Inspection on 17/08/06 for 1 Middlefield Close

This inspection was carried out on 17th August 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 no outstanding requirements from the previous inspection report, but made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Middlefield Close 16/08/07

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 17th August 2006 13:30 Middlefield Close (1) DS0000013438.V297282.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.V297282.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.V297282.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 alisonbeverley@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), Learning disability over registration, with number 65 years of age (2), Physical disability (4) of places Middlefield Close (1) DS0000013438.V297282.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. 21st November 2005 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. The home is owned and managed by New Support Options Limited 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 service users and parking for several cars to the front of the building. The home has its own vehicle for accessing activities in the local community, trips out and attending day centres. The current scale of charges are £1,100- 1,300.00 per week. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit on the 17th August 2006 took place over 7.5 hours commencing at 13.30 until 20.30 and was initially conducted with the registered manager, Mrs Alison Beverley and a senior support worker. In discussion with the staff the inspector was advised that the service users prefer to be known as supported people and will be referred to as such throughout the report. Throughout the site visit the inspector met with all the supported people and the staff on duty. The main focus of the site visit was to ascertain that that the requirements made during the previous inspection in November 2005 had been met. Due to the complexity of some supported persons needs it was difficult to obtain direct feedback regarding their views and opinions of the home. Therefore, observations of behaviour, body language and ways of communicating were noted during the inspection. A full tour of the premises took place and documents inspected included care plans, risk assessments, health care records, finance and medication procedures, health and safety records, menu plans and activity charts. Staff records were sampled at New Support Options Head office on the 1st September 2006. The inspector would like to thank the supported people, registered manager and staff for their time, assistance and hospitality during the inspection. What the service does well: What has improved since the last inspection? The home has recently purchased a new wheelchair adapted vehicle. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 6 The garden of the home has significantly improved with attractive borders, sensory equipment, and gazebo and home grown vegetables used by the home. The homes staff are committed to working with the supported people on an individual basis which has improved the lives of the people they support and person centred planning is in the early stages of development in the home. What they could do better: Improvements are required in the clear documentation of person centred plans (service users care plans) and the documentation of risk assessments to ensure the supported persons welfare and well being. A relative commented that they felt that more could be done to relieve the possible tedium of the supported peoples lives, and they rarely saw the television on as their relative used to enjoy watching the screen. All records relating to any supported person need to be recorded and stored for each individual supported person in a manner, which reflects their rights to dignity, privacy and confidentiality. Some comments received by the inspector from relatives indicated that the home does not always consult with them regarding issues of their relatives care. An improvement would be that all staff remember to include and talk to peoples relatives and involve them more fully in the lives of their relatives. The homes policies and procedures for the administration and safe handling of medication require immediate attention to ensure that supported people are protected by these arrangements. The complaints procedure must be available to supported persons representatives and all staff must receive training in safeguarding vulnerable adults. This will ensure that all representatives are aware of what to do in the event of a concern and that their views are listened to. It will also ensure that the staff are suitably trained to protect supported people from abuse. A number of shortfalls regarding a supported persons bedroom decoration and respect/dignity regarding their personal belongings and infection control were evidenced and requirements for improvements made. Satisfactory recruitment checks must be completed prior to the employment of care staff in order to ensure the safety and welfare of the supported people. CSCI have required a training plan regarding the homes staff achievement of the National Vocational Qualification to ensure that supported people are supported by trained and competent staff at all times. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 7 The registered person must ensure that the home is kept in a good state of repair and the worn kitchen cabinets must be replaced to promote the health and safety of the supported people. The registered person must ensure that risk assessments are completed for the use of the ‘overflow fridge’ and the policy and procedure for handling supported peoples finance is reviewed. This will ensure that supported people are protected by these arrangements. 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. Middlefield Close (1) DS0000013438.V297282.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.V297282.