Inspection on 26/02/08 for 1 Old Station Close

This inspection was carried out on 26th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Old Station Close 19/03/07

1 Old Station Close 12/12/05

1 Old Station Close 08/08/05

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 1 Old Station Close Shepshed Leicestershire LE12 9NJ Lead Inspector Ruth Wood Unannounced Inspection 26th February 2008 10:40 1 Old Station Close DS0000062107.V360031.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 1 Old Station Close DS0000062107.V360031.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. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Old Station Close Address Shepshed Leicestershire LE12 9NJ 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) 01509 506218 01509 506441 Prime Life Ltd *** Vacant *** Care Home 21 Category(ies) of Learning disability (7), Mental disorder, registration, with number excluding learning disability or dementia (21) of places 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person falling within category LD to be admitted to the home unless that person also falls within the category of MD - ie dual disability. No person to be admitted to the home in the category MD/LD when 7 persons in total in this category are already accommodated in the home. 19th March 2007 Date of last inspection Brief Description of the Service: 1 Old Station Close is a residential care home for a maximum of 21 people who have either mental health illnesses or learning disabilities. The home is purpose built and is separated into three smaller units named Peach Abbey, Strawberry Manor and Cherry Lodge, all linked by an adjoining corridor, with the main office located off this corridor. Each unit has its own garden, kitchen, lounge and dining area. All communal accommodation is located on the ground floor and bedrooms are located on the first and second floors. The home is located in Shepshed, Leicestershire and is close to the town centre and local amenities. Fee levels are arranged directly with local authorities and additional payments are made for some service users for one-to-one support. Information about the home and the support and services included is available in the service users’ guide. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place on two consecutive weekdays between 10:40 and 16:40 on the first day and between 10:00 and 13:00 on the second day. The support plans of four service users were looked at in detail and their support needs discussed with the acting manager and other staff members. The inspector spoke with three of these service users and a further eight service users. Interaction between service users and staff was observed and recruitment and training experiences were discussed with three staff members. A variety of records were examined, including those relating to service users’ finances, staff recruitment and fire system testing and maintenance. All communal areas were viewed together with three service users’ rooms. What the service does well: What has improved since the last inspection? What they could do better: The information in the service users’ guide needs updating so that service users have up-to-date information about the current manager and staff team to enable them to make an informed decision as to whether the service can meet their needs. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 6 The support that people need and how it should be delivered must be expressed more clearly in support plans and this information should be easily accessible to staff at all times. Plans about how people are supported to manage their diabetes need particular attention and staff need some training in this area to make sure that their understanding of the condition is sufficient to offer good support. Staff would also benefit from training in how to communicate with service users who have a hearing loss. The support plan of one person with a hearing loss needs clarifying to make sure that staff communicate with them in a consistent and appropriate way. Opportunities for developing and maintaining some service users’ independent living skills could be improved. Records of meals served must be kept regularly and include any information of choices made available to people with specific dietary needs. This will enable better monitoring of the nutritional quality of food served. Medication records must be completed each time any person’s medication is administered and the reason for any gaps must be identified and recorded. All staff should receive training in meeting the needs of people with mental ill health, managing challenging behaviour, recognising abuse and safeguarding vulnerable adults; this should be regularly updated. Staffing levels should be reviewed to make sure that they are sufficient to meet the needs of service users and to ensure the safety of staff and service users. 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. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 Quality in this outcome area is adequate Service users’ needs are assessed before they come to live in the home but information available about the service is out of date; this makes it difficult for service users to make a fully informed decision about what the service offers. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide, still contain details of the staffing arrangements in place in May 2007, including information about the previous registered manager. This must be updated so that the information given to people accurately reflects current personnel, their qualifications and experience. There have been no new admissions to the home since October 2006. Social workers’ comprehensive assessments were in place for this service user. The acting manager has recently visited a prospective service user at their current home to begin the assessment process. She explained that this would involve further discussions with the service user, their family and placing social worker as well as visits to the service. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate Support plans and risk assessments do not always contain sufficient, easily accessible information to enable staff to meet service users’ needs consistently and effectively; this may place both service users and staff at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four service users’ support plans were examined and discussed in detail with the acting manager and the senior support worker. The inspector also spoke with three of the service users, some of the staff involved in supporting them and observed the interaction between them. All four plans contained a great deal of information but it was not always clear where to find information about how a service user should be supported. Some risk assessments did not clearly identify specific risks to service users and how these should be managed (for example in relation to ongoing medical conditions). Although there was a note on some risk assessments to indicate that they had been reviewed, the date the review had taken place was not always noted or noted accurately. Risk assessments relating to challenging behaviour did not consistently state the agreed response. This lack of clarity 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 10 may lead to confusion as to how to support certain people with complex needs and ultimately could place both service users and staff at risk. There was no clear communication plan in place for one person who had a hearing impairment and staff had not received training on how to communicate or meet this person’s needs in relation to their hearing loss. Staff members were observed communicating with them in different ways, some more successful than others. Discussion with the senior support worker also indicated that there was some confusion as to the communication level of the service user and it was suggested that a communication assessment would be appropriate before putting together a definitive communication plan for all staff members to follow consistently. The placing authorities of three of the service users have contracts with the service to provide additional one-to-one hours ranging from 21 to 77 hours per week. It is not clear from support plans how this additional one-to-one time is allocated and used. Copies of the rota given to the inspector identified a staff member, who was under 18, as being allocated to work with a particular service user. The service user’s social worker had informed the home that no one under the age of 18 should work with this person because of their particular needs. Discussion with the staff member confirmed that although she was allocated on the rota to work with this service user she did not do so because of these restrictions. Therefore it was unclear as to how this person’s one-to-one needs were to be met. One person’s support plan contained information of work recently completed with them by an advocacy service suggesting that information about this kind of service is available and accessed by service users. The two service users who responded to the Commission’s survey said they always or sometimes make decisions about what they did each day. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 11 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 adequate Some service users are involved in activities that meet their social and vocational needs but staffing levels may limit some service users’ choices in these areas. Not all service users are encouraged to be involved in the day to day running of the home to enhance their independent living skills This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service is split into three separate blocks each with its own kitchen and dining area. Feedback from surveys and observation of practice and discussion with staff members on the first day of the inspection indicated that the practice within the home had been to cook within one block and redistribute food to the other blocks. Records of meals served in each block could either not be found or did not contain full information about the food served or alternatives offered to those with additional dietary needs. This would make the monitoring of people’s diets problematic. The manager said that she had recently been reviewing the kind of food served and was trying to promote the use of the individual kitchens and for service users to be involved in the preparation of food. Copies of new menus were seen and these appeared to offer a good range of food and a nutritionally balanced diet. On 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 12 the second day of inspection food had been delivered to the home and there was a wide variety of fresh fruit and vegetables. The inspector observed lunch being prepared in one block and a service user was being encouraged to be involved with this by preparing vegetables. Four people are involved in a regular daytime activity outside of the service. One person attends college and the acting manager said that she was looking into college courses for other service users. Three people attend a day centre on a part-time basis. Several service users spoke about accessing local facilities such as shops and cafes. One said that they regularly visited a snooker hall with other service users and a member of staff. The majority of people are not actively involved in domestic activities in the home, the majority of these being undertaken by the staff team including service users’ laundry. Independence in some of these areas could be further promoted for some service users. The relative who responded to the Commission’s survey stated that the home helped their relative keep in touch with them and some service users said that they had been supported to send Mother’s day cards. The two service users who responded to the survey said that they could sometimes but not always do what they wanted during the evenings and at weekends but sometimes lack of staff meant that they could not do this, “sometimes I suffer because there is no one to take me out”. A relative commented in the survey that there are, ““Very few outings due to lack of staff and drivers” It was noted that staffing rotas indicate that day staff’s shifts end at 8pm with only two night staff allocated to work after this time. This would limit the nature of evening activities if staff support were required, particularly if a person wished to spontaneously visit a venue outside of the home. Service users have had the opportunity to go on holidays and short breaks with staff support in previous years and the acting manager said that plans were being made for such holidays to take place in the coming year. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 13 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 General health and personal support needs are met but improvement is needed in staff’s management and understanding of one chronic condition to ensure consistent health support is given. Medication is generally well managed, although recording must be improved to ensure the continued health and wellbeing of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The four support plans examined showed evidence that people have access to regular optical, dental and chiropody services. On the first day of the inspection one person was supported to attend the dentist by a member of staff. Support plans contained information about how people should be supported with their personal care needs. Information about how to meet some service users’ needs in relation to their diabetes was not clearly expressed in support plans. Staff (including senior staff and the acting manager) displayed a lack of knowledge about the condition, “He hasn’t really got diabetes” meaning that their diabetes was controlled by diet and tablets. No record could be found of what people with diabetes had eaten so there was no mechanism in place to judge whether their diet was an appropriate one. One person’s plan did contain a clear risk assessment as to how to monitor their diabetes and respond appropriately to 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 14 problems. However another person’s plan did not contain this information. It is recommended that training be arranged for all staff in understanding diabetes and how they can support people to manage their condition. Medication storage and records were examined. There were some gaps in medication administration records, which the senior staff member was unable to explain. The code ‘O’ meaning ‘other’ had also been used within the records but no explanation given on the record as to what this stood for. Suitable arrangements were in place for the storage and administration of controlled medication. The medication room was clean and tidy and there were no excessive stocks of medication. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 15 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 Not all staff feel able to share concerns/complaints about the running of the service neither have all staff received training in dealing with challenging behaviour or in recognising abuse. This may lead to service users and or staff being at risk as a result of poor or inconsistent practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Social services and Prime Life are currently investigating an allegation made by one staff member about another staff member’s behaviour towards service users. As part of this investigation the staff member who made the allegation was suspended for withholding information concerning potential abuse of service users from the company. The person accused of abuse was not suspended while the investigation was undertaken. It is recommended that the company’s policy in relation to such investigations be reviewed to ensure that it is consistently focussed on protecting the interests of service users. Notices about how to complain were posted on kitchen notice boards and service users spoken with said that they would take any concerns to staff members. Responses given by the four staff members who responded to the Commission’s survey, as to how they would take forward any concerns about the service were very polarised. Two staff indicated that they had a good relationship with management and felt confident that concerns would be listened to. Two however felt concerns expressed to the manager had not been listened to. It would therefore appear that some work is needed to ensure that the company’s policy on dealing with complaints, concerns and 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 16 issues surrounding safeguarding need to be more successfully communicated to all staff and implemented consistently. One staff member was interviewed about their understanding of whistle blowing. The staff member said that they had not received any training in the recognition of abuse but was clear about their responsibilities to report any concerns that they may have concerning service users’ welfare. Some of the service users living at the service exhibit behaviour that can challenge staff members; this includes exhibiting verbal and physical aggression. How to deal consistently with such behaviour should be more clearly outlined within service users’ support plans and these plans should be readily accessible to staff to ensure that there is consistency of approach. Records demonstrate that some staff have received NAPPI training (a system of non-abusive psychological and physical intervention). It is strongly recommended that this training be renewed for all staff at least on an annual basis, again to ensure consistency of approach to challenging situations and that service users and staff are safe from injury or abuse. Similarly not all staff have undertaken recent training in safeguarding procedures and protocols and it is recommended that this be put in place and renewed annually. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 17 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, 30 Quality in this outcome area is good Old Station Close provides service users with a clean, comfortable and spacious environment This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of all communal areas was made, together with some service users’ bedrooms. All communal areas appeared clean, tidy and well furnished. The service users’ rooms seen were well furnished and individually decorated to reflect their personalities and tastes. One service user said how much they liked their room and the view from their window over the surrounding countryside. The two service users who responded to the Commission’s survey said that the home was always fresh and clean; this was confirmed during both days of the inspection when the home was fresh and clean and there were no foul smelling odours. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate There are not always sufficient staff on duty, with the appropriate levels of experience to effectively meet service users’ needs This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff’s recruitment records were examined. These were comprehensive and contained evidence of identity, record of previous employment and evidence that Criminal Records Bureau checks had been received before the person started work at the service and that their names had been checked against the vulnerable adults register. The service has recently experienced a high level of staff turnover (The AQAA stated that twelve staff have left employment in the last twelve months) and the acting manager informed us during the inspection that four staff would be leaving within the next month. On the second day of inspection there were two new staff members on duty (one working their second day) who were currently undertaking their induction and were therefore unable to undertake certain duties such as supporting a service user outside of the home without another member of staff being present. Another staff member on duty was under 18 and was again therefore limited to the kind of tasks she could undertake (such as no personal care) and in one case the people she could work with and support. The acting manager (who was engaged in the office 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 19 for the majority of the inspection) and two staff members had to supervise the work of the new and junior staff members across the three units and undertake the majority of tasks. The placing authorities of three of the service users have contracts in place with the home to provide additional one-to-one hours ranging from 21 to 77 hours per week. It is not clear from the support plans in place how this additional one-to-one time is allocated and used. Discussion with the acting manager and senior carer indicated that the interpretation of ‘one to one’ was not fixed. Discussion with one service user who had been out with a staff member in the service’s mini bus with two or three other clients indicated that this was thought of as part of their one-to-one time. The one-to-one time for one service user was identified as time spent helping the service user to manage their catheter bag or for night staff to sit downstairs and talk with the service user in the lounge at one or two ‘o clock in the morning. No additional staff were noted on the rota during these hours to take account of this service user’s particular needs. The relative who responded to the Commission’s survey commented that there are, “never enough staff to cover one to one hours” Copies of the rota (18/02/08 to 09/03/08) identified a specific staff member (who is under 18) as being allocated to work with the service user who has an additional 77 hours per week of additional one-to-one time. The service user’s social worker has informed the home that no one under the age of 18 should work with this service user because of their particular needs. Discussion with the staff member confirmed that although they were allocated on the rota to work with this service user, they did not do so because of this. There appeared to be no one allocated on the rota for the three-week period to meet this person’s one-to-one needs. The rota also showed that no one was allocated to provide the additional support required by another service user whose local authority pay for an additional 30 hours per week one-to-one for the three week period, with the exception of 19 hours allocated during one week over two days. The staff rota showed (and discussion with staff confirmed) that there are routinely only two staff members on duty from 8pm to 8am. Given people’s complex needs and the requirement for one-to-one support, staffing levels must be reviewed to ensure that they are sufficient to meet the needs of service users and ensure their and staff members’ safety. The high percentage of new, relatively inexperienced staff should also be considered when conducting this review. Not all staff, including the current acting manager, have received training in working with people with mental disorders. Neither have all staff received recent training in responding appropriately to challenging behaviour and recognising abuse (see Outcome area ‘Complaints and Protection’). Given service users’ needs, this should be arranged as a matter of priority. Training 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 20 records did show that staff have received training in working with people with learning disabilities and the AQAA states that 12 of the 15 staff employed have achieved a National Vocational Qualification at level 2 or above; a further staff member is undertaking this training. Although the majority of service users are male (14 out of 18) only two out of the current staff team of 15 are male. Ways should be considered to improve the gender balance of staff so that it more accurately reflects the gender composition of service users. Two of the four staff who responded to the Commission’s survey said their manager sometimes met with them to give support and discuss their work, one said they regularly did this, one said they never did. The acting manager said that she had only managed to complete two support worker’s supervision sessions so far but did intend to implement regular staff supervision. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 21 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, 38, 39, 40, 41, 42 Quality in this outcome area is adequate Changes in management and a high recent staff turnover mean that some systems to ensure the smooth running of the home and ensure service users’ needs are consistently met have not always been in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has undergone two changes in management since the previous key inspection. A new manager was registered at Old Station Close on 01/08/08. This manager was transferred to another service in November 2007. The current acting manager transferred from another Prime Life service for people with learning disabilities. The acting manager holds a National Vocational Qualification in care at level 4 and the Registered Manager’s Award. She has not yet received any training specifically in relation to working with people with mental disorders. Since the previous inspection there has been a high staff turnover and the responses from some staff members (but not all) to the Commission’s survey 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 22 have indicated that some have felt unsupported through these changes and a perception that their concerns have not been listened to (please see the Outcome area relating to Complaints and Protection). The acting manager has not had sufficient time to implement regular supervision for all staff members and this may have contributed to some staff members feeling unsupported during the recent changes. Prime Life has a formal quality monitoring system in place but the results of the most recent quality assurance audit were not available on the day of the inspection. A representative from Prime Life’s management team also makes regular visits to the home to monitor the quality of the service but the reports of all visits since the previous key inspection were not available on the day of inspection. One service user’s financial records were examined in detail and the system in place for managing all service users’ finances was reviewed. All transactions were listed and the service user and a member of staff had signed against each transaction. Where a service user is unable, two members of staff sign against the record. Balances held are checked on a regular basis. External Prime Life personnel audited the system on February 19th 2008. The records examined appeared up-to-date and accurate. Fire records were examined and found to be accurate and up-to-date. Information in the AQAA suggests that electrical and gas systems are regularly tested and serviced. A number of safe working practices were noted during the inspection visit. All knives are kept locked away when not in use and warning notices were routinely used to indicate that floors had been recently mopped. No obvious breaches of health and safety were noted during the visit. The AQAA stated that all staff had received training in food hygiene but during the first day of inspection one staff member involved in food preparation said that they had not received this training. It is recommended that staff training in relation to food hygiene be audited to ensure that all staff have the knowledge necessary to prepare food safely. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 2 2 2 2 3 X 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4&5 Requirement The Statement of Purpose and Service Users’ Guide must accurately reflect the current staffing provision within the service to ensure that prospective service users have accurate information to make an informed choice about whether the service can meet their needs. Service users’ support plans must be made fully accessible to staff members to ensure that there is consistency in the way that service users are supported. Service users’ support plans must clearly identify how additional one-to-one hours for identified service users are allocated and met. Risk assessments must clearly identify the risk to the service user and state the agreed response to be followed consistently by all staff. Full and accurate records of food served in the home must be kept to ensure that the nutritional quality of people’s diets can be monitored DS0000062107.V360031.R01.S.doc Timescale for action 18/04/08 2 YA6 15 30/04/08 3 YA6 15 30/04/08 4 YA9 12 30/04/08 5 YA17 17 30/04/08 1 Old Station Close Version 5.2 Page 25 6 YA20 13 (2) 7 YA32 18(1) 8 YA33 18 (1) Gaps in the recording of medication must be evidenced to ensure that there is an accurate record of which medication service users have received and when. The Registered Person must ensure that staff responsible for the care and welfare of service users, receive training relevant to the needs of service users with regards to their mental health including specific forms/types of mental health Given the complexity of the needs of some service users and their need for one-to-one input, staffing levels must be reviewed to ensure that they are sufficient to meet the needs of service users and ensure staff and service users’ safety. 30/04/08 31/05/08 04/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA6 Good Practice Recommendations Staff should receive appropriate training in how to communicate with people with a hearing impairment. A clear communication plan should be put in place for the person with a hearing impairment to ensure consistency of support and approach from staff in meeting this person’s needs. Opportunities for developing and maintaining independent living skills should be facilitated. Training should be arranged for all staff to improve their understanding of diabetes and how they can support people to manage their condition. All staff should receive training in how to manage service users’ behaviour that could challenge. This training should be renewed annually. All staff should receive training in safeguarding adults’ DS0000062107.V360031.R01.S.doc Version 5.2 Page 26 3 4 6 7 YA16 YA19 YA23 YA23 1 Old Station Close procedures and protocols. This training should be renewed annually. 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 1 Old Station Close DS0000062107.V360031.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!