Inspection on 21/11/06 for 11 Lane End

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 Good. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

11 Lane End 27/02/06

11 Lane End 15/08/05

11 Lane End 16/02/05

11 Lane End 22/06/04

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Dalewood Respite Care

Orchard,The

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 11 Lane End Crowmarsh Hill Wallingford Oxfordshire OX10 8DG Lead Inspector Lilian Mackay Unannounced Inspection 21st November 2006 08:20 11 Lane End DS0000013101.V320804.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 11 Lane End DS0000013101.V320804.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 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. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 11 Lane End Address Crowmarsh Hill Wallingford Oxfordshire OX10 8DG 01491 826794 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) stephenrees@milburycare.com http/www.milburycare.com/home.html Milbury Care Services Limited Miss Judith Barrow Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 6 27th February 2006 Date of last inspection Brief Description of the Service: 11 Lane End, 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 men with learning disabilities, five of whom have lived together since 1992 when the home was first registered and the residents were relocated there from a large institution. The home provides 24 hour staff support for them. The current manager was registered in 2006. No new residents have been admitted in recent years and it is not anticipated that any will be in the foreseeable future. The fees for this service range from £885.95 to £1083.46 per person per week. Extras include chiropody, haircuts, toiletries, activities and a contribution to petrol and aromatherapy. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “key” inspection where the inspector inspects the service against all the key standards. It was a look at how well the service is doing and took into account the information submitted by the service’s manager and any information that the CSCI has received about the service since it was last inspected. The inspector spent four and a half hours at the home examining policies, procedures, clients’ and staff records and other documentation. The inspector observed a breakfast time at the home and spoke to all four staff on duty at this time and one resident. Feedback was also obtained by means of questionnaires sent to residents, relatives and Health and Social Care professionals with knowledge of the service. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service provided. The purpose of this inspection was to see how the agency is meeting the National Minimum Standards for Care Homes for Adults 18 to 65 and Care Homes for Older People. The age of residents ranges from 54 to 74 years of age. The home had six male residents and a staff team of 14 including ten permanent staff and four “bank” staff at this time. The home’s manager also manages a house in Oxford. Unlike 11 Lane End, this is not a registered care home and the residents there are supported through supported living arrangements. The manager therefore has to work to two very different sets of standards. The management team at 11 Lane End includes two senior support workers. Although the home was accommodating only male residents at this time, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Feedback was obtained from interviews with two staff. Staff confirmed that recruitment and induction procedures were adequate, that they were aware of adult protection procedures, that they met with their manager regularly, that they received formal supervision and that they had group meetings at least every three months. Staff commented, “I am very happy with what X has done both for the men and the staff. She has stabilised the staff team. Before there were few permanent staff – now most of them are.” Another staff member commented, “The training is really good here”. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 6 Feedback was obtained from six residents who completed questionnaires with the assistance of two members of staff advocating on their behalf. All six felt that they had not chosen the home themselves and that they had not received enough information about the home before they moved in. All six felt that they made decisions about what they did each day, that they could do what they wanted during the day, in the evening and at the weekend, five felt the home was always kept clean and felt that the staff treated them well. Three felt that carers listened and acted on what they said. Clients’ comments included - “Activities are suggested to me and I decide whether or not I want to do them.” “I have very little speech but can make my wishes known. I can say “car” and the staff will usually take me for a ride”. “Staff ask me if I would like to go out and I will say “yes” or “no”.” “Staff help me a lot as I have no speech and find it hard to make decisions. However, I am offered different activities and choices every day.” Feedback was obtained from two social and health care professionals who completed questionnaires. Both confirmed that the home communicated clearly and worked in partnership with them, that there was always a senior member of staff to confer with, that staff demonstrated a clear understanding of residents’ care needs, that any specialist advice given is incorporated into the service user plan, that residents’ medication is appropriately managed in the home, that management/staff take appropriate decisions when they can no longer manage residents’ care needs and both were satisfied with the overall care provided to residents in the home. Neither had ever received a complaint about the home. One confirmed that the home’s inspection report was made available to them on request. Whilst one felt that s/he could not see residents in private, this is possible as all residents have their own rooms. Feedback was obtained from two relatives who completed questionnaires. Both confirmed that staff welcome them in the home at any time, that they could visit their relative in private, that they were kept informed of important matters affecting their relative, that they were aware of the home’s complaints procedure, and both were satisfied with the overall care provided at the home. One felt consulted about their relative’s care and one had access to the home’s inspection report. Relatives commented, “Very impressed by the way I found X”. “We would like more staff input for all residents”. The inspector would like to thank the 11 Lane End manager, staff, and the residents for their courtesy, assistance and hospitality during this inspection. What the service does well: The home has provided enormous continuity for residents in terms of where they have lived and whom they have lived with. There is a person-centred approach to care planning and a key worker system is in operation where the care needs of individual residents are the responsibility of individual members of staff. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 7 Residents’ rights are respected in their daily lives. Residents have good access to health care. The home has a friendly, relaxed atmosphere with positive relationships between residents and staff. The manager is responsive to any requirements and recommendations made by the CSCI as part of the inspection process. What has improved since the last inspection? What they could do better: 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. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 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 Outcomes 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) 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 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 suitability 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Adults 18-65 and Older People 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Milbury Care Services has a system in place for assessing people’s needs and wishes prior to admitting them to the home. EVIDENCE: Five of the residents have lived together since 1992 when the home was first registered and the residents were relocated from a large institution. There has been excellent continuity in terms of whom residents have lived with and where they have lived. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 10 No new residents have been admitted to the home in recent years and it is not envisaged that any will be in the foreseeable future. The home’s Policies and Procedures Manual has a comprehensive process in place for assessing the needs and wishes of potential new residents should the occasion arise. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Adults 18-65 and Older People 7,14,33. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ wishes and needs are set out in individual person centred plans. Residents’ care plans and personal information are written and maintained to a high standard. Residents are supported to make decisions about their day-today lives and appropriate action is taken where their wishes involve an element of risk. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 12 EVIDENCE: There is a person-centred approach to care planning, which focuses entirely on the wishes and needs of the individual rather than around organisational constraints. It is accessible and meaningful to the residents themselves. There is a key worker system in operation where the care needs of individual residents are the responsibility of individual members of staff. These processes ensure residents’ rights are respected in their daily lives. The person centred plans seen were fully focussed on the individual residents and were set out in a clear and simple way. These emphasised the importance of effective communication in ensuring that individual residents could make choices and have those choices respected, and made good use of pictures to make them accessible and meaningful to the residents concerned. The manager has acknowledged that a pictorial format is not always suitable for all residents and is exploring other helpful ways of promoting person-centred planning for them. The inspector saw that processes such as the fire safety, complaints and menu planning systems have been adapted and changed to make them more accessible and meaningful to residents. Staff members were seen communicating effectively with residents and offering them choices and opportunities. The inspector saw that residents’ wishes were respected. The inspector saw residents being offered the opportunity to go out and to help with domestic chores. The manager reported that she had been unsuccessful in obtaining an independent advocacy service for those residents with no family or other contacts outside the home. 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 the inspector saw examples of these which included activities such as using the kitchen, making hot drinks, going up and down stairs and having a bath. Such assessments enable residents to enjoy more freedom and independence and are incorporated into residents’ person-centred plans. During the inspection three residents went out shopping with staff. From discussions with staff and notes read the inspector concluded that residents have a very busy lifestyle with a variety of opportunities to get out and about. Residents’ advocates commented, “I make decisions by standing up and going to my bedroom and getting my things.” “I have no speech but I can use body 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 13 language and gestures to show what I want.” “Staff ask me and I will stand up [when making decisions]. I do not have any speech but I will stand up from my chair and walk towards the door when I am not happy. Carers act when I stand up. I will walk to where I want to go.” 