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving to the home have sufficient information available to them in order to ensure that the home would meet their needs. EVIDENCE: There have been no admissions to the home since the previous site visit in November 2005. The Statement of Purpose and Service User Guide were sampled and have been up-dated and both documents remain person centred and include pictures and photographs as well as words. Each supported person’s bedroom and the communal areas of the home are illustrated in the guides. The inspector sampled licence agreements within the service users guide, which were individually stored in the supported persons bedroom. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected 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. Supported people are encouraged to make decisions about their lives and assistance as needed. Improvements are required in the clear documentation of person centred plans (service users care plans), specific guidelines of support must be reviewed and the documentation of risk assessments to ensure the safety and wellbeing of the supported people. EVIDENCE: The inspector evidenced that the home has several systems in place regarding care planning/person centred care plans. The systems include 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, an informal person centred plan for example a photo album. The photo album had been made into an attractive and personalised case history which includes photos of staff, the person’s aspirations, dreams, and activities, family and friends, and a set of person centred planning documents. The manager explained that currently two supported people have an informal person centred plan and it is envisaged that the informal plans will be Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 11 developed with the remaining supported people and their relatives, representatives and friends. The care planning documents in the large double file for one supported person sampled by the inspector were dated July 2005. The documents detailed a comprehensive history of the supported person which included their childhood history, likes and dislikes and visits to relatives. The two communication profiles were comprehensive and the file also contained a section of every aspect of the care needs of the individual, and a reference section on each page. Overall the documents were in a state of disarray and some part completed. The manager showed the inspector another folder, which contained blank copies of a supported persons person centred plan, which had not been completed. Details of the supported persons care manager and community support worker were incorrect and required updating. In general the state of the care planning documents sampled pertaining to the one supported person were unmanageable and did not offer a consistent plan of care and support needed by the supported person. It is required that the home prepare a written plan (person centred plan) which clearly demonstrates how the supported persons needs in respect of their health and welfare are met. The plan must be kept under review, made available to the supported person and their representative. The manager advised that the Quality Auditor Senior Practitioner was working with staff to implement the person centred plans and that the home is awaiting input from the family and staff. The manager explained that each supported person has a key worker who oversees the care plans for each individual. 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 evening meal the inspector noted that one supported person was encouraged to leave the table when they wanted and to return when they chose to. Independence was promoted with several supported people independently eating their meals with staff available should they need additional support. The inspector sampled a variety of risk assessments in place for example using the bath, health care emergencies whilst in the bath/shower, using toilet without supervision, moving and handling assessment, nutritional risk assessment, falling out of bed, support regarding epileptic seizures in the community, opportunity to go swimming, refusing to take medication, appropriate use of monitor system, getting into the mini bus, informed choice regarding health care appointments and ingestion of foreign objects. All the risk assessments had been signed as being updated in June 2006 by a member of staff who had since left the home. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 12 The inspector noted that one supported person was assisted to sit in an armchair with a lap strap in place and no risk assessment had been completed or the use of the lap strap subsequently been agreed by other health care professionals or the persons family members. Reference to the use of a wheelchair lap strap was documented and seen. It was noted that the risk assessments included a section, which asks if other health care professionals, care managers, and family members have been consulted regarding the risk assessments and the sections had not been completed. An immediate requirement has been made that use of any restraint for service users must be clearly documented and agreements made with the supported person, where possible, and their representatives and documented in order to safeguard the supported person and staff from suspected abuse or harm. It was noted that the front sheet for risk assessments had not been signed by all staff to confirm they had read the risk assessment and agreed to work within the risk management framework. Additionally the risk assessment list did not contain the current staff member’s names. A requirement has been made the home must ensure that all staff sign and agree to support people in conjunction with the agreed working practice in order to ensure the safety and well being of the supported person and the staff member. There was a lack of confidentiality in that as a record for eye appointments found in a supported persons file had been adapted with the use of correctional fluid as the document contained all the names and results of the eye appointments for the other supported people in the home. It is immediately required that all records relating to any supported person are recorded and stored for each individual in a manner which reflects their rights to dignity, privacy and confidentiality. Nighttime records were sampled and detailed the support given to individuals through the night. Some comments received by the inspector from relatives indicated that the home does not always consult with them regarding issues of their relatives care. An improvement would be that all staff remember to include and talk to peoples relatives and involve them more fully in the lives of their relatives. