Inspection on 15/08/05 for 11 Lane End

This inspection was carried out on 15th August 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

11 Lane End 21/11/06

11 Lane End 27/02/06

11 Lane End 16/02/05

11 Lane End 22/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Lane End 11 Lane End, Crowmarsh Hill Wallingford Oxon OX10 8DG Lead Inspector Julian Griffiths Announced 15 August 2005 10:00 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 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 Older People and 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. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lane End Address 11 Lane End, Crowmarsh Hill, Wallingford, Oxon. OX10 8DG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01491 826794 stephenrees@milbury.com Milbury Care Services Limited Mrs Judith Barrow Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: NA Date of last inspection 16 February 2005 Brief Description of the Service: This home, situated between Oxford and Reading, is run by Milbury Care Services Limited. It is an ordinary house in a small, modern residential development. It accommodates six people with learning disabilities who had until the early 1990s lived in a large institution, and provides staff to support them 24 hours a day. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which means that it was planned in advance with the manager, that the manager was in the home throughout and had been able to supply the inspector with a lot of information about the home before the inspection took place. It also meant that the inspector was able to seek the opinions of people associated with the home in advance of the inspection. This report should be read in conjunction with the report of the unannounced inspection on 16th February 2005. The inspector was in the home from 10am until 4.30pm on the day of the inspection. During that time he talked with residents, staff and the manager, looked around most of the home and looked at written records. Everyone at the home was welcoming and helpful. The inspector found that the overall standard of service was high and continuing to improve. Relatively few requirements and recommendations were made, although one of these, to do with dental care, involved an important element of the service. It was disappointing to see that requirements from previous inspections, concerning the physical standard of the laundry and kitchen, had not been addressed. The inspector was told that improvements were in the pipeline. What the service does well: Residents’ wishes and needs are set out in individual plans. Residents are supported to make decisions about their day-to-day lives. Residents are supported where their wishes involve an element of risk. Residents are supported to keep in contact with their families. Residents are supported to choose what they want to eat and drink. Residents’ rights are respected in their daily lives. Residents receive a high standard of personal support. Residents have good access to healthcare. Residents’ medicines are safely managed. The home seeks to respect residents’ wishes in respect of their death. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 6 Residents’ views are listened to and acted upon. The home takes steps to protect residents from abuse. The residents’ home is generally safe, suitable, comfortable, homely, clean and well maintained. All residents have a private bedroom and a variety of shared spaces. Special equipment has been fitted to meet the needs of one resident. The home employs enough staff to meet residents’ needs. Staff are provided with training and supervision to ensure a high standard of service. The home is well managed. Residents have benefited from numerous improvements since the current manager took up post. A Quality Assurance system is in place which is based on the views of residents and people close to them. The manager promotes the health and safety of residents and staff. What has improved since the last inspection? What they could do better: A system needs to be put in place to ensure that routine dental check-ups are offered regularly. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 7 Residents’ medicines that are no longer in use need to be returned to the pharmacy. The kitchen remains in a poor state and requires complete refurbishment in line with a previous inspection requirement. The laundry requires a ceiling and washable floor and walls in line with a previous inspection requirement. The manager is advised to seek an alternative solution to the problem which necessitates the fitting of a barrel bolt to the outside of a WC door. For the protection of residents, two written references need to be obtained in respect of all applicants for staff posts. 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. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Standards Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitablity of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Milbury Care has a system in place for assessing people’s needs and wishes prior to admitting them to the home. EVIDENCE: Since it opened, no new residents had been admitted to the home, and it was not anticipated by the manager that any would be in the foreseeable future. However, the inspector saw in the home’s Policies and Procedures Manual that Milbury does have a detailed and comprehensive process in place for assessing the needs and wishes of potential new residents should the occasion arise. