Inspection on 18/01/07 for 12 Shenfield Way

This inspection was carried out on 18th January 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

12 Shenfield Way 27/10/05

12 Shenfield Way 28/04/05

12 Shenfield Way 19/01/05

12 Shenfield Way 20/07/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 12 Shenfield Way 12 Shenfield Way Brighton East Sussex BN1 7EX Lead Inspector Jane Jewell Key Unannounced Inspection 18th January 2007 12:30 12 Shenfield Way DS0000060274.V307723.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 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 12 Shenfield Way Address 12 Shenfield Way Brighton East Sussex BN1 7EX 01273 296364 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) www.fosteringinbrightonandhove.org.uk Brighton & Hove City Council Elizabeth Ann Bateman Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is 3. Service users should be aged between18 and 65 years on admission. Only adults with a Learning Disability who have been assessed as requiring residential care are to be accommodated. 27th October 2005 Date of last inspection Brief Description of the Service: 12 Shenfield Way provides residence and care to up to three younger adults with a learning disability. The building is owned and maintained by Kelsey Housing Association with the services and staffing supplied by South Downs Health NHS Trust and Brighton and Hove City Council. The home provides long term placements with day care in the main provided by the home. The home was opened in 2002. The home is a detached two-storey building, situated in Brighton. It is located in an elevated residential area on the outskirts of Brighton, with some access to local amenities, including a food shops, pubs and cafe. All bedrooms are single occupancy and are individually decorated with one bedroom providing ensuite facilities. Communal areas comprise of a lounge/dining room and kitchen. The homes literature states that its aim is to support service users to lead an ordinary life. The fees for residential care are currently £101,000 per week, depending on the services and facilities provided. Extra such as: Transport, leisure activities Personal expenditure, clothing, toiletries, sweets magazines and hairdressing are additional costs. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been comprised from an unannounced inspection undertaken over 5½ hours and information gathered about the home prior to the inspection. This includes: residents survey questionnaires, discussion with relatives and stakeholders involved in resident’s care and records submitted to the Commission for Social Care inspection (CSCI) including a Pre-inspection questionnaire. The inspection was facilitated by Jon Stodart (Acting manager). The inspection involved a tour of the premises, observation, examination of records and discussion with residents and staff. There were three residents living at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Staff work hard and are innovative in meeting the needs of residents who have complex needs. Residents benefit from a well supervised, experienced and enthusiastic staff team that know their needs and with some staff having worked at the home for a number of years. Comments about staff included: “Staff show a lot of understanding about son’s needs, they are wonderful” “very good excellent” and “the staff are excellent with my son they try and provide stimulation for him all the time” Residents are given support in order to have active social and leisure experiences. Integral to the ethos of the home is ensuring and respecting residents’ rights to make decisions about their daily lives. Residents are supported to maintain relationships with their families. Comments made by relatives included: “one of the best homes we have come across”; “they treat my son as an individual”; and “We as parents are very please with the home, communication is very good and my son always appears to be very happy” . The home balances the rights of tenants to take reasonable risks as part of an active lifestyle against any unacceptable risk to themselves or others. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 6 It was clear that where the home had concerns about meeting the changing or emerging needs of residents, additional support or advice is sought from health care professionals. 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. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 and 5 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Some information about the homes services and facilities is available should the need arise for this to be shared with prospective residents and their representatives. Prospective residents would benefit from an admission process that ensures their individual needs and aspirations are assessed prior to moving into the home. The home is able to identify and meet the needs of the service users. EVIDENCE: There is information available about the home, to inform current and prospective residents about the services and facilities, this includes a combined statement of purpose, service user guide and licence agreements. It was previously required that the statement of purpose be updated to accurately reflect the current services provided at the home. The acting manager reported that this had been undertaken. The acting manager felt that these documents included sufficient information to help inform prospective residents about the home. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 9 There have not been any new admissions to the home for a number of years. Therefore, this standard could only be assessed in respect of the admission procedure for prospective residents. The acting manager was aware of the admission criteria for the home and knowledgeable about admissions practices that would ensure a full social care needs assessment being undertaken to inform any decisions about whether needs could be met at the home. There are also policies to ensure an effective pre-admissions process and moving in plans. The acting manager said that prospective residents would be encouraged to visit the home prior to admission, along with any placing care manager, family or representative. The type and length of visits would depend upon the individual need. In the past staff have visited day care services, in order for the prospective resident to become familiar with staff prior to moving into the home. Residents are aged between 35yrs and 40yrs with two residents having lived at the home since it opened. Residents have very complex individual needs including challenging behaviour. There was a wide range of evidence that the home is able to meet these needs. Permanent staff were able to demonstrate a clear knowledge and understanding of the needs of each resident and also how those needs are consistently met. All relatives consulted spoke positively about the home. A sample of their comments include: “one of the best homes we have come across”; “they treat my son as an individual”; “the change in him in just three months of being at the home was just wonderful” and “We as parents are very please with the home, communication is very good and my son always appears to be very happy” It was previously required that residents have a contract with the home. The acting manager reported that a Licence agreement is available to inform residents and their representatives of their rights and responsibilities whilst staying at the home. This contract is made in conjunction with South Downs Health NHS Trust, Brighton and Hove City Council and Kelsey Housing Association and is in a pictorial format for ease of understanding. However, it could not be ascertained that residents and their representatives had these licence agreements or their contents discussed with them. It was identified that the licence agreement did not accurately reflect the range of additional costs and the total fees payable. A resident had recently purchased a new mattress, the licence agreement showed that beds are included in the placement fees. The acting manager was asked to explain this and provided the appropriate refund. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 and 9 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents’ benefit from support plans which detail information about how to support them safely and appropriately, but they would benefit further through their regular review and update. Services are designed to provide appropriate care and support, in ways which maximise independence and choice for residents. The home balances the rights of residents to take reasonable risks against any unacceptable risk to themselves or others. EVIDENCE: Each resident has a care plan, which includes background information, communication details, daily routines and personal care support. These provided clear guidance for staff on how to support resident’s needs. There was however, little reference to the individual goals and aspirations of residents and the targets leading to their attainment. This has been recommended. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 11 Residents named workers (Keyworkers) are responsible for the review of care plans and the frequency of reviews varied. This resulted in some changes in residents’ needs not being recorded and the appropriate guidance provided for staff on how to support those changes. Those permanent staff consulted had worked at the home for a number of years and demonstrated a good understanding of residents’ needs along with any recent changes. However, in order to ensure consistent support for residents it is necessary that care plans identify the range of residents’ needs and be reviewed frequently and recorded as having been reviewed. Permanent staff consulted were very knowledgeable about the individual needs and preferences of residents’ This included an awareness of the subtle signs of some residents of their well or ill being especially where verbal communication is not the main method of communication. The standard of daily recording was good with a clear account of actions and events that had occurred, these were written in a style that was respectful and non judgmental. The home has a developed system for enabling residents to take reasonable risks towards achieving an enhanced lifestyle. Written risk assessments are used to identify any risks faced or posed by residents and the control measures needed to help manage or reduce any risks. An individual risk assessment from is completed for each potential risk, which meant that there was a considerable amount of these in each care plan. This often made it difficult for staff to easily retrieve the guidance needed to manage the risk. It is recommended that this system be reviewed to enable easier retrieval of essential information. Restrictive practice agreements are used where residents rights or freedoms are limited to ensure their health and safety. The acting manager said that these are reviewed every six months to ensure that they remain relevant. It is recommended that the safety bars across the work counters, on either side of the kitchen entrance, should also be considered within these agreements and reviewed regularly to establish if their presence remains necessary. It was evident that integral to the ethos of the home is ensuring and respecting residents rights to make decisions about their daily lives. Staff were observed using a variety of communication tools to provide appropriate choices regarding food, drink, activities and personal care. A staff member said that they often make choices on behalf of residents based on their knowledge of residents’ likes and dislikes. The care plans contained guidance on how to promote choice for a resident who communicates by none verbal means. Residents participate in the day to day running of the home in accordance with the range of their strengths and tolerances. For example some residents help with light domestic duties. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 and 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents’ lives are enriched by the home providing various opportunities for occupation and leisure and by residents being supported to make decisions about their daily routines. Resident’s benefit by being supported to maintain relationships with their families. The meals are good offering both choice and variety and catering for individual preferences. EVIDENCE: There are various arrangements in place for day care provision including attending local day care services, where there is an opportunity to participate in a range of informal education and occupation. On some days day care is provided by the home and is mainly leisure based. On these days a planned “programme of participation” identifies what activities and occupation residents should be offered, with some flexibility shown depending upon residents’ preferences at the time. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 13 These individual programmes included: swimming, horse riding, shopping, walks, sessions. An agency member of staff said ensure that residents’ lifestyles and routines aromatherapy, music therapy, church, social clubs and sensory how helpful these forms were to were consistently maintained. The home has its own transport, which enables access to a wide range of leisure and recreational facilities. Staff were knowledgeable about local events and places of interest and records showed that use is made of local amenities such as pubs, shops and cafes. A staff member said that they had to be creative in their use of the activities budget to ensure that maximum number of activities were undertaken from this limited resource. However they felt that the limited budge and a high use of agency/ relief staff did impact on the number of events they were able to undertake. Residents are supported to go on an annual holiday which they fund themselves, with staffing paid for by the home. A staff member said how much fun this was and how much the residents seemed to enjoy them. Care plans describe the significant others for each resident and where there is family contact staff support the resident to maintain regular contact. For one resident this involves regular visits home or to church or meeting relatives out for meals. A relative spoke of the family parties that the home organises and spoke of how their family never wanted to visit in previous homes but now the whole family are involved. Another relative said how staff are very keen on them visiting as often as they can and how they are always made to feel very welcome. All relatives consulted spoke of how staff keep them in regular contact and they are kept informed of any changes in needs. Staff were observed involving residents in as much choice in planning their day to day support and activities as possible, depending upon their individual tolerances, but recognise the importance of routine for some residents. During the inspection residents were observed to move around the communal space freely, choosing which rooms to be in and what level of company they wanted to enjoy. Tenants were able to choose when to spend time on their own, and can do so in their own bedrooms. As part of a restricted practice agreement access to the kitchen for residents is restricted based on health and safety grounds. Two residents are involved in some light cooking and snack making under supervision. The lunchtime meal was observed with residents receiving sensitive and appropriate support. There was a varied menu, offering a varied and nutritious meals. Staff were knowledgeable about residents individual likes and dislikes. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 and 20 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Resident’s benefit from the provision of flexible and respectful personal and healthcare support. Residents receive flexible, consistent, dignified and sensitive support to meet their personal, emotional and health care needs and are protected by the systems in place to manage medication. EVIDENCE: Staff were observed providing dignified and sensitive support in a relaxed and friendly manner. The allocation of named workers for each resident (keyworker) helps to support the consistency and continuity of the support provided. Agency staff said that they are usually allocated to support the same residents. Permanent staff were very knowledgeable about the individual personal care needs of each residents. A relative said “if the staff on duty are ones that know my son very well, they react to Peters ways of communication” 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 15 There was documentary evidence that residents are supported to access a range of health services, to meet their individual needs. This included: opticians, dentists, chiropodists and community health care teams. Residents are registered with local GP’s with prompt medical intervention being sought for any concerns. There is an established system for the administration of medication, which provides good, clear and comprehensive arrangements for the management of medication. As a matter of good practice it was discussed that the medication cupboard be replaced by one, which enables better storage arrangements. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents and relatives felt able to raise any concerns about the service. Residents are largely protected by the home’s practices but further safeguards need to be put into place to reduce the risk of harm or abuse. EVIDENCE: There is a complaints procedure, although it is recognised by staff that residents would require support to make a formal complaint. The acting manager stated in information submitted both before and during the inspection, that there have not been any complaints about the service in the last twelve months. All relatives consulted said that they did not have any concerns and if they did felt able to approach any member of staff in order to discuss. It was previously recommended that the homes adult protection policies be updated to include changes in legislation and guidance. The acting manager reported that the previous manager had undertaken this. Staff demonstrated some understanding of their responsibilities under adult protection guidelines but were not always clear as to whom to report suspected concerns. Not all staff had undergone training in adult protection or an update on changes in guidance. This has been required to ensure that staff are fully aware of their role under adult protection. In the interim it was suggested that the home display the adult protection reporting flow chart provided, by Brighton and Hove council. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 17 Staff said that there were policies and procedures on the management of challenging behaviour designed to guide them on the appropriate techniques in order to safeguard residents and themselves. The manager holds the personal finances for all residents, there was a transparent system for the handling of residents’ money. The system had an easy audit trail from receiving benefit monies to cash transactions. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 28 29 and 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents live in clean and homely environment with further work needed to ensure that it is well decorated and meets the needs of residents living there. EVIDENCE: The home is located in a residential area in an elevated position overlooking Brighton. To access local amenities and transports links involves some steep inclines. Two staff members felt that the location of the home did not promote easy access to amenities and facilities. The maintenance of the building is undertaken by Kelsey Housing Association. It was previously required that the maintenance budget holder be identified and that a redecoration programme be developed. In response to this requirement the previous manager along with an occupational therapist identified some works that they felt would improve the living arrangements. This has not yet been undertaken and there are no clear plans as to when and if this work will be completed. Staff have decorated some residents bedrooms and this has been completed to a good standard. Parts of the communal areas are in need of minor redecoration. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 19 In order to address this and clarify whether intended building works are to go ahead it remains necessary that a plan of redecoration and repair be completed. The environment within the home is based upon the needs and tolerances of residents with much effort made by staff to try and create a homely environment. It was discussed that the metal bars across the kitchen which are lagged with insulation piping were not aesthetically pleasing. Resident’s bedrooms are highly individualised reflecting their tastes and preferences. The use of contents labels on bedroom furniture to indicate where items of clothing should be stored and personal care information displayed was discussed with the acting manager as this did not promote residents’ dignity. They felt that this information was necessary in order to inform agency /relief staff. Communal space consists of a combined lounge dining room. There is a rearwell maintained secure terraced garden, which has been landscaped to aid its safe use. It has a patio area with seats. Access to the garden is not level and this was sighted as one of the reasons why not all residents can use this area independently. Concern was noted by the inspector regarding the lack of suitable communal space that residents are able to freely access. This is in particular reference to being able to meet residents individual needs to walk and run around. A staff member spoke of the difficulties when all three residents are together at the home, how cramped it is and can be a trigger for some challenging behaviour. Despite these difficulties staff spoke of the many techniques they use to limit the effects of this, for example, by going out as much as possible and encouraging time spent in bedrooms. A relative also mentioned that the limited space inhibited resident’s free movement. It has been required that the provision of communal space be suitable for the needs of residents. There is a further plot of garden, which staff felt could be made secure and safe in order for residents’ to be able to enjoy independently, but funding is required in order to undertake this. The kitchen area is restricted and has a lockable gate and bars across the counter to limit resident free access on the grounds of their health and safety. Although the kitchen area is spacious, staff spoke of the difficulties presented by its layout and lack of storage. Following the inspection, Environmental Health were contacted by the inspector to identify when they last visited and to establish whether any recommendations had been made. No recommendations were made, it was noted that the kitchen was worn. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 20 There are sufficient number of toilets and bathing facilities located around the building. It was noted that a walk in shower had poor access. It was reported that there is limited need for aids and adaptations, other than a need for level access into the garden. All areas of the home were observed to be clean with a high standard of hygiene maintained. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 and 36 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents’ benefit from a well supervised, experienced and enthusiastic staff team that know their needs and with a core group having worked at the home for a number of years. However, reducing the number of shifts being covered by agency/relief staff and improvements to management of training would aid the continuity of care and increase resident’s safety. EVIDENCE: It was observed throughout the inspection that permanent staff understood their roles and had good planning skills. The tasks of the day were organised at handover and the individual staff appeared confident in carrying them out. Permanent staff had a clear understanding of the purpose of the service and how their role contributed to the achievement of this. Staff consulted with spoke respectfully and professionally regarding residents and demonstrated much commitment towards the home and enthusiasm towards supporting residents. Residents were observed being affectionate towards staff that they knew and were relaxed in their company. A sample of comments about staff included “Staff show a lot of understanding about my son’s needs, they are wonderful”; “very good”; “excellent” and “the staff are excellent with my son they try and provide stimulation for him all the time” 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 22 The acting manager