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected 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 good. This judgement has been made using available evidence including a visit to this service. The home encourages and enables the supported people to lead fulfilling lifestyles both inside and outside the home. Menus sampled evidenced a healthy diet. EVIDENCE: The home has recently purchased a new wheelchair adapted vehicle. Several supported people went out for a drive in the afternoon and were observed being supported in a safe and competent manner by the staff. The staff were noted to be attentive and engaged with the supported people throughout the inspection. During the afternoon staff were noted to engage with one person in building Lego. The home has developed a pictorial staff rosta and a weatherboard in kitchen for one supported person who is interested in the weather. The inspector also noticed that one supported person was keen to adopt an elephant and staff had enquired on their behalf about how to arrange for the adoption. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 14 The inspector sampled documentation, which demonstrated that supported people are encouraged to spend time and nights away from the care home to visit family and friends. Relatives comments included ‘I am more than satisfied with the care my relative receives and very grateful to the staff for bringing him home every fortnight.’ ‘ My relative seems the happiest at Middlefield than he has ever been elsewhere’. Another relative commented that they felt that more could be done to relieve the possible tedium of the supported peoples lives, and they rarely saw the television on as their relative used to enjoy watching the screen. The inspector noted there were a variety of records related to activities for supported people and activity sheets in care plans, which were dated July 2005. Activity plans documented a variety of activities including physiotherapy, music and aromatherapy. The home has significantly developed the garden area for the supported people, and includes the home growing some vegetables; attractive flower borders and pot plants have been arranged. The inspector shared an evening meal in the kitchen /dining room with all the supported people and it was noted that the staff member prepared the meal in a safe and competent manner. The supported people were encouraged to be independent in having their meals and staff were available to support one person in a dignified way. One supported person was free to leave the table and return when they chose to with staff responding positively to the person’s individual needs. The meal served was wholesome and served to each person individually. The table was pleasantly arranged and included napkins and condiments and one staff member ate their evening meal with the supported people. The home has developed a see/read menu, which was bright and attractive and attached to the notice boards in the kitchen area for all people in the house to see. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 15 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 poor. This judgement has been made using available evidence including a visit to this service. Some documents evidenced that people are supported in a way, which they prefer and the support is consistent and supported people have a know how the care will be provided. The recording of healthcare appointments needs improving to evidence clearly that each supported persons health care needs are being met. The homes policies and procedures for the administration and safe handling of medication require immediate attention and currently do not protect the supported people. EVIDENCE: The inspector sampled some records, which indicated how the supported person prefers to be supported regarding their personal care and how the care must be undertaken in a predicable and consistent way by staff. The care plan also evidenced that particular working practices must be adhered to by staff regarding the safety of the supported person for example use of a monitor in the persons bedroom and the person wearing a protective helmet when undertaking certain activities. The care plan evidenced that the supported person had attended some health care appointments, which included specialist health care, medication level checks and eye appointments. The health care documents in the section within Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 16 the care plan sampled by the inspector were noted to be unmanageable and it was difficult to ascertain a clear audit trail of appointments attended. The inspector noted that the care plan did not contain any chiropody appointments and the manager advised that these were only recorded in the supported persons financial receipts within the persons cash tin. Community eye care appointments had been undertaken in the home in 2004. It has been required that the home must ensure that details of any plan and attendance to healthcare appointments are recorded for each individual in order to ensure that their healthcare needs are being appropriately monitored and met. The inspector sampled the homes medication