peoples existing skills and offering more stimulating meaningful activities. The staff meeting minutes state that the home have been informed by a relative that a person newly admitted to the home likes to have the Bible read to them and a staff member has suggested a picture bible and supporting the person on a regular basis to church on Sundays. The manager explained that the home had improved their links with people’s friends and family and a party was being held at the weekend called ‘Circle of friends’ and all people significant to the supported people had been invited. Staff had also arranged to transport people to and from the event in order that people could meet. One comment received by a relative of a supported person stated ‘it was so good to meet with other relatives at the party last week.’ The inspector noted there were a variety of records related to activities for supported people and included physiotherapy, music and aromatherapy, going to church, using the telephone and watching favourite films. As previously documented the home are organising a trip to Disneyland Paris for three people who have expressed a wish to visit and a ‘count down’ chart with pictures of Disney land was in the hallway in order that people were encouraged and supported to anticipate their holiday. The manager advised that people’s family, friends and care managers had been informed of the holiday and risk assessments had been completed to ensure safe travelling. During the inspection it was noted that the gardener and a member of staff were busy tidying up the garden and mowing the lawns for the party. The garden remains attractive and accessible for people to use. Several supported people were observed to be eating their meals independently with staff available should they need additional support. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 16 The staff meeting minutes indicate that staff are aware and support people with differing diets and are vigilant to people’s health in respect of diet. The home have developed a variety of laminated photographs which illustrate food in order that the supported people can use these as prompts to help in the planning of the menu and discussing what they would like to eat. The homes fridge was well stocked with fresh dairy products and vegetables and the kitchen served as a dining area. Records of fridge and freezer temperatures and food temperatures were available and well recorded. Middlefield Close (1) DS0000013438.V345445.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 adequate. This judgement has been made using a range of evidence including a visit to this service. The home has some recording and documentation to evidence that the supported people receive personal care in the way they prefer and attend health care appointments to ensure their wellbeing and welfare. The homes medication procedures are robust to ensure the safety and wellbeing of all people in the home. EVIDENCE: The one care plan sampled contained clear documents regarding the ways in which the supported person has their personal care needs attended. Preferences were noted with regard to gender specific care, choice with regards to clothes and their freedom to move around in their home. Some records regarding the health care needs of the supported person were clearly documented and included occupational therapists records and physiotherapy reports, GP appointments and specialist health care professional appointments. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 18 The manager showed the inspector some documents which she advised would be used to record the health care needs of all supported people when the new care plans and person centred plans had been developed and these would be available to record appointments attended. The manager explained that for people who cannot use the standing weighing scales they are supported to other New Support Options Homes to have their body weight checked on scales, which are more suitable for them. The medication cupboard is located in a safe place within the home and is locked to ensure security and safety. The home has a monitored dosage system in place and manager has recently reviewed the medication procedures of the home to ensure the safety and welfare of the supported people and staff administering medication. The inspector sampled the medication administration charts and noted that staff administering medication initialled them accurately. Records were in place, which clearly demonstrated the way the person preferred to take their medicines, their photo, and any known allergies. The inspector noted that emergency cards had been developed by the new manager, which included people’s medication and health needs, their allergies, photos and specific support needs regarding communication and health. One relative spoken with on the telephone expressed relief that these documents had been updated in order that they felt sure their relative was well supported in the event of an emergency or admission to hospital. It was noted that a cupboard for storing stock medication was in the corridor and the inspector and managers agreed that improved storage of the stock medicines to another metal cabinet would be more beneficial. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. The homes complaints procedures need to be improved and people are supported to express their concerns and have access to a complaints procedure. Supported people are protected from abuse and have their rights protected. EVIDENCE: The home has a clear complaints procedure, which needs to be updated to include the new commission details and management of the home. The manager advised that she would also be developing the complaints procedure in order that it would be more accessible for the supported people for example the use of pictures. No complainant has contacted the commission with information concerning a complaint made to the service since the last inspection. The AQAA details that no complaints have been received since the last key inspection. One relative spoken with on the telephone advised that they had requested, following the previous inspection, some information regarding their relative from the previous manager and this had not been forthcoming. They then made a formal request in the form of a complaint and the matter was dealt with promptly by the homes Area Manager. Whilst sampling the complaints log the inspector noted that there was a lack of documentation with regard to how the home had responded to complaints Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 