Inspection on 21/11/06 for 10 The Crescent

This inspection was carried out on 21st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

10 The Crescent 07/09/07

10 The Crescent 13/02/06

10 The Crescent 23/06/05

10 The Crescent 17/11/04

10 The Crescent 08/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Crescent, The (10) 10 The Crescent Pewsey Wiltshire SN9 5DP Lead Inspector Alison Duffy Key Unannounced Inspection 21st November 2006 12:30 Crescent, The (10) DS0000028316.V320251.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 Crescent, The (10) DS0000028316.V320251.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. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crescent, The (10) Address 10 The Crescent Pewsey Wiltshire SN9 5DP 01672 562266 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) Landlace Care Homes Ltd Mrs Nanette Lance Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2006 Brief Description of the Service: 10 The Crescent is a residential care home, which accommodates four service users with a learning disability. The home is one of three residential care homes owned by Landlace Care Homes Ltd. Mrs Nan Lance is the responsible individual and also the registered manager. Mrs Lance undertakes shifts as part of the working roster and also covers additional shifts within the organisation at times of annual leave or sickness. Mrs Lance has recently employed Mrs Angie McGrorty as the organisation’s service manager. 10 The Crescent is located within a residential area of Pewsey and is within walking distance of local amenities. The property is semi detached and furnished to a good standard. Service users have single room accommodation on either the ground or first floor. There is a spacious kitchen with dining area and a separate lounge. The home has two members of staff on duty throughout the waking day when all service users are at home. At night, one member of staff provides sleeping in cover. The fees for living at the home are based on individual need and are between £594.00 and £825.00 a week. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on 21st November 2006 between the hours of 12.30 and 3.40pm. Mrs Teresa Pound, a support worker was on duty and assisted throughout. Within this time, discussion took place with three service users within the kitchen. The inspector also viewed the medication systems and the safekeeping of service users’ personal monies. A second day was arranged to complete the inspection. This took place on 22nd November 2006 between 10.30am and 3.30pm. The inspector initially met with Mrs McGrorty, service manager, in another of the care homes within the organisation. Discussion took place with Mrs McGrorty regarding recent developments and further intended improvement. Documentation including staff training and recruitment were also viewed. Further time was spent within 10 The Crescent to view care-planning information. During this time, between 2pm and 3.30pm, two service users were in the home with one member of staff. Service users gave positive feedback about the home and spoke of important aspects of their lives. These included daily activity and holidays. Positive relationships were evident and communication was informal and animated. Following the site visit, as part of the inspection process, surveys were sent to service users and their primary relative. Surveys were also sent to each service user’s GP and social worker. Positive feedback was received. One relative confirmed ‘I couldn’t wish for anything better. XX has a better life than I could give. They are always out. They go into Pewsey and go on holiday. The staff are very good and have got to know XX well. If there are any problems they let me know. The home is always very clean and homely. XX is very happy there.’ A health care professional reported ‘I have no major concerns to report. It appears to me that the staff are keen to work closely with services and to continue to improve the quality of care they provide.’ All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The environment is comfortable, homely and domestic in style. Service users are able to personalise their own space and use their room as they wish. Important relationships are promoted and animated responses are evident between service users and staff. Service users take part in varied activities of Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 6 their choice. Service users are able to assist with housekeeping responsibilities and meal preparation, as they wish. Service users are able to choose and plan a holiday of their choice, which may include a trip to another country. Meal arrangements are based on fresh produce and service users’ preferences. What has improved since the last inspection? What they could do better: Mrs McGrorty is currently overseeing the day-to-day management of the home although Mrs Lance is the registered manager. Clarity is needed regarding individual management responsibilities and the designated leadership of the home. Risk assessments currently give insufficient clarity within control measures. McGrorty has acknowledged this and reported that risk will be the next targeted area. While various systems such as service user satisfaction surveys have been developed, there is not an implemented quality assurance system. Mrs McGrorty reported that she is planning to address the shortfall when other identified matters, which need greater priority, have been completed. There are two staff on duty when all service users are at home. However, staffing is reduced to one, when some service users are out. This restricts individual choice and does not use the opportunity of enabling individual activity. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 7 Ensuring staff sign all medication when administered and countersigning any changes to instructions, would minimise the risk of error. 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. Crescent, The (10) DS0000028316.V320251.