Inspection on 17/06/08 for 1 The Glade

This inspection was carried out on 17th June 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 The Glade 23/11/09

1 The Glade 11/05/09

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 1 The Glade 1, The Glade Bromham Beds MK43 8HJ Lead Inspector Sally Snelson Unannounced Inspection 17th June 2008 11:15 1 The Glade DS0000071552.V366576.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 The Glade DS0000071552.V366576.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 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 The Glade Address 1, The Glade Bromham Beds MK43 8HJ 01234 827068 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) The Fremantle Trust Mrs Karen Ruth Fiore Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability -Code LD The maximum number of service users who can be accommodated is: 6 5th April 2007 2. Date of last inspection Brief Description of the Service: 1 The Glade is a home for up to six adults with learning disabilities, managed by Fremantle in conjunction with Bedfordshire Pilgrims Housing Association who are responsible for the maintenance of the building. The home is a large bungalow situated on the outskirts of Bromham village, approximately 5 miles from Bedford town centre. There are six bedrooms, a dining room, 2 lounges, a relaxation room, and a family room. In addition, a staff office, surgery, laundry, kitchen, bathing and toilet facilities are provided. There are no facilities for people with a physical disability, apart from one toilet. The bungalow is set in substantial grounds, which includes a separate building, used as an activity room. Some of the people living in the home demonstrate behaviours, that challenge, and to this end, access to the home is through a secure gate, controlled by staff. High fencing surrounds the home, meaning that the people living in the home are free to roam safely, within the bungalow’s grounds. Parking for several cars is available to the front, and side of the building. The home’s Statement of Purpose sets out that the home aims to provide a specialist service for people with Autistic Spectrum Disorder, or associated needs. 1 The Glade DS0000071552.V366576.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. Up until 1st March 2008 1 The Glade, a home for up to six adults with learning disabilities, was managed by Bedfordshire and Luton Partnership NHS Trust (BLPT). Fremantle now runs it in conjunction with Bedfordshire Pilgrims Housing Association - who are responsible for the maintenance of the building. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for younger adults that takes account of residents’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. The inspection was a key inspection, was unannounced and took place from 11.15am on 17th June 2008. The registered manager, Karen Fiore, was present throughout, and Mark Kingman, the operational manager joined the inspection. Feedback was given throughout the inspection and at the end. During the inspection the care of two people who used the service (residents) was case tracked. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home were observed for their reaction to situations and staff were spoken to and their opinions sought. Any comments received about the home, plus all the information gathered on the day was used to form a judgement about the service. Prior to the inspection two service users and two members of staff had completed surveys. The inspector would like to thank all those involved in the inspection for their input and support. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Most care plans had been reviewed to reflect the changing needs of people who lived in the home, but they still needed to be in more detail and changes made to documents when changes were identified. The front door was now open in the day so residents could access front garden at all times. The TEACHH board has been implemented and this meant that residents were aware of the activities for the day and when they were planned. The amount of activities provided for residents, both in and outside the home had improved. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 7 Staff were reporting incidents of possible abuse correctly, and in a timely fashion, to those that need to be made aware. Staffing levels had improved and at all times there were sufficient staff on duty to meet the needs of the residents. Staff were working flexibly to ensure that this happened, particularly at busy times when people needed to be supported to attend different places at the same time of day. What they could do better: As detailed throughout the report there are still a number of areas that need to be improved and as a consequence we will ask the manager to provide an Improvement plan as to how this will be done. Areas that need improving are:There must be a service users guide that provides the service users with information about the home. Any contract or statement of terms and conditions must be accurate and signed by, or independently on behalf, of the service users. There must be a written plan for all aspects of care, which is detailed and involves the service user if at all possible. Also service users should know their assessed and changing needs and personal goals are reflected in their individual plan, and plans should be person centred. Staff must ensure that people are supported to take risks as part of an independent life style. This would involve lifting some of the restrictions within the home. Those service users assessed as being suitable to move towards independence should be supported with independent living skills as part of their daily routine, for example, doing the laundry, preparing drinks and meals. Staff must ensure that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. This refers to the decision to regularly weigh people and then not act on the information. Staff must ensure that there is a clear and effective complaints procedure, which includes the stages of, and timescales, for the process, and that service users know how and to whom to complain. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 8 This needs to be part of the Service Users Guide and in formats suitable for the people living at the home. The home’s premises must be suitable for its stated purpose; accessible, safe and well maintained; and meet the individual and collective needs of the people living in the home in a comfortable and homely way. The must be a training plan that demonstrates that staff are trained for the conditions of the people living in the home. In the case of new admissions the training must be completed in advance prior to admitting users with specific needs. 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 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 9 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 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 10 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): 1,3,5. People who use this service experience poor quality outcomes in this area. In order to protect people living in the home any documentation which provides information for service users should be accurate and produced in a format that is suitable for them to understand, or should be signed by an independent advocate on their behalf. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were provided with a copy of the Statement of Purpose, which had been reviewed and updated by the registered manager. The Statement of Purpose was a large comprehensive document. It had some factual inaccuracies, such as stating that support plans would be reviewed monthly when in fact other procedures suggest at least annually, or that a service users guide was available in different formats, when a guide was not available in any format. The Service Users Guide not being available was disappointing, as at the last inspection this had been described as being a good document in need of some adjustments. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 11 There had been no new admission to this home since the last inspection so it was not possible to assess this standard under the new providers. The home had two vacancies. Under the previous providers the registered manager had had little say in who could be admitted to the home, as a panel made the decision. The manager commented that she was looking forward to assessing a prospective resident, to ensure that the home could meet their needs and that they would appear to fit in with the current client group. The manager explained the admission process, and it was detailed in the Statement of Purpose. If this process was followed it would provide prospective residents with a phased admission to the home. The staff team kept themselves updated with some mandatory training, but there was little evidence that they had, or because of staffing levels were able to, complete all the specialist training needed to meet the assessed needs of all the residents. This is referred to within the staffing section of the report. Service users had signed contracts, which had been reviewed by the manager 03/06/08. It was noted that these stated that the service users were responsible for providing their own bedding and towels. The manager was unaware that National Minimum Standard 26 indicated that the provider of the care provided these, but the operational manager confirmed that Fremantle would expect to provide these items. The contracts also stated ‘I also pay for entertainment, meals and snacks. This statement was also discussed and it is apparent that it needs to be expanded to include what and when it is expected service users should pay for. It was disappointing that the manager had signed and reviewed this document without making the changes, particular as the AQAA indicated that it was a known area for improvement. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 12 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 People who use this service experience adequate quality outcomes in this area. Risk assessments were completed but these were basic and mainly focused on keeping residents safe. The care plans included basic information necessary to deliver some of the person’s care but they were not detailed, or person centred, and could leave the person receiving inconsistent care. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All of the residents had care plans referred to as support plans, and the registered manager, following her return from maternity leave, had reviewed these. However there was little evidence, with the exception of the day care plans, that the plans had been written in a person centred style or what, if any, involvement the service user had had in them. The last two reports had stated ‘there was no evidence of service user or service user 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 13 family/representative involvement in the care planning process. There was also no evidence of PCP (person centred planning) for any of the service users’. We will expect to see some improvement in this by the next inspection now the service is settled under the new management. The plans would benefit from being written in more detail and including all aspects of care. For example, while touring the building it was apparent from the slight smell of urine in a bedroom that a resident had a problem with continence or urinating in the correct place. The care plan did not make any reference to this, or how it should be dealt with. At the time of the inspection the home had a heavy reliance on agency staff and it was therefore important that staff produced detailed care plans to ensure that there was the consistency of care for the service user that they would want. There was some evidence that staff were encouraging people in the home to make choices and decisions, and supporting them to do so. For example at mealtimes