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Residents’ wishes and needs are set out in individual plans. Residents are supported to make decisions about their day-to-day lives. Residents are supported where their wishes involve an element of risk. EVIDENCE: Since she took up post at the beginning of the year the manager has been striving to make systems at the home more person-centred. This was clearly reflected in the changes seen by the inspector to the care planning system, although this was still very much a work in progress. Plans seen were fully focussed on the individual, were set out in a clear and simple way, emphasised the key role of effective communication in ensuring that individuals could make choices and have those choices respected, and made heavy use of pictures to Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 11 make them accessible and meaningful to the people concerned. A resident told the inspector that he had worked with staff to produce his plan and had enjoyed the process. The manager acknowledged that a pictorial format was not helpful to all residents and said that there was active consultation with the people most closely involved with those residents to find the most helpful way of taking person-centred planning forward with them. The inspector saw that other processes in the home had been adapted and changed to make them more accessible and meaningful to residents, for example the fire safety, complaints and menu planning systems. These developments are very positive. A staff member demonstrated to the inspector that she was able to communicate effectively with service users and the inspector saw that she offered choices and opportunities to residents and respected their wishes. Records seen also provided evidence of this. The inspector saw residents being offered the opportunity to go out, and to help with domestic chores, which was declined. There were no apparent restrictions on residents’ freedoms within the home. The locking of the front door, commented on in the previous report, had stopped and been replaced with an audible alarm to notify staff members if the front door was opened. The manager said that she was in contact with a local advocacy group (WEBCAS) in the hope of obtaining an independent advocacy service for residents, particularly those with no family or other contacts outside the home. Records relating to the systems in place for managing and safeguarding residents’ money were seen. Each resident was seen to have an individual bank account with all expenditure recorded. The manager said that all records were regularly audited by a Milbury employee independent of the home. Residents’ money kept in the home was seen to be kept securely. The manager said that the nature of residents’ bank accounts was soon to change so that money could not be withdrawn without the resident himself being present. Where a resident wishes to do something that involves an element of risk the nature of the risk is assessed by the home and safeguards put in place to protect the resident’s welfare. Such assessments are recorded and examples were seen by the inspector. These included assessments for activities such as using the kitchen, making hot drinks, going up and down stairs and having a bath. It was good to note that assessments enabled residents to enjoy more freedom and independence. One assessment, in respect of using the road, stated “I don’t need anyone to hold on to me when I’m walking”. The manager said that she and staff were in the process of reviewing all such assessments and incorporating them into residents’ person-centred plans. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experiencd in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 Residents’ opportunities for activities in and out of the home are increasing. Residents are supported to keep in contact with their families. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 13 Residents’ rights are respected in their daily lives. Residents are supported to choose what they want to eat and drink. EVIDENCE: It was reported by the manager and a staff member that, in the past, the residents had had very few opportunities for activity, but that this had changed dramatically in the past few months. Staff members reported, and records showed, that residents were accessing local art & craft and music groups, local leisure facilities, pubs and social clubs, sensory sessions, shopping and social events. The manager said that residents were now being supported to carry and use their own money when out. Historically it was the case in this home that residents retired to bed very early. Recent staff meeting records seen showed that evening staffing levels were now such that residents could be offered opportunities to go out in the evening and that the manager was positively encouraging this. On the day of the inspection residents went out in the morning and the afternoon, some to the bank, some to a local café and park. Within the house residents were seen to enjoy favoured activities such as spending time in the garden or colouring. They were encouraged to undertake light household chores but their wishes in this regard were respected. Some residents were helping to put clean laundry away, another was drying-up dishes. The manager said that residents now had the opportunity to go on holiday, which they had not had for years. A resident told the inspector that he was going to Devon this year. Residents’ relatives who responded to the Commission’s pre-inspection survey said that they were welcomed when they visited the home and could see their relative in private. They said that they were consulted about their relatives’ care. The manager said that four of the six residents had relatives with whom they were in meaningful contact, making or receiving