file, which contained a medication administration policy updated in 26.4.05. The file also included medication policies and procedures dated 2000, 1999,and staff signatures of staff that were no longer employed. The policy referred to West Berkshire Housing Consortium and also contained a document relating to the optician in 2002. No records were found regarding a general medication review for the supported people and the manager explained that this was due to the complexity of arranging a multi disciplinary meeting to review the medication of the supported person. A Pharmacy Audit record was evidenced and dated 22.9.03. The manager stated that a more recent medication audit had been undertaken but the record of the visit could not be located. Medication administration charts witness forms were sampled and were not fully complete. The records for staff to administer non-oral medication in an emergency were dated 2002 and included the name of a current supported person and a two supported people who had left the home. The inspector sampled records for medication to be given on an as needed basis and it was noted that the guidelines were well defined and had been adhered to by staff administering medication in order to ensure the wellbeing of the supported person. A care plan indicated that a jelly mixture called Thick and Easy was given to a supported person with their medication and it is recommended that the preferred way people are supported to take their medication is recorded clearly within the persons medication profile. An immediate requirement has been made that the home documents and clear and comprehensive policy and procedure for the receipt, recording, storage, safe handling, administration and disposal of medicines in the care home be reviewed. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 17 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. The arrangements for complaints and safeguarding adults require improvement to ensure people are confident that their views are listened to and acted upon, and that all staff are trained and competent to protect supported people from abuse. EVIDENCE: The home has a complaint procedure, which includes details of how to make a complaint and also documents the Commission for Social Care Inspection (CSCI) details. The inspector observed that it would be difficult for the people being supported to raise complaints as only one person uses formal speech to communicate. The manager advised that the staff rely on external input e.g. families, other carers, members of the public, the staff also rely on observation of residents body language, tone etc. Written comments received from relatives indicated that not all relatives had received official advice about how to make a complaint. A requirement has been made that the home supplies a written copy of the complaints procedure to any person acting on behalf of the supported person in order to ensure that all concerns and complaints are investigated. The home has a copy of the Surrey Multi Agency Safeguarding Adults policies and procedures dated 2005 and the inspector sampled the New Support Options generic policy and procedure for safeguarding adults. Staff records relating to vulnerable adults training evidenced that the registered manager had undertaken the Surrey Multi Agency Safeguarding Adults training in 2004. The staff training records for safeguarding adults were Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 18 not up date. In discussion with the manager she advised that she was not confident to cascade training to the staff team although the staff receive safeguarding adults training as part of their induction. A requirement has been made that all staff attend training in the protection of vulnerable adults within the timescale set in order to ensure the protection and safety of supported people in their care. The home has no current referrals under the Surrey Multi Agency safeguarding adult’s procedures. The manager told the inspector that she has confidence in the staff members ability and awareness to whistle blow if they observed or had cause for complaint regarding a supported persons care. The inspector asked two members of staff, on separate occasions during the site visit, what the process of whistle blowing was in the home and both staff members responded confidently stating that they would have confidence that the organisation and the manager would deal with the alleged malpractice appropriately to safeguard the supported person. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 19 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, 25, 27, 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The premises provide a homely environment however a number of shortfalls regarding a supported persons bedroom and their personal belongings were evidenced and requirements for improvements made. The home was observed to be clean and hygienic. EVIDENCE: The home offers a purpose built environment, which is light, airy and homely and contains no malodours. The lounge had been recently decorated. The inspector sampled all supported person’s bedrooms and noted that all except one, as detailed below, had been newly decorated. Each room was individualised and contained personal items belonging to the supported person. One bedroom sampled by the inspector was part decorated and it was evident in discussion with the manager that no plan had been arranged for the completion of the decoration. The inspector noted that personal items for the supported person for example their framed pictures, wall clock, rug and electric toothbrush were stored on the floor of the room. The inspector noted Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 20 that the supported persons clothing in their wardrobe for example shirts and trousers had not been ironed after being laundered. The supported persons bed linen had a continence pad over the bottom sheet, which was soiled. It was observed that the supported person did not use formal speech to communicate and would not be able to ask staff to complete the decoration and take more care of their personal possessions. An immediate requirement has been made that the supported persons bedroom decoration is completed, their personal possessions are stored appropriately and the home ensures that satisfactory standards of hygiene are maintained in the home. The home has adequate bathroom and toilet facilities and the inspector noted that following the previous site visit the home has decorated the bathroom to make it more homely. The manager explained that the bath and the shower facility within the home offer an opportunity for the supported people to make a choice which option they prefer. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Supported people in the home benefit from clarity of staff roles and responsibilities. Staff achievement of the National Vocational Qualification (NVQ) needs to be reviewed and staff recruitment checks improved in order to ensure the safety and well being of the supported people. EVIDENCE: Staff observed during the site visit showed commitment and care to the people being supported. The staff spoke favourably of the manager and the organisation. It was noted that some staff engaged very positively and encouraged non-verbal communication with several supported people in a dignified manner. The inspector sampled the staff files on the 1st September 2006 at the New Support Options local area office in Aldershot. New Support Options undertake the initial advertising of the vacancy and two senior managers undertake the short-listing process, which includes the registered manager. New Support Options have recruitment and selection policy, which incorporates equal opportunities and the inspector, sampled three staff files. One of the three staff files of a newly appointed staff member did not contain adequate references. A requirement has been made that satisfactory checks Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 22 must be completed prior to the employment of care staff in order to ensure the safety and welfare of the supported people. All staff have job descriptions and employment contracts in order that they are clear about their roles and responsibilities. The inspector was advised that staff applicants are invited to visit the care home in order that both parties can meet and the supported people have an opportunity to express their views about the prospective member of staff. The home has four new members of permanent staff and four new bank staff who work regularly when required. The staff team comprise of twelve staff, which includes bank staff. Records indicated that three staff were currently undertaking an National Vocational Qualification (NVQ) and the manager explained that due to the recent turnover in the staff group and the general lack of NVQ assessors in the region the organisation as a whole is not achieving the targets regarding achievement of NVQ. CSCI have required a training plan to address this shortfall. The inspector sampled the New Support Options training and development plan and all staff mandatory training was sampled as current. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 23 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): 37,39,40, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The supported people benefit from a well run home. Supported people can be confident that their views will be taken into account regarding development of the home. The health and safety of supported people needs to be improved to fully promote and protect their welfare. EVIDENCE: The registered manager has attained her Level 4 National Vocational Qualification (NVQ) and Registered Managers Award and is currently undertaking the NVQ Assessor award in order to support staff to achieve their NVQ qualification. New Support Options are continuing to undertake an evolution pathway which is centred on making the organisation/services as a whole more person centred led. The organisation has several documents regarding the pathways of the process, which evaluates each month the progress made within each service. The Quality Auditor Senior Practitioner visits the service each month to support Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 24 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 not labelled and stored in compliance with food hygiene standards and hot food temperatures had not been recorded since 3.8.06 due to the battery thermometer running out. A requirement has been made that the home must ensure that all food is stored in compliance with food hygiene standards and all hot food temperatures are recorded in order 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 accidents since March 2006 that had occurred in the home had not been reported to the Commission for Social Care Inspection. (CSCI) The inspector spoke with the senior staff member who was on duty on two of the occasions when the incidents had not been reported and outlined the legislative requirements for reporting accidents and incidents to the CSCI The inspector sampled the recorded fridge and freezer temperatures, which were well recorded. All fire extinguishers throughout the home had been serviced and fire safety records were documented. The kitchen/dining room area was noted to be suitable for the needs of the supported people and had been recently decorated. Several cupboards in kitchen were ill fitting due to wear and tear and also the chipboard was noted as cracked. It is required that the worn kitchen cabinets are replaced due to the health and safety of the supported people. In the kitchen the inspector noted a fridge which contained a padlock the manager advised that the fridge was an ‘overflow fridge’ which contained additional dairy products and other goods. The manager explained that one supported person would throw the contents away if they were not locked in the fridge. A requirement has been made that a risk assessment is completed in order to ensure that restrictions of food are clearly documented in order to protect the supported persons rights and welfare. 