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 Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Due to the long-term nature of the service, it was not appropriate to address the above standards. Service users reported being happy with the service received. Consideration is being given to realistic fee levels, which in turn will enable further development of service provision. EVIDENCE: Service users have lived at the home for a number of years. Mrs Pound reported that staff have worked as a team to address changing needs of service users. Mrs Pound confirmed the importance of enabling service users to remain at the home for their life, if at all possible. This is unless their needs change significantly and there is no other option but to move on to a more appropriate placement. Due to long term nature of the service, the above standards in relation to choice of placement were not assessed. From evidence of previous placements however, a clear admission procedure is in place and adhered to. Mrs McGrorty is currently in the process of re-costing the service. A review of all fees is being requesting from all placing authorities. Mrs McGrorty is expecting this to be achieved through a formal review of each placement. Once achieved, additional funding will be available to further develop the service. Crescent, The (10) DS0000028316.V320251.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning gives an overview of care required yet the new anticipated system will ensure greater service user focus. While decision-making is encouraged, consideration is being given to ways in which this can be further developed. Service users are encouraged to be independent yet greater focus on the formal assessment process would enhance individual safety. EVIDENCE: Mrs McGrorty reported that she is intending to develop the existing care plan format. This will incorporate a more person-centred plan, which will enable full involvement of service users. Mrs McGrorty is aiming to involve social workers and any others, who service users may wish to be involved. Mrs McGrorty showed some examples of documentation. These were positive and will be an invaluable tool if completed efficiently. At present all service users have a care plan, which details guidelines of care provision. The information is detailed and reflects individuality. Not all plans Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 11 however were fully up to date. Mrs McGrorty reported that she is aiming to develop monthly key worker meetings. This will enable the service user and key worker to reflect on the month’s events. A summary will then form part of the plan. In addition to care planning information, all service users have a daily diary. Entries within these are detailed and provide information about ill health, food consumed and activities undertaken. Within discussion with service users it was evident that on a general basis, service users are able to chose what they want to do. For example, attending day services, watching television in their own room, assisting with housekeeping tasks and meal preparation were aspects that were undertaken through choice. Mrs Pound confirmed that the addition of a member of staff when the home increased its occupancy to four was invaluable. This has enabled greater quality time to be spent with service users. However when there are less service users within the home, there are occasions when staffing levels are reduced. This was discussed with Mrs McGrorty. It was suggested that opportunities for individual external activity should be taken during these times. It was agreed that reducing staffing levels, also reduces the ability for service users to exercise their own choices. Mrs McGrorty reported that these aspects would be addressed following successful recruitment of staff. Mrs McGrorty confirmed that she wanted to build on responsibilities and decisionmaking. For example, service users are now being encouraged to answer the telephone and the front door. Service users are encouraged to take reasonable risks in relation to individual ability. This may include making a hot drink, meal preparation or housekeeping tasks. Mrs Pound confirmed that although sensible risk is encouraged, safety is paramount. Enabling service users to have a bath unattended or going out alone without staff support is not promoted. A number of risk assessments are in place yet these do not give detailed information. Mrs McGrorty confirmed that the risk assessment process is an area requiring further attention. A new risk assessment format has been developed and all are in the process of being reviewed. Mrs McGrorty confirmed that she is also intending to work with staff to enable risk to be risk-aware rather than risk-adverse. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 12 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to follow their preferred interests and a range of external activity is promoted. Positive focus is given to matters such as holidays, which significantly improve quality of life. Important relationships are promoted and service users are encouraged to be involved with daily housekeeping tasks. Meal arrangements are based on service users’ preferences, with an emphasis on fresh produce and home cooking. EVIDENCE: Mrs McGrorty confirmed that she is aiming to improve the focus of what service users would like to achieve within their future. Within this, is an emphasis on individual wishes and developing new experiences. Mrs McGrorty confirmed that networking and finding out what is actually available, within the vicinity of the home, is an integral part of offering such experience. All service users have public transport (bus) passes. It is therefore the intention to develop the use of these, in order to initiate further opportunity. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 13 Service users spoke with enthusiasm regarding their daily activities. This included day services, college and work placements. One service user spoke of enjoying trips out and swimming was a favourite event. Another service user explained that they all now help with the home’s shopping. All have individual tasks such as looking for items, reading the shopping list or carrying the bags. A coffee or a meal out is then undertaken before coming home. One service user spoke of visiting a fast food chain. Another enjoyed a local pub. The home has its own transport and therefore trips out to places of interest are regularly undertaken. Service users spoke positively of their holidays in the summer. Some chose to go to Spain while others preferred a holiday complex in this country. Service users confirmed that they are able to follow their own routines. A timetable for housekeeping tasks has been developed. Service users are able to choose what they would like to do. One service user reported that they now all sit down over a cup of tea and devise the menu for the week. A shopping list is then devised. A computer has been purchased so that service users are able to further enhance their skills, if they choose to do so. Within leisure time, service users are encouraged to socialise and follow their preferred routines. Specific television programmes such as soap operas were reported to be enjoyed. Interactions between service users and staff were productive. Lots of discussion was evident and the home in general was animated with a domestic style atmosphere. Service users have developed friendships with others within Landlace Care Homes and also through their attendance at day services and external clubs. Social interaction is therefore promoted and personal friendships are supported. Staff ensure privacy and are discreet and respectful when service users, within a relationship, wish to spend time together. Family contact is promoted and service users are able to receive visitors within their private accommodation or communal areas. Visitors are offered refreshments and hospitality was noted throughout the inspection. One service user reported that they are able to help prepare the evening meal if they wanted to. Another service user confirmed that they decline cooking but will help with the clearing up. Positive comments were made about the food. Mrs Pound confirmed that meal times are very flexible. If for example, service users are going out, a quick meal such as lasagne is made. Healthy eating is promoted and meals are generally based on fresh produce. Service users are able to help themselves to fresh fruit as required. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 14 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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive varying levels of support according to their level of ability. Current levels of monitoring ensure service users’ health care needs are met. Additional measures would ensure medication systems provide greater protection. EVIDENCE: Service users receive varying levels of support with daily living skills. The assistance required is clearly stated within care planning information. A record of all health care appointments is maintained. This includes intervention from various health care professionals such as the GP, District Nurse, Physiotherapist and Occupational Therapist. Specialised support to manage conditions such as epilepsy was noted. In this instance an epilepsy and intervention plan were in place. Staff had maintained detailed monitoring records so that health care personnel could assess the efficiency of medication. All service users are registered at the same practice although have appointments with different GPs. One service user reported that during a recent period of ill health, staff were very good. Another service user confirmed that staff call the doctor quickly. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 15 Service users do not administer their own medication. The staff member on duty administers such via a monitored dosage system. All medication is stored securely within a locked cupboard that is attached to the wall. There are limited amounts of medication and these were orderly stored. The medication administration records were generally maintained. There were two gaps however whereby medication had been administered yet staff had not documented the administration. Two topical creams, contained labels ‘as directed.’ Discussion with the GP or pharmacy is therefore advised to ensure clear labelling. Within the medication administration record, a directive had been changed. This involved one tablet being changed to two. Mrs Pound explained the reason for the change but was advised to evidence this within written form. Staff must also ensure that items such as eye drops are documented when administered. As good practice, staff record the reason for administering ‘as required’ pain relief, on the back of the medication administration record. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 16 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users appeared clear regarding who they need to speak to if they are unhappy. Systems to increase awareness of adult protection have been developed. The arranged training will further ensure service users’ protection. EVIDENCE: The home has a complaints procedure that contains the required information in relation to regulation. The procedure is not however within a user-friendly format. Service users confirmed that they would speak to Teresa or Paul (members of staff) if they had a problem. This was also confirmed within comment cards. Mrs McGrorty has now devised complaint reporting forms and a complaint log. Within discussion, Mrs McGrorty also confirmed that she intends to further develop communication systems. This includes the use of pictorial formats and advice from the speech and language therapist. Mrs McGrorty reported that she is aiming to particularly address those service users who have more limited communication skills. At the last and subsequent inspection, a requirement was made to ensure all staff undertake adult protection training. Mrs McGrorty confirmed that the home has an adult protection-training package. External training, taking into account local policies has also been arranged for all staff in January 2007. All staff have been given a copy of the ‘No Secrets’ documentation regarding adult protection. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 17 Service users do not manage their financial affairs and all have appointees with their placing authorities. Some small amounts of money are kept securely on behalf of service users. These were examined and all were found to correspond with balance sheets. All receipts are now attached on a monthly basis giving greater organisation. At the last inspection due to errors, a requirement was made to tighten the system. A regular audit has now been implemented. Staff also countersign all transactions. A managing finances policy has been developed and all staff have been given a copy. This was undertaken in relation to a requirement made at the last inspection to formalise expectations of additional costs to service users. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment continues to be comfortable, clean, homely and well maintained. Service users’ bedrooms demonstrate individuality and reflect individual interests. Laundry facilities continue to meet existing needs. EVIDENCE: 10 The Crescent is a semi-detached property, within a residential area of Pewsey. The home is within close proximity to local amenities. All service users have a single room on either the ground or first floor. Rooms are individual in style and have been personalised to varying degrees. All have a range of personal entertainment equipment, which is regularly used. The home has a large kitchen with dining area and a separate lounge. The lounge has patio doors leading to an outside seating area. There is a large garden within which one service user has a vegetable plot. Current service users do not smoke so the home operates a non-smoking policy. The hot water is centrally regulated and since the last inspection, hot water temperatures are monitored and recorded appropriately. Radiators, within areas that have been assessed as Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 19 high risk, have been covered. The environment was noted to be clean and odour free. There have been no changes to the laundry facilities. Current arrangements were reported to meet existing need. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is good yet reducing staffing levels in relation to the number of service users within the home reduces the opportunity of exercising individual choice. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are assured greater protection through significant developments within staff supervision, recruitment and staff training. EVIDENCE: The staffing roster demonstrated that staffing levels continue to be maintained at two staff on duty when all service users are at home. On the second day of the inspection, there was one member of staff with two service users. While this appeared adequate, both service users needed to make the trip to collect other service users from their day service. They were happy to do this, yet reducing staffing levels in accordance with the number of service users within the home, reduces service users ability to make their own choices. In the past when the home accommodated three service users, there was one member of staff on duty. Mrs Pound confirmed that having two members of staff on shift Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 21 makes a vast difference to the service. Greater opportunities are available and service users also receive more one-to-one time with staff. Staff members within the organisation generally work in one specific service. 10 The Crescent therefore has its own staff team. Mrs McGrorty reported that she is planning to reorganise this, so that staff work across all homes and have an understanding of all service users needs. It will also enable service users greater variety with whom they work with. Within this, staffing levels of all the homes will be reviewed. Mrs McGrorty has prepared a number of staffing rosters and is actively recruiting. Once in post, staff deployment will be further addressed. Since Mrs McGrorty has been in post, formal staff supervision has been instigated. All staff have now had two supervision sessions. It was reported that these have worked well although time is needed to fully reach the potential of the sessions. To date, discussions have centred on service users and service provision. Particular attention has been given to the key worker role. Mrs McGrorty is also aiming to develop the responsibilities of staff. Key aspects, such as fire safety, have been delegated to specific members of staff. Mrs McGrorty has recently completed a training review and has identified her findings within a training matrix. In order to enable service users, with more specialised communication needs, to express their views, Mrs McGrorty believes that training in communication skills is paramount. She has therefore requested the input of a speech and language therapist. Signing courses are also being investigated. Mrs McGrorty reported that further areas of required development are risk assessments. Risk management training is therefore being investigated. Topics regarding first aid and manual handling are being arranged in order to ensure all staff are fully up to date. Challenging behaviour refresher courses are also being arranged. All staff have completed epilepsy and medication training. Within the whole staff team, three staff have completed NVQ level 2. Two are currently undertaking level 2 and a number of others are in the process of being enrolled. Mrs McGrorty is aiming to raise this number so that the majority have the qualification. Mrs Pound confirmed that regular staff meetings are now in place. Staff are given an agenda to add matters they wish to discuss. All staff receive a copy of the minutes. The meetings are held away from the care home so they are not interrupted. Mrs Pound reported this was positive. Mrs Pound also reported that having a meeting enables all staff to give their views and feel listened to. It also assures that ‘things get done.’ Staff are also given their own copy of memos. All are asked to sign a copy, which is kept on file. Recent matters have included the disciplinary procedure and imposing restrictions. Recruitment documentation has been significantly developed enabling greater organisation and efficiency. A checklist has been developed and all information is now ordered, within individual files, to demonstrate a robust process. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 22 Documentation of the two most recent members of staff were viewed. The application forms were detailed and references were in place. Copies of letters demonstrated an invitation to an interview and confirmation of gaining the post subject to a successful CRB disclosure and references. Mrs McGrorty confirmed that the most recent applicant was awaiting her disclosure so a start date had not been confirmed. Crescent, The (10) DS0000028316.V320251.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Since commencing her post as service manager, Mrs McGrorty has made significant developments to service provision. However, further consideration of roles and responsibilities will assist with the clarity of the home’s leadership. Service users are encouraged to give their views, yet a formal quality assurance system will enable further development of provision. While health and safety is given consideration, the development of some areas would assure further protection. EVIDENCE: As stated earlier within this report, Mrs Lance is the registered manager and the registered provider. Mrs Lance undertakes some shifts as part of the staffing roster and provides cover at times of annual leave and sickness. Mrs Lance has a nursing qualification but has not undertaken the Registered Manager’s Award. Mrs Lance has recently employed Mrs McGrorty as service Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 24 manager. Mrs McGrorty is currently overseeing the day-to-day management of the three homes within the organisation. Within this Mrs McGrorty is also developing systems to be used in all of the care homes within the organisation. So far, Mrs McGrorty has made significant progress. This has included staff supervision, arrangement of training, staff meetings and more efficient systems such as staff recruitment. Mrs McGrorty has a clear focus regarding further development and is motivated to achieve. It is not clear at this stage, whether there will be any changes to the home’s registration of manager. Mrs McGrorty agreed to keep CSCI informed following further discussion with Mrs Lance. At the last inspection, a requirement was made to develop a quality assurance system. Mrs McGrorty reported that she is planning work for this but has not, understandably, had time to implement a great deal. User-friendly service user satisfaction surveys are in place and other questionnaires have been developed. An auditing system is planned. The requirement has therefore been repeated although Mrs McGrorty confirmed the system would be in operation shortly. Health and safety is given consideration yet risk assessments require greater detail and clarity. A new risk assessment format has been devised. Mrs McGrorty reported that this area is intended, to be the next area of development. The building is well maintained. Door guards have been fitted so that fire doors are not inappropriately propped open. Hot water temperatures are now being maintained. Crescent, The (10) DS0000028316.V320251.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 X 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 1 X X 2 X Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Unless it is impracticable to carry out such consultation, the registered person shall after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met. (All plans must be kept up to date and reflect any change in need) A new care plan format is in the process of being devised and key worker meetings will ensure monitoring. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (Risk assessments must address potential risks and give sufficient detail to demonstrate adequate control measures are in place.) The registered person shall DS0000028316.V320251.R01.S.doc Timescale for action 28/02/07 2 YA9 13(4)(c) 28/02/07 3 YA20 13(2) 22/11/06 Page 27 Crescent, The (10) Version 5.2 4 YA23 13(6) make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Staff must sign the medication administration sheet to demonstrate the administration of medication) The Registered Person must 31/01/07 make arrangements for service users, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (All staff receive adult protection training.) This was identified at the last and subsequent inspection. A date for the training has now been arranged. The registered person shall 28/02/07 establish a system for evaluating the quality of the services provided at the care home. (A quality assurance system, which takes into account service user and other interested parties views, must be implemented.) 5 YA39 24 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 YA20 YA20 Good Practice Recommendations The Registered Person should ensure that any change within the dosage of medication is fully evidenced. The Registered Persons should ensure that all medications are clearly labelled and instructions including ‘as directed’ are discouraged. DS0000028316.V320251.R01.S.doc Version 5.2 Page 28 Crescent, The (10) 3 YA33 4 YA37 The Registered Person should ensure that staffing levels do not restrict and reduce service users from pursuing individual activities when other residents are being supported by external services. The Registered Person should ensure that clarity is given to the roles and responsibilities of the management team. Crescent, The (10) DS0000028316.V320251.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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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