visits, and also telephone calls and the occasional letter. While the inspector was in the home a resident’s close relative phoned and was enabled to speak to him in private. Arrangements were made for her to visit, with other family members, on the following day. A resident’s diary showed that he had gone to stay with his parents for several days at the beginning of the month. Staff members were seen to respect residents’ privacy, knocking on bedroom doors and encouraging residents to maintain their privacy, for example when using the bathroom. The manager said that residents were given their mail unopened. Residents were seen to be confident and at ease in their home and to access all parts of it, including the kitchen and office, without restriction. Residents Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 14 were positively welcomed into the office and encouraged to be a part of what was going on. The menu seen by the inspector showed a varied and appetising diet, with breakfast, a light lunch, a main evening meal and a light supper. A staff member said that drinks and snacks were available to residents between meals should they wish. The inspector was shown laminated photographs of various dishes which staff used to assist residents to make choices about what should be on the menu, but with some residents it was a matter of observing and taking note of their reactions to different foods and planning accordingly. The manager related how a change in seating positions at the dining table had enabled a resident to see the choices another resident was making, which had enabled him to make his own choice known to staff. The inspector saw records of a recent staff meeting in which staff had been encouraged to really involve the residents in choosing the menu. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 and 21 Residents receive a high standard of personal support. Residents have good access to healthcare. A system needs to be put in place to ensure that routine dental check-ups are offered regularly. Residents’ medicines are safely managed. Residents’ medicines that are no longer in use need to be returned to the pharmacy. The home seeks to respect residents’ wishes in respect of their death. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 16 EVIDENCE: The home’s system of person-centred planning, the records for which were seen, seeks to ensure that all the support provided by staff is consistent with the individual resident’s wishes. Routines such as times for getting up and going to bed are according to individual wishes. Records seen showed people retiring to be at many different times, and a staff member described how an individual conveyed to staff members whether or not he wished to get up. Records and discussion with staff showed that residents were supported to choose their own clothes and footwear. The inspector saw that residents were well dressed, with their own individual style. One resident had access to a hoist and wheelchair to meet his mobility and personal care needs. The manager stated that a keyworker system was in place through which a named staff member took lead responsibility for an individual’s person-centred plan, holidays, clothes, activities, healthcare, money and “ensuring they lead the life they want to lead”. Records relating to residents’ healthcare were inspected. These showed regular medication reviews and overall health checks, as well as eye tests and chiropody. A record was seen of a resident declining two opportunities for a flu vaccination. Regarding dental check-ups, the last recorded in all residents’ records seen was on 19/08/04, almost a year previously. The manager said that no arrangements had been made for check-ups since this date. It is required that a system be put in place to ensure that all residents have the opportunity for regular dental check-ups at intervals specified by their dentist. The inspector looked at residents’ medication, at the records associated with this, and observed a staff member administering medication to a resident. Medicines were seen to be stored securely and with access limited to authorised and responsible staff members. The contents of the medication cabinet were well organised, clean and properly labelled. The Boots monitored dosage system was in use. A prescribed cream, Betnovate, was seen which had been prescribed in June 2004. The resident’s medication record did not include this preparation. Prescribed medication that is no longer in use must be returned to the pharmacy for disposal. Administration and disposal records were seen and the latter had been signed by the receiving pharmacist. During the administration process a staff member was seen to keep medication secure, to have the GPs instructions to hand throughout and to sign the administration record immediately after. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 17 The manager said that, as part of the person-centred planning process, work had been initiated with residents and their close relatives to find out what their wishes were in respect of their deaths, in particular with regard to funeral arrangements and wills. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16, 18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are sageguarded. (OP NMS 35) The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 16, 18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. Residents’ views are listened to and acted upon. The home takes steps to protect residents from abuse. EVIDENCE: Whilst the primary means of listening to residents and acting upon their views is through the person-centred planning process the home does have a proper complaints procedure which meets the required standard in terms of the information it provides and the timescales for dealing with complaints. The inspector also saw a very simple and user-friendly procedure, mostly using pictures, for residents to use. There was a complaints record book which to date had not been used as the manager said that no complaints had been received. The manager said that the home had not made or received any allegations or concerns involving abuse of residents. Records showed that all staff had received training in the protection of vulnerable adults. The Berkshire Code of Practice for adult protection was seen to be present in the home. The manager was asked to obtain a copy of the Oxfordshire Multi-Agency Codes of Practice and to ensure that all elements of the home’s existing protection practice were consistent with it. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28, 29 and 30 The residents’ home is generally safe, suitable, comfortable, homely, clean and well maintained. All residents have a private bedroom and a variety of shared spaces. Special equipment has been fitted to meet the needs of one resident. The kitchen remains in a poor state and requires complete refurbishment in line with a previous inspection requirement. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 20 The laundry requires a ceiling and washable floor and walls in line with a previous inspection requirement. The manager is advised to seek an alternative solution to the problem which necessitates the fitting of a barrel bolt to the outside of a WC door. EVIDENCE: The home is a large, modern, detached family house on a small residential development in a village, but within walking distance of the pleasant market town of Wallingford. It is domestic rather than institutional in character. The interior had recently been redecorated and it was light, bright, clean and very pleasant in most of the areas seen. The exception was the kitchen/dining room where the units are damaged and worn out and look shabby. The manager and her line manager said that it was scheduled for complete refurbishment in September 2005. Laundry equipment was located in the home’s detached garage. Inspection requirements have been outstanding since at least June 2004 to bring this facility up to the required standard. The manager and her line manager stated that this also was to be completed in September 2005. Furnishings were comfortable and homely, if sometimes a little worn. The inspector was told that some carpets and the seating in the lounge, and door handles were scheduled for replacement in the near future. Each resident has a private bedroom. One has a key to his room. The inspector saw that where a resident did not have his own key this was written in to his person-centred plan, and the reason why explained. Three residents enabled the inspector to see their rooms. These were very different in character according to the needs and wishes of each, but all were comfortably furnished and well decorated and showed evidence of each resident’s interests. There were three bathrooms, one downstairs and two upstairs, giving residents good access to WCs, baths, a shower and wash basins. One bathroom was fitted with ceiling mounted tracking and a hoist. All bathrooms were lockable. The inspector was disturbed to see a barrel bolt fitted to the outside of one of the bathrooms, giving the potential for residents to be locked inside either accidentally or intentionally. The manager said that the reason for this was that, at night, when the ceiling mounted hoist was in its on-charge position, residents could walk in and bang their heads on it. Thus the door was kept locked at night and residents had access to the adjacent bathroom. The inspector found the door bolted when he tried to use the bathroom during the inspection. The manager is advised to seek an alternative solution to this problem. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 21 The shared spaces in this home are the lounge, the kitchen/dining room, the office, where some residents enjoy spending time, and the garden which some residents, and one in particular, enjoy. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 34 and 35 (Adults 18-65) and Standards 27,29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36. The home employs enough staff to meet residents’ needs. The use of temporary agency staff has been greatly reduced, promoting consistency of support for residents. Staff are provided with training and supervision to ensure a high standard of service. Because of the high number of staff recruited over the last 6 months, for which the manager is commended, it was clearly not possible for the target of 50 of staff trained to National Vocational Qualification Level 2, to be reached at the time of this inspection. For the protection of residents, two written references need to be obtained in respect of all applicants for staff posts. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 23 EVIDENCE: The manager and staff spoken to said that in their opinion there were enough staff members on each shift to meet residents’ needs. A staff member who had worked in the home for six months said that to her knowledge residents had not missed a single activity because of shortage of staff. The duty rota seen showed that there were usually three staff members on duty throughout the day, sometimes two (six occasions over a period of 4 weeks) and sometimes four. The manager said that the minimum safe number of staff on shift was two. A staff member said that the minimum number of staff needed on duty in order to provide residents with the opportunity to go out was three. A staff member said that because staff enjoyed coming to work there was a low rate of absence and a high degree of staff reliability. A staff meeting record seen noted that there were now enough staff on duty to enable residents to have the opportunity to go out in the evenings if they wanted to. Records showed that six staff had been recruited and employed in the last 6 months, drastically reducing the number of hours for which agency staff were employed; the manager’s line manager said that agency hours had reduced from 247 in a week to 27. All new staff received a structured induction training programme, and some were engaged on the LDAF (Learning Disability Awards Framework) Foundation training course. One staff member was said by the manager to have achieved NVQ Level 2. Staff training records showed the availability of in-service training in areas such as manual handling, First Aid, adult protection, person-centred planning, non-violent crisis intervention, food safety and health & safety. Records seen showed regular staff team meetings (also attended by residents if they wished). The records showed meetings that were positive, focussed on action and quality of service, and which promoted accountability. Records showed that staff received regular, planned and recorded supervision. A staff member said that in her experience supervision was never missed. Records relating to the recruitment of two staff members were inspected and found to include all those documents specified under Schedule 4 of the Care Homes Regulations with the exception, in one case, of a second reference. The manager said that she had tried but had experienced difficulty obtaining this. The inspector’s view was that there still remained avenues to explore in obtaining a second reference for the staff member concerned and that this needed to be addressed. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 39 and 42 (Adults 18-65) and Standards 33,35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39 and 42 The home is well managed. Residents have benefited from numerous improvements since the current manager took up post. A Quality Assurance system is in place, which is based on the views of residents and people close to them. The manager promotes the health and safety of residents and staff. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 25 EVIDENCE: Staff members said that they felt well supported. One said that staff were valued by the manager in so far as they themselves valued the residents, because the entire management focus was on quality of life for the residents. Another staff member said that the manager had made a big difference to the home in that the environment of the home had improved and the residents had opportunities for many more activities. Records showed that Milbury was fulfilling its responsibility to visit the home every month and report in writing on its conduct. A record was seen of the most recent of the home’s annual development plans. This was seen explicitly to record residents’ views, some of which (e.g. regarding greater choice of activities) were seen to have been acted upon, and others of which (e.g. regarding obtaining a garden summerhouse) were being actively discussed. Regarding health and safety the inspector looked at records relating to fire safety, gas boiler servicing, electrical appliance testing and hoist servicing and found that all were in good order and up-to-date. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 26 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 3 Score ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x 3 3 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING 2 x 3 3 3 3 2 Score 11 12 13 14 15 16 17 Standard No 31 32 33 34 35 36 x 1 3 2 3 3 x 3 3 x x 3 x Version 1.40 Page 27 CONDUCT & MANAGEMENT PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lane End Score 3 2 2 x 37 38 39 40 41 42 43 H57-H08 S13101 Lane End V234660 150805 Stage 4.doc 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 YA19 Regulation 13(1)(b) Requirement It is required that a system be put in place to ensure that all residents have the opportunity for regular dental check-ups at intervals specified by their dentist. It is required that prescribed medication that is no longer in use be returned to the pharmacy for disposal. It is required that the kitchen be completely refurbished to an acceptable standard. It is required that the laundry area be given a ceiling and washable floor and walls. It is required that two written references be obtained in respect of every person employed at the home, and that copies of these be kept in the home and available for inspection. Timescale for action 31/08/05 2. YA20 13(2) 31/08/05 3. 4. 5. YA24 YA30 YA34 23(2) 13(4) 17(2) 30/09/05 30/09/05 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Lane End Refer to Good Practice Recommendations H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 28 1. Standard YA23 It is recommended that the manager obtain a copy of the Oxfordshire Multi-Agency Codes of Practice for the Protection of Vulnerable Adults and ensures that all elements of the home’s protection practice are consistent with it. The manager is advised to seek an alternative solution to the problem which necessitates the fitting of a barrel bolt to the outside of a WC door. 2. YA27 Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South, Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Lane End H57-H08 S13101 Lane End V234660 150805 Stage 4.doc Version 1.40 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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