staff provided a plated version of the meals available for the residents to choose from. Also residents had very individual activity plans which were tailored to their needs. We witnessed one service user agreeing to go for a walk with another person living in the home and staff members, he the changed his mind and this was accommodated without interfering with what the other person wanted to do. All of the residents had the opportunity to meet with an advocate and Fremantle management were clear that advocates should be used when procedures and decisions needed to be altered such as in the case of the contract. The staff team were very reluctant to support people to take some risks and as a result were over protective to all. For example the kitchen door was kept locked at all times, even by staff who were in the kitchen preparing sandwiches, because one service user had a tendency to go into the kitchen and eat and drink what was around. In one bedroom we noted that wardrobe doors and drawers were locked because sometime in the past this service user had torn his clothes. He had not torn the clothes he was wearing and staff did not know if this behaviour continued, because everything was locked away. We discussed with the manager the need to reduce some restrictions and monitor and document outcomes; particularly as one of the people living at the home had been assessed as possibly being suitable to live in supported living accommodation. The manager believed that a lack of permanent staff was the barrier to this. 1 The Glade DS0000071552.V366576.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): 11,12,13,14,15,16,17 People who use this service experience adequate quality outcomes in this area. People were being provided with more opportunities to participate in meaningful activities throughout the day, however there was little evidence that people were being supported and encouraged towards any degree of independence. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were concerned that one of the people living at 1 The Glade had been assessed as being potentially suitable for supported living, but nothing he was doing in the home was helping him to achieve any independent living skills, with the exception of supporting staff do some of the food shopping when it was his turn. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 15 None of the people living in the home were able to work. Since the last inspection two people were attending day care activities, some were swimming and another horse riding, but the staff from the home were providing the majority of the activities. The day care was well supported by the care staff and offered a phased approach for one person who could not cope with long periods aware from familiar surroundings. On the day of the inspection all of the people had been out to a snoozelan session, when the inspection started. We were told that this was the only activity that all the people living at the home participated in together. Later in the morning a motivator instructor also came into the home to do some motivation exercise with those that wanted to. This happened fortnightly and care staff encouraged the exercises between times. In the afternoon two people went swimming and two planned to go for a walk with staff, although only one choose to go when the time came. Two people had indicated that they would like to go to the pub in the evening and this had been planned and was on their TEACHH board (Treatment and Education of Autistic and related Communication-handicapped Children). Each individual had a board that indicated what activities they were doing and the board was used to help them appreciate when things started and finished. The manager admitted that the main barrier to activities outside the home was staffing, because of the shortage of permanent staff that knew the individuals well and were insured to drive the homes transport. Another view was that this should not be a barrier and taxi should be used if a driver was not available. One person told us in their ‘have your say about’ survey that they would like more to do at weekends. The home benefited from having a detached room that was used as an activity room. The activity officer used a method, which by moving activities from one box to another, helped people with autism appreciate the start and end of an activity. This approach along with the TEACHH boards was reported to be beneficial. These sessions were well documented and appeared to be appreciated. The manager had asked staff to indicate if they would be available to support residents to have holiday. As the Statement of Purpose indicated that people will be supported to have at least 7 days holiday a year, it should be an expectation that staff can do this and the initial planning should be with the service users. Since the last inspection the home had created links with a local religious leader who visited and conducted a service once a month for those who wanted it. We did not witness any relatives or friends visiting the home but professionals visitors were welcomed into the home and people living at the home appeared relaxed with visitors. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 16 The daily routines in the home did not promote independence, as people were not free to move about the home because of the restrictions to so many areas that were kept locked. The people living in the home did not help to prepare and serve meals. This was because the size and design of the kitchen was not safe to meet their needs. For over two years management had spoken about the possibility of redesigning the kitchen to address these issues. A meeting with the housing association was planned for the next day and it was hoped work would start imminently. It was also hoped that an independent living area, with a kitchenette and family style washing machine, would be put into the activity room. The inspection spanned two mealtimes and we witnessed sociable occasions with people being offered food choices in an appropriate way, and staff eating with service users. During the inspection we witnessed some positive interaction between staff and the people living at 1 The Glade. People living in the home were provided with regular drinks, however they did not have free access to snacks and drinks, including cold drinks and fresh fruit, because the kitchen was locked. 