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 14 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 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 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Adults 18-65 and Older People 10,12,13,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 15 Residents are supported to keep in contact with their families and their rights are respected in their daily lives. They are supported in choosing what they want to eat and drink and have varied opportunities to take part in activities both within their local community and inside their home. Residents’ views are listened to and acted upon. EVIDENCE: The home’s system of person-centred planning ensures that 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. Through an examination of records and discussion with staff the inspector concluded that residents were supported to choose their own clothes and footwear. The inspector saw that residents were well dressed, with their own individual style. Staff members reported, and records showed, that outside the home residents attend a sensory room, local art & craft and dance and music groups, local leisure facilities, pubs and social clubs, play skittles and golf, go shopping, go to pubs and clubs, visit garden centres and attend local activities such as fetes, regattas etc. Staff members reported, and records showed that within the home residents enjoy aromatherapy, cookery, gardening, watching the TV and videos, listening to the radio, drawing, books, doing household chores, doing puzzles and having foot spas and barbecues. Residents were seen to be supported to carry and use their own money when out. Residents are offered opportunities and positively encouraged to go out in the evening. Residents went out on the morning of this inspection. Within the house residents were seen to enjoy favoured activities such as spending time in the garden and listening to music. They were encouraged to undertake light household chores and their wishes in this regard were respected. All residents were reported to have gone on holiday this year for the first time. All but one of the six residents had relatives with whom they had meaningful contact such as making or receiving visits, telephone calls and the occasional letter. It was reported that one resident had been reintroduced to his family this year after a long estrangement. One resident told the inspector that he regularly visits his parents. Staff members were seen to respect residents’ privacy for example when using the bathroom. It was reported that residents are given their mail unopened. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 16 An observation of staff practice whilst assisting with feeding indicated that some staff would benefit from further training in this area. 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. It was reported that drinks and snacks are available to residents between meals should they wish. The inspector saw laminated photographs of various dishes which staff use to assist residents to make choices about what should be on the menu. With some residents it is a matter of observing and taking note of their reactions to different foods and planning accordingly. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Adults 18-65 and Older People 8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have good access to health care as staff support residents in accessing their GP and other community healthcare services when needed. The recording of medicines administered needs to include the administration of prescribed creams. EVIDENCE: There is a bath hoist and a wheelchair to meet one resident’s mobility and personal care needs. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 18 The key worker system in place ensures that an identified staff member takes responsibility for an individual’s person-centred plan, their holidays, clothes, activities, health care, money and for ensuring they lead the life they want to lead. An examination of residents’ records confirmed that residents have the opportunity to have dental check ups and other routine health checks such as eye tests and chiropody. There has been an improvement in this area since the last inspection and plans are afoot to introduce recorded health action plans for residents. The inspector commends this development. The inspector examined residents’ medication and the associated records. Evidence was seen that the application of prescribed creams are not always recorded. For accountability any handwritten entries or changes made to medication profiles should be initialled or signed by the person making the entry or change. Medicines were seen to be stored securely with access limited to authorised, trained and responsible staff members. The contents of the medication cabinet were well organised and clean. A monitored dosage system, where the medications are made up by the pharmacist into blister packs, is used. Prescribed medications no longer in use are now returned promptly to the pharmacy for disposal. This has been an area of improvement since the last inspection. The disposal records were seen and the receiving pharmacist had signed these. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 19 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 safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Adults 18-65 and Older People 16,17,18,35. Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Residents are safeguarded from abuse and their views are listened to and acted upon. EVIDENCE: Whilst the primary means of listening to residents and acting upon their views is through the person-centred planning process, the home also has 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 saw a simple, user-friendly procedure, mostly using pictures, for residents to use. The inspector examined the complaints record book. To date this has not been used and the manager reported that this was because no complaints had been received. No complainant has contacted the CSCI with information concerning a complaint about the service since the last inspection. An examination of the complaints log confirmed this. One out of six clients who responded to a questionnaire via his advocate reported that he knew whom to contact if he wanted to complain. None of the residents had ever needed to do so. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 20 Residents’ advocates commented about residents complaining - “I do not have any speech but I will go and stand next to the staff and hold my hands together.” “I do not have any speech but I will go to the staff and hold their hand and take them to what I want [when I am not happy]. Staff always do what I ask them to do when I take them to it”. “I do not have much speech but the staff know if I am not happy by body language etc. and respond accordingly.” “The staff will help me [if I want to make a complaint].” “Staff know if there is something wrong with me but I cannot speak out if I want to complain. Staff would try and find out what was upsetting me.” The manager reported that the home had not made or received any allegations or concerns involving abuse of residents. Staff spoken to confirmed that they had received training in safeguarding vulnerable adults from abuse. The home has a copy of the Oxfordshire Multi-Agency Codes of Practice for reference. An examination of residents’ financial records confirmed that these were meticulously recorded, demonstrated staff accountability to residents and that money was kept safely and accessible to residents. The home has a friendly, relaxed atmosphere with positive relationships between residents and staff. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30. Adults 18-65 and Older People 19,26. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The home’s appearance benefits from a planned programme of refurbishment and decoration and it is generally suitable, comfortable and homely. All residents have their own bedrooms in addition to adequate communal areas. Specialist equipment is provided where necessary. The laundry has been refurbished to make it easier to clean. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 22 EVIDENCE: During this inspection one resident was bumped in the head by the kitchen door and staff reported the adjacent bathroom door to be also dangerous. For residents’ safety, advice must be taken immediately from the health and safety person for Milbury Care Services about these, written risk assessments drawn up and the recommended action taken. The two unrestricted windows on the first floor could compromise residents’ safety and must be restricted. It is recommended that the pathway in the garden be re-laid, as it is currently uneven and could cause an accident. The front door has an audible alarm to notify staff members when the front door is opened. Security lights have been fitted to make it safer for staff and residents when visiting the laundry. This year new curtains/blinds have been purchased for all the communal areas, three residents’ bedrooms have been recarpeted and four of them have had new furniture. Whilst most of the home’s furnishings were comfortable and homely the stair carpet was fraying and there were three shabby tables in the lounge. Each resident has his own bedroom. One resident has been encouraged to use a key to lock his room in his absence but has shown little interest in doing so. The inspector saw several residents’ bedrooms. These were very different in character according to the needs and wishes of each, but all were clean, attractive, comfortably furnished and well decorated and showed evidence of each resident’s interests. The home has three bathrooms, one downstairs and two upstairs, so residents have good access to WCs, baths, a shower and washbasins. One bathroom was in dire need of refurbishment. It was unheated, the wallpaper needed replacing and there was water damage to the woodwork. It had recently been fitted with a floor covering which was unsuitable because it did not prevent water seeping down to the floorboards. One bathroom is fitted with ceiling mounted tracking and a hoist and another has been converted to a wet shower room. All bathrooms are lockable. The shared spaces in the home are the lounge, the kitchen/dining room and the garden, which some residents, and one in particular, enjoy. The kitchen has recently been totally refurbished and is now very attractive. The home’s future refurbishment programme includes refurbishing the bathroom identified by June 2007, recarpeting the hall stairs and landing [March 2007] replacing the home’s double glazing and obtaining a garden summerhouse. Residents were seen to be confident and at ease in their home and to have access to all parts of it, including the kitchen and office, without restriction. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 23 Residents were positively welcomed into the office and encouraged to be a part of what was going on. With the exception of the entrance area where there was a strong odour of urine the home was clean and fresh smelling. The importance of locking away toxic substances needs highlighting as the inspector saw a container with carpet cleaner left out in the room adjacent to the laundry which residents have access to. The laundry room has been redecorated, had new flooring fitted and a new tumble dryer installed. Arrangements were reported to be in place for the removal of soiled waste. Residents’ advocates commented, ”Hoovering, dusting and cleaning are done every day and when necessary throughout the day.” “The house is cleaned every day and I sometimes help.” “The home is cleaned every day although we can make a mess at times. It is always cleared up with us.” 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 24 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 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. Adults 18-65 and Older People 27,28,29,30. Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policies and practices are such that they ensure residents are protected. The home employs enough staff to meet residents’ needs. Staff are provided with adequate training and supervision to ensure a good quality service is provided. EVIDENCE: An examination of the recruitment records for the one member of staff employed since the last inspection confirmed that two written references are now obtained in respect of all applicants for staff posts. There has been an 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 25 improvement in the recording in staff recruitment records since the last inspection. There has been a comparatively high turnover of staff with three having left the home since the last inspection. Two of these transferred within the organisation and now work in supported living arrangements in Oxford for Milbury Care Services. The staff spoken to said that in their opinion there were enough staff members on each shift to meet residents’ needs. The duty rota seen showed that there were usually three staff members on duty throughout the day, sometimes two and sometimes four. It was reported that the minimum safe number of staff on shift was two. A staff member reported that the minimum number of staff needed on duty in order to provide residents with the opportunity to go out was three. There are now enough staff on duty to enable residents to go out in the evenings if they want to. The home does not employ enough permanent