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 there was no written in house policy and procedure regarding securing supported peoples money and a requirement has been made that the procedure is documented to ensure that measures are in place to continue to safely secure peoples finance. The manager explained that external auditors audit the supported persons financial records yearly. Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 1 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 1 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 1 X 3 x 3 2 x 2 x Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15.(1)(a-d) Requirement Timescale for action 17/10/06 2 YA9 13.(4)(a-c) 3 YA9 13.(7) 4 YA9 13.(8) The registered person must ensure that the home prepares a written plan (person centred plan) to demonstrate how a supported persons needs in respect of their health and welfare are met. The plan must be kept under review and made available to the supported person and their representative. The registered person must 17/10/06 ensure that all staff sign and agree to support people in conjunction with the agreed working practice and risk assessments in order to ensure the safety and well being of the supported person and the staff member. The registered person must 17/10/06 ensure that no supported person is subject to physical restraint, including the use of straps in an armchair, unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service users. The registered person must 17/08/06 ensure that on any occasion a DS0000013438.V297282.R01.S.doc Version 5.2 Middlefield Close (1) Page 27 5 YA10 6 YA19 7 YA20 8 YA22 9 YA23 supported person is subject to physical restraint, the registered person shall record the circumstances including the nature of the restraint, and ensure that agreements are made with the supported person, where possible, their significant others including Care Managers and health care professionals, and the actions documented in order to safeguard the supported person and staff from suspected abuse or harm. 12.(4) The registered person must ensure that the home is conducted in a manner that respects the privacy, dignity and confidentiality of the supported people. 13.(1 b) The registered person must 17.(1 a) ensure that details of any plan Sch 3.3 (m) and provision of specialist healthcare is recorded for each individual supported person, including chiropodist and opticians appointments. 13.(2) The registered person must ensure that the home documents a clear and comprehensive policy and procedure for the receipt, recording, storage, safe handling, administration and disposal of medicines in the care home to ensure the safety and welfare of the supported people. 22.(5) The registered person must ensure that the home supplies a written copy of the complaints procedure to any person acting on behalf of the supported person in order to ensure that all concerns and complaints are investigated. 13.(6) The registered person must DS0000013438.V297282.R01.S.doc 17/08/06 17/10/06 17/08/06 17/10/06 17/10/06 Page 28 Middlefield Close (1) Version 5.2 10 YA25 23.(d) 11 YA25 12.(4)(a) (5)(b) 12 YA25 12.(4)(a) 13.(3) (4)(a)(c) 13 YA34 7,9,19,Sch 2 14 YA32 18.(1)c(i) 15 YA40 13.(6) ensure that arrangements are made by training staff or by other measures to prevent supported people being harmed or suffering abused or being placed at risk of harm and abuse. The registered person must ensure that all parts of the home are kept reasonably decorated and the supported persons bedroom decoration is completed. The registered person must ensure that the home is conducted in a manner, which respects the dignity of service users with regard to their personal belongings and laundered clothing. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the home and service users are treated with respect and dignity regarding management of continence. The registered manager must ensure that satisfactory checks, including references, must be completed prior to the employment of care staff in order to ensure the safety and welfare of the supported people. The registered person must ensure that all staff receive training appropriate to work they are to perform. CSCI have required a training plan regarding the homes achievement of the National Vocational Qualification. The registered person must ensure that a procedure is documented to ensure that measures are in place to DS0000013438.V297282.R01.S.doc 17/08/06 17/08/06 17/08/06 17/10/06 17/10/06 17/09/06 Middlefield Close (1) Version 5.2 Page 29 16 YA42 17 YA42 18 YA42 19 YA42 20 YA37 continue to safely secure peoples finance. 13.(4)(a)(c) The registered person must ensure that all food is stored in compliance with food hygiene standards and all hot food temperatures are recorded in order to ensure as far as reasonably practicable the home is free from hazards to service users safety. 37 (1)(a-g) The registered person must give notice to the CSCI without delay regarding any event which affects the safety and welfare of the supported people. 23.(2)(b) The registered person must ensure that the home is 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. 13.(6) The registered person must ensure that a risk assessment is completed in order to ensure that restrictions of food in the ‘overflow fridge’ are clearly documented in order to protect the supported person’s welfare. 24A The registered person must provide the CSCI with an improvement plan detailing how the home intends to improve the services provided in the home. 17/08/06 17/08/06 17/11/06 17/09/06 17/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Middlefield Close (1) DS0000013438.V297282.R01.S.doc Version 5.2 Page 31 - 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. 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