1 The Glade DS0000071552.V366576.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 People who use this service experience adequate quality outcomes in this area. Residents had access to healthcare services. Staff made sure that those who could had appointments in the community, while those unable to leave the home or access community services with others, were managed by visits from local health care professionals. Medication records were fully completed, included required entries, and were signed by appropriate staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All of the people living at the home needed some degree of support with their personal care. Care plans had been written for these activities but would benefit from even more detail, and describe how the support should be provided. Although all the people living at the home were male there were more than twice as many females than males employed as carers. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 18 Staff ensured that service users kept appointments with GP’s, consultants and other health professionals. Since the last inspection staff had been recording service users weights on an ad-hoc basis. The manager had reinstated a monthly weight check stating that she felt it was necessary to ensure people were eating well. However, it was noted that staff were not acting on variations in weight. For example one person’s weight had increased by 6.4kg over the last month, but there was nothing to indicate whether this was expected or should be addressed. This sudden weight increase had not been recorded in a nutritional assessment and no action had been taken. The medication and medication records of the two service users case tracked were looked at in detail and it was apparent that procedures had improved, and that staff were ensuring that Medication Administration Charts (MAR) were completed accurately. All medications were correctly accepted into the home, administered and stored. We were able to correctly reconcile those medications that were given as required, and from original boxes and bottles. We had been informed correctly when it had been noted that a medication had been forgotten. These omissions were identified quickly and acted upon. The supplying pharmacist was offering a medication training update to all the staff. The home needs to have a controlled drug book before any controlled drugs can be accepted into the home. 1 The Glade DS0000071552.V366576.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): People who use this service experience adequate quality outcomes in this area. Training of staff in safeguarding was regularly arranged by the home. Other training around dealing with physical and verbal aggression is also made available to staff as needed, and as a result the need to use restraint has reduced considerably. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There was a complaints procedure as part of the Statement of Purpose, but it was not in a suitable format for the people living at the home and people did not have a Service Users Guide. Fremantle had a produced a leaflet in words and picture encouraging people living at the home to ‘speak out’ if there was a problem. This leaflet was pinned up in the office but it was not apparent how service users had been made aware of it. The manager reported that there had been no complaints made to or about the home since the last inspection. She was aware of the need to document any complaint investigation keep the record. There had been an improvement in staffs understanding of safeguarding vulnerable adults (SOVA). This had come about as the result of additional SOVA training and a better relationship with the safeguarding team. Any allegations of abuse, including service user on service user were now being correctly reported to us via Regulation 37, and to the safeguarding team at the Local Authority. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 20 Service users monies were now being appropriately held on their behalf and used correctly. Staff were checking the balances of service users monies at the change of every shift. This needs to assessed and reduced. Staff undertook Non-Aggressive Physical and Psychological Intervention (NAPPI) training so as to not have any need to use any form of restraint on residents. This training had resulted in staff using de-escalation techniques to manage residents challenging behaviour and resulted in everyone appearing much calmer. 1 The Glade DS0000071552.V366576.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): 24,26,30 People who use this service experience adequate quality outcomes in this area. There was evidence that staff were meeting with the housing association to ensure that the house had the necessary environmental changes so that it would meet the needs of the people living at 1 The Glade. This meant that people would live as comfortably as possible. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home was operating in conjunction with Bedfordshire Pilgrims Housing Association (BPHA), who were responsible for the maintenance of the building. Previous inspection reports had raised a number of concerns regarding the environment. “There was evidence that the current kitchen was unsafe, or was 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 22 not easily used by some of the people living in the home because of their very specific needs. Because of the size of the kitchen, some dry and frozen food was being stored elsewhere in the home. There were also concerns about the size of the oven”. The inspector was informed that nothing had changed since the last inspection. However there were plans from BPHA to address these concerns by refurbishing the kitchen although it was unlikely that a bigger oven could be fitted in due to the small size of the kitchen. Staff believed that if the cooker size was not increased that they would not be able to manage to cook for all the people living in the home and staff when the home was fully occupied. The toilets and bathrooms had been refurbished, although unfortunately a service user had tried to pull up areas of the flooring and BHPA were not prepared to replace it again. Staff had made the floor safe but it was not aesthetically pleasing. One bedroom and the dining did not have any curtains. We were informed that this was because a service user would pull them down. However there were curtains (on poppers) in other areas of the home. Some furniture had been replaced and more furniture was on order. As already stated many of the areas of the home were not accessible to the people who lived there because they were kept locked, in an attempt by staff to keep people safe. The operational manager promised the situation would be risk assessed and some areas ‘opened’ within the next fortnight. The garden had been tidied, but the levels outside were very uneven and not at all appropriate for one of the service users who had mobility problems. Staff had requested that BHPA prepare an area of the garden in which vegetable could be grown. One person living at the home was particularly anxious to do this. Since the last inspection other areas of the home had been tidied and utilised, for example the activity room had been converted to also promote a TEACCH approach with the service users. A TEACCH approach aims to create an autism-friendly environment, in which to teach in a highly structured way. It was therefore necessary to keep the activity room free from clutter so as not to distract. The relaxation room had been “done up” and was being used to help reduce peoples stress and anxiety. The home was clean and generally free from offensive odours on the day of this inspection. 1 The Glade DS0000071552.V366576.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): 32,33,34,35,36 People who use this service experience adequate quality outcomes in this area. The home had a reliance on agency staff, which was putting restrictions on some activities for people living at the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Although the permanent staff team was small, over 80 of them staff had an NVQ level 2 or above, however this could be diluted, when considering the percentage of staff with an NVQ, because of the use of agency staff. Where possible the home block booked agency staff so that the people living at 1 the Glade got to know the staff and had a consistent staff team. One of the people using the service had responded in his have your say survey ‘I like the same people and get anxious when lots of different people look after me’. On the night of the inspection, because of an unexpected need to change the rota, two agency staff would be working together, but both were known to the service users. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 24 Staff had between them done a variety of different trainings but there was no clear way to see who had completed what training, who needed a particular training or when a refresher course was due. Previous reports for this service commented ‘There was evidence that a number of staff had still not been trained to meet the specific needs of the new and existing the people living in the home’. Since then most staff had some training about autism and person centred planning PCP, (although PCP had yet to be introduced). The manager wrote in the AQAA that staff would benefit from training on makaton, the communication method used by some service users, and also about key working, which is the way that staff relate to particular service users. A new member of staff, who had not worked in care recently, had gone through an induction period, and it was obvious from speaking with her that she had a basic understanding of the needs of the people she was caring for, had started to have medication training and was aware of how to safeguard people and make referrals. This member of staff had been started on a clear pova first check as her Criminal Record Bureau (CRB) check had taken over a month to date. We were happy that the duties she was given meant that she was supervised at all times. The manager reported that she had recently successfully recruited new staff and was awaiting their cleared checks in order to give them a start date. The company ensured that the home has sufficient staff on duty to work with the people living at the home, although one person told us via his advocate ‘there is not much to do at weekends’; Presumably because of staffing levels. With the exception of the missing Criminal Record Bureau check, which the manager had told us about, the two staff care files we looked at were complete and included the appropriate information and provided evidence that staff were interviewed, checked, recruited and inducted correctly. Since her return to work the manager had a supervision plan that would ensure that staff were regularly supervised. However, we needed to see that this is operational and that the supervision sessions are meaningful and cover the areas detailed in standard 36 of the National Minimum Standards, for this standard to be met fully. 1 The Glade DS0000071552.V366576.