staff to meet residents’ needs but uses its own “bank” of four staff to meet its staffing requirements. It was reported that these bank staff had recently worked 52 shifts in the home over an eight-week period. This is an improvement on previous practice and the use of temporary agency staff has been greatly reduced, promoting consistency of support for residents. New staff receive a structured induction training programme, and some are doing the LDAF (Learning Disability Awards Framework) Foundation training course. Whilst the recommended 50 of care staff trained to NVQ Level 2 or above has not been achieved within the recommended timescale, no evidence was found that staff were other than adequately skilled to do their jobs. Staff training includes manual handling, First Aid, adult protection, personcentred planning, non-violent crisis intervention, NVQ, food safety and health & safety. Staff spoken to confirmed that they receive adequate training to ensure they always work within their areas of competence. The records seen did not show that regular staff team meetings were taking place but staff spoken to about this reported this to be the case. It is recommended that the minutes of all staff meetings be recorded with a copy kept in the home accessible to staff members for reference. Residents attend these meetings if they wish. The records seen showed that these meetings were positive, focussed on action and quality of service, and promoted accountability. Staff spoken to confirmed that they received regular, planned and recorded supervision. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 26 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 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42. Adults 18-65 and Older People 31,33,35,38. Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 27 The home promotes the health and safety of residents and staff and is well managed. The manager is highly motivated and provides clear leadership for staff. There is a process for reviewing the overall quality of the service provided by the home periodically which includes consultation with residents. EVIDENCE: The manager is responsive to any requirements and recommendations made by the CSCI as part of the inspection process. Staff members reported that they felt well supported. Staff feel valued by management and appreciate the positive changes that have taken place in the previous 12 months since the home came under new management. Staff confirmed that the experienced manager provided clear leadership and support. She has a clear vision for the further development of the home and provides consistent quality care for the residents. Since the beginning of 2006 numerous improvements to the service have been made including a reduction in the use of agency staff, the introduction of person-centred planning, a significant increase in the activity opportunities available to residents and the home has been substantially refurbished. Whilst evidence was seen that Milbury Care Services was fulfilling its responsibility to visit the home every month to report on the conduct of the home, evidence was not seen that records are kept following these visits as required by the legislation. Such records must be kept available for inspection in the home by the CSCI inspectors. During this inspection the kitchen door hit a resident and the inspector closely avoided also being hit. An examination of the accidents record showed that no accidents had been recorded in the home since the last inspection. It is recommended that management review with staff the accident reporting procedures. The manager confirmed in writing that the records of health and safety checks and the servicing of equipment were in good order and up-to-date and that all the recommended policies and procedures were available and that these were recently reviewed to ensure they remained up to date. Records relating to the managing and safeguarding of residents’ moneys were examined and found to be in good order. Each resident was seen to have an individual bank account with all expenditure recorded. The manager reported that a Milbury employee independent of the home regularly audited all records. Residents’ money kept in the home was seen to be kept securely. Money cannot be withdrawn from residents’ bank accounts without the resident himself being present. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 28 It was reported that whilst a recent Review of the Quality of Service Provision has been carried out that the results of this had yet to be collated. These will be sent to the CSCI when this is done. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 2 42 3 43 X 3 3 X 3 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 11 Lane End Score 3 3 2 X DS0000013101.V320804.R01.S.doc Version 5.2 Page 30 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 YA20 Regulation 13 Requirement Improve the recording of medications administered by always recording the application of prescribed creams, initialling/signing handwritten entries/changes to medication profiles and checking all medication profiles to ensure they indicate medication to be taken as required. Ensure residents’ safety by: 1. Taking health and safety advice immediately regarding the two doors identified in the report and instigate the necessary action. 2. Restricting unrestricted first floor windows. 3. Relaying the garden pathway. Redecorate the bathroom identified. Keep Regulation 26 visit records available for inspection in the home by the CSCI inspectors. Timescale for action 31/12/06 2 YA24 13 28/02/07 31/12/06 28/02/07 28/02/07 31/12/06 3 4 YA24 YA41 16 26 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 31 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 3 4 5 Refer to Standard YA30 YA24 YA35 YA35 YA41 Good Practice Recommendations Eradicate the odour of urine in the entrance hall. Ensure toxic substances are stored safely. Provide additional training for staff on assisting with feeding. Ensure 50 of care staff are trained to NVQ Level 2 or above. Review the accident reporting procedures with staff. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 11 Lane End DS0000013101.V320804.R01.S.doc Version 5.2 Page 33 - 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. 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