20 for example there were no copies of letters sent to a complainant to acknowledge their complaint, no detailed evidence of any investigation undertaken by the home and if the complaint had been satisfactorily concluded. It has been required that the documentation is improved in order to evidence that the home undertakes robust investigations of complaints and people feel free to openly express their opinions and views and complaints are satisfactorily concluded. The manager demonstrated that she was aware of the local authorities multi agency procedures for safeguarding adults and advised that the home follows these procedures. The AQAA details that there have been no safeguarding referrals under these procedures since the last inspection. The inspector noted that the home has a whistle blowing policy and procedure, which is available to staff in order to safeguard people in their care. Staff spoken with during the inspection demonstrated an understanding of the procedures for safeguarding adults and the inspector noted that the manager had made available postcard size safeguarding documented guidance throughout the home in order to offer an open atmosphere in respect of detecting and reporting bad practice. There was difficulty locating the staff training records however the managers advised that all staff receive safeguarding vulnerable adults training and where some staff had not attended the training plans were in place for the staff to attend the in house training in order to safeguard people in their care. The manager advised that she felt confident to present in house safeguarding training to all staff and this would be implemented. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 29, 30. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. The physical layout of the home enables the supported people to live in a safe environment. The home is clean, pleasant and hygienic throughout. EVIDENCE: During the tour of the premises the inspector noted that all areas of the home were well decorated and the home was clean and hygienic throughout. The manager advised that one supported persons bedroom had been recently decorated and another person, with their relative, had chosen paint colours for their bedroom. During a telephone conversation with a relative this was confirmed that the supported person had been helped to make a choice about the redecoration of their room. All people’s rooms were clean and homely with their personal affects and items of leisure. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 22 One room had a stain on the ceiling and the manager advised that this was to be attended to the following day by contractors. The bathrooms were spacious and clean and were assessed by the manager as meeting the current needs of the supported people. The manager explained that an occupational therapist had recently visited the home and had assessed the use of grab rails for a person newly admitted to the home in order to assist with their moving and handling needs and to promote and maintain their mobility skills. The front and back gardens were well maintained and the supported people had the freedom to use both areas for relaxation. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are skilled and in sufficient numbers to provide 24-hour support to the individuals living at the home. Documentation needs to be available to evidence that the home has a robust system for the induction, training development and recruitment of staff to ensure the supported peoples needs are met appropriately and safely. EVIDENCE: The home currently employs ten care staff. On the day of the inspection there were three staff on duty. All staff were observed as skilled in supporting the people in their care and were knowledgeable regarding the specific needs of individuals to ensure their safety, well being and offer reassurance. The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector sampled one staff file, which contained an application form, with two references, evidence that face- to -face interviews had taken place and the job description in order that the staff member was clear about their roles and responsibilities. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 24 There was no documented evidence that a CRB clearance had been obtained and no evidence that induction and mandatory training had been undertaken apart from a current moving and handling certificate in the staff members file. The manager asked the staff member about their records and was advised that their induction folder was at home. A requirement has been made that documentation (for example a checklist) regarding the selection, recruitment and safe vetting of staff must be available within the home in order to evidence that safe vetting practices to ensure the safety and well being of supported people are being undertaken. The area manager and newly appointed manager had difficulty locating the staff training records to evidence that staff had received mandatory training and that the training was current. The manager advised that she would be collating an updated list in order to confirm that all staff have received the necessary. CSCI were advised that the manager had identified some shortfalls in the staff training and the home has been prompt to ensure that staff training for first aid and health and safety has been booked to be attended within a month. The AQAA identifies that 60 of staff are currently involved in achieving their National Vocational Qualification in Care (NVQ) awards. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. 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 a range of evidence including a visit to this service. The management and administration of the home needs to be improved. The home is run in the best interests of the supported people. Health and safety in the home needs to be better managed. EVIDENCE: The pace of the home was designed to meet the needs of the supported people. It was evident through observation and talking with staff that the manager had good knowledge about managing the care home and had the skills and experience to ensure the safety and well being of all persons in the home. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 26 Comments received from the three relatives spoken with on the telephone stated that they felt that the manager was ‘approachable’ and that ‘ there is an altogether nicer atmosphere and approach in the home’. The newly appointed manager has attained her Level 4 National Vocational Qualification (NVQ) and Registered Managers Award. As previously documented it was noted during the inspection that the documentation in the home is in disarray and was viewed as unmanageable during the inspection. The inspector has recommended that the newly appointed manager be given dedicated time in order to address this shortfall and this was agreed at the time of the inspection. The manager will have a two-week supernumerary time frame, to be extended if necessary, in order to render the homes records and office space more effective to ensure the overall efficient management of the home. The manager explained that each supported person has a pictorial Quality Assurance booklet, which is currently being completed with the supported people, and their relatives if they choose. The Quality Auditor Senior Practitioner visits the service to support and encourage staff to work and support people in a person centred way for example how can the aspirations of service users be met within the residential setting. The inspector noted that food stored in the home refrigerator was labelled and stored in compliance with food hygiene standards and hot food temperatures had been recorded to ensure as far as reasonably practicable the home is free from hazards to the supported people. The inspector sampled the accident and incident records within the home and noted that three incidents in March 2007 that had occurred in the home had not been reported to the Commission for Social Care Inspection. (CSCI) The incidents involved a person falling out of bed, omitted medication and falling from a wheelchair with the person banging their head. It was noted that during the last inspection in August 2006 that similar incidents had not been reported to CSCI. A further requirement has been made that the home must give notice to the CSCI without delay regarding any event, which affects the safety and welfare of the supported people. A letter of concern has been sent to the responsible individual and an email communication has confirmed that the manager has met with all staff to inform them of their duties to report incidents with regard to the Regulation 37 notification legislation. The kitchen/dining room area was noted to be suitable for the needs of the supported people. A previous requirement made during the last inspection in August 2006 that the worn kitchen cabinets are replaced due to the health and safety of the supported people had not been met. The manager advised that she and the staff had consulted with the supported people regarding their choice and had also been arranging the kitchen refurbishment with the housing Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 27 association. A further requirement has been made that the worn kitchen cabinets are replaced due to the health and safety of the supported people within the timescales set. The inspector noted that the seat cover on the Arjo bath chair was unclean and the seat cover worn. The manager advised that a new seat cover would be purchased and a requirement has been made that arrangements must be made for the prevention of spread of infection in the home. Hand washing facilities were available throughout the home and clinical waste disposal appropriately managed. The inspector sampled the finance records for one person supported and noted that the procedure was robust and all transactions accounted. The manager advised that a written policy and procedure had been implemented with regard to staff seeking authorisation from the persons significant others and care manager’s prior to any expenditures over a certain amount in order to safeguard all concerned. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 3 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 3 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 3 X X 1 X Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 15.(1)(2)(a-d) Requirement The home must prepare a clear written care plan to demonstrate how a supported persons needs in respect of their health and welfare are met. Timescale not met 17/10/06 The plan must be kept under review and made available to the supported person and their representative. Timescale not met 17/10/06 All supported people’s risk assessments must be accessible and available and kept under review in order to prevent individuals being harmed or being placed at risk of harm or abuse. The homes complaints procedures must be improved to evidence that complaints received by the home are fully investigated. The home must ensure that person must ensure that the complaints procedure shall be appropriate to the needs of the supported people. Timescale for action 16/10/07 2 YA6 15.(2)(b) 16/10/07 3. YA9 13.(6) 14.(2)(a-b) 16/10/07 4 YA22 22.(3)(4) 16/10/07 5 YA22 22.(2)(5) 16/10/07 Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 30 6. YA34 7,9,19,Sch 2 7. YA42 37 (1)(a-g) 8. YA42 23.(2)(b) 9. YA42 13.(3) 10. YA37 24.A Documentation (for example a checklist) regarding the selection, recruitment and safe vetting of staff must be available within the home evidence that safe vetting practices to ensure the safety and well being of supported people are being undertaken. The registered person must give notice to the CSCI without delay regarding any event, which affects the safety and welfare of the supported people. Timescale not met 17/08/06 The home must be kept in a good state of repair and the worn kitchen cabinets must be replaced due to the health and safety of the supported people. Timescale not met 17/11/06 Arrangements must be made for the prevention of spread of infection in the home and the Arjo bath chair cover must be deep cleaned or replaced to ensure robust infection control. The registered person must provide the CSCI with an improvement plan detailing how the home intends to improve the services provided in the home. 16/10/07 16/08/07 16/12/07 30/08/07 17/10/07 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 YA37 Good Practice Recommendations The inspector has recommended that the newly appointed DS0000013438.V345445.R01.S.doc Version 5.2 Page 31 Middlefield Close (1) manager be given dedicated time in order to address this shortfall and this was agreed at the time of the inspection. The manager will have a two-week supernumerary time frame, to be extended if necessary, in order to render the homes records and office space more effective to ensure the overall efficient management of the home. Middlefield Close (1) DS0000013438.V345445.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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