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): 37,39,40,42, People who use this service experience adequate quality outcomes in this area. There needs to be systems in place to show that the home fulfils its stated purpose and meets the needs of the people living there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager had been on maternity and sick leave for over a year and since January 2008 had had a phased return to work. There had been a number of changes, including the change from BLPT to Fremantle since her return and the deputy had been off for most of this time. However it looked as if the home was going into a more settled phase and in order to show a 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 26 commitment to the role and to meet the requirements the manager should complete NVQ level 4 in management and care or an equivalent such as the Registered Managers Award (RMA) as soon as possible. The home manager had a foundation degree in care management. The registered manager must also have a plan for the areas of the home that she needs to audit to be sure that staff are working correctly, as ultimately she has overall responsibility for the home. For example during the inspection it was noted that documents had not been reviewed or filled in correctly and although she was able to say “I was not here then’, or’ ***is responsible for that’, she must have a plan to audit what she knows should be being done. When Fremantle took over the management of I The Glade a quality audit was carried out. This audit was detailed and referenced back to the last report and the National Minimum Standards. What it did show was that very few improvements had been made under the previous providers following the last inspection and many of the improvements noted in this report were as a result of the new management. The service must now continually monitor, assess and plan. We must also see evidence that all stakeholders have been involved in quality reviews. The home manager told us that she had undertaken workshops and training with the new provider to enable her to follow the provider’s policies and procedures and ethos of working. The Fremantle policy folders were neatly displayed on shelves in the office but it was apparent that some staff were still thinking ‘in the old way’ and not always referring to the policies. No health and safety concerns were noted during the inspection. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 x 3 2 4 x 5 1 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 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 1 12 2 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 2 x 2 2 X 3 x 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 28 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 5 Requirement There must be a service users guide that provides the service users with information about the home. Any contract or statement of terms and conditions must be accurate and signed by, or independently on behalf, of the service users. There must be a written plan for all aspects of care. The plan must be detailed and involve the resident where possible. Staff must ensure that people are supported to take risks as part of an independent life style. Those service users assessed as being suitable to move towards independence should be supported with independent living skills. The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. This refers to the decision to regularly weigh people and then not act on the information. The registered person ensures DS0000071552.V366576.R01.S.doc Timescale for action 01/09/08 2 YA5 5(b)(c) 01/08/08 3 YA6 15(1) 01/08/08 4 5 YA9 YA11 13(4) 16(2) 01/09/08 01/08/08 6 YA19 12 01/08/08 7 YA22 22 01/09/08 Page 29 1 The Glade Version 5.2 8 YA24 23 that there is a clear and effective complaints procedure, which includes the stages of, and timescales, for the process, and that service users know how and to whom to complain. This needs to be part of the Service Users Guide and in formats suitable for the people living at the home. The home’s premises must be suitable for its stated purpose; accessible, safe and well maintained; and meet the individual and collective needs of the people living in the home in a comfortable and homely way. This is a re-stated requirement in relation to the kitchen and the fittings and furniture within the home. The must be a training plan that demonstrates that staff are trained for the conditions of the people living in the home. In the case of new admissions the training must be completed in advance prior to admitting users with specific needs. 01/09/08 9 YA35 18 01/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The Service Users Guide and the Statement of Purpose must be produced in a format that is acceptable to those living at the home. This may mean providing them in more than one additional format. Service users should know their assessed and changing needs and personal goals are reflected in their individual DS0000071552.V366576.R01.S.doc Version 5.2 Page 30 2 YA6 1 The Glade 3 4 5 6 YA7 YA12 YA13 YA14 YA26 7 8 9 YA36 YA37 YA39 plan and plans should be person centred. Staff should ensure that they can demonstrate how service users have been supported to make choices. Staff should continue to consider ways in which service users can be stimulated and take part in even more meaningful activities inside and outside the home. Consideration should be given to service users having an annual break from the home if they want to. Service users should be provided with the fittings and furniture listed in National Minimum standard 26, unless it is document that it is not in their best interest. For example when curtains are not in place this should be documented with the reason why and how this impacts on the service user and others in the home. Staff should have meaningful supervisions, which are well documented, and offer them the chance to discuss work and personal issues and training needs. The registered manager should show a commitment to the role by completing the RMA. The quality audits should be built upon and show stakeholder involvement. 1 The Glade DS0000071552.V366576.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region 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. 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