reported that almost half the staff team have obtained a National vocational Qualification (NVQ). Many of the staff team hold qualifications in areas unrelated to care. The minimum staffing levels is for three staff to be on duty throughout the waking day, with an additional member of staff during planned outings. Staff consulted felt that this was usually sufficient to meet the individual needs of residents, but expressed concern at the number of shifts being covered by relieve /agency staff which meant that they often had to work with staff who did not always know the needs of residents. The acting manager reported that where possible the same agency staff are used in order to promote consistency. It was previously required that agency and relief staff are appropriately supervised and have access to the staff meetings. The acting manager reported that agency staff now receive supervision. It was reported that there has been some turnover of staff with some vacancies yet to be filled. As a result a significant number of shifts are being covered by agency/relief staff. Despite the best efforts of staff, the level of relief/ agency use did however effect the continuity of the support provided and the level and type of activities undertaken. In order for this situation to improve it is necessary that the use of agency /relief staff be significantly reduced. The acting manager reported that the recruitment process is followed which involves an application form, interviews, CRB checks and written references prior to employment commencing. In the sample of recruitment files examined copies of these checks were not all available. The acting manager assured the inspector that copies had originally been obtained but had been temporarily mislaid. The acting manager agreed to ensure that recruitment files were better organised in order to evidence that residents are being protected by the homes recruitment practices. There is a core group of staff who have worked at the home for a number of years and who have considerable experience of supporting people who have learning disabilities. However, the staffs knowledge of residents must be underpinned by improved management of training to ensure that staff have undertaken the mandatory and specialist training needed to work safely with residents. This includes training in manual handling, first aid, fire safety, food hygiene, adult protection and health and safety. Staff said that they receive regular supervision with either the acting manager or the resource manager regarding their performance and conduct. Staff consulted felt well supported by the acting manager to undertake their roles and felt able to approach them for advice and guidance. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 42 and 43 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The acting manager ensures a clear ethos and values of the home enable staff to provide good quality care to residents. A range of regular health and safety checks helps to ensure the health and safety of residents and staff, this should be further supported by the completion of a fire risk assessment. EVIDENCE: The acting manager had been overseeing the home for the four months prior to the inspection and has worked at the home since it opened. He has many years experience of working with people who have a learning disability and showed a good understanding of the daily running of a residential home. All persons consulted about the manager spoke positively about him with particular reference to his resident focused approach. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 24 A sample of comments made about the manager includes: “excellent, clear absolutely no mixed messages, consistent and transparent”; “very approachable”; “ knows all of the residents really well” and “very person centred”. At the time of the inspection there were no plans for them to apply to become the registered manager of the home. In the interim until a registered manager is appointed it was clear that the acting manager provides effective management with a clear sense of leadership and direction. The acting manager is proactive in ensuring that the home creates a warm, open, positive and inclusive atmosphere for residents and staff. A relative was anxious that any new manager might change the ethos of the home as they felt that the current resident focused ethos was best for residents. There are some mechanisms in place for the acting manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. This includes: relative feedback questionnaires, placement reviews, and regular staff meeting. In line with the previous requirement to provide a quality audit tool this is now completed monthly to identify the homes achievements. Written guidance is available for staff on issues related to health and safety. Records submitted by the previous manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment had been undertaken. Some systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks, maintenance of fire equipment and fire drills. However, a fire risk assessment could not be located. It has been required that one be undertaken which records all of the actions to be taken to ensure adequate fire safety precautions at the home. The acting manager acts as the home’s budget manager and the organisation manages the financial viability of the home. There are clear lines of accountability between the home and the organisation. 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 2 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 X X 3 2 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 26 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation Requirement Timescale for action 30/03/07 2 YA5 3 4 YA23 YA24 5 6 YA24 YA35 6 YA33 5(1)(bb) & That the Terms and Conditions (bc) of residency is agreed with each service user or their representative and which includes the range of additional fees to be paid and the total fee payable. 15(2)(b) That care plans are updated and reviewed regularly to reflect changes in the needs and preferences of service users and recorded as having been reviewed. 13(6) That staff undergo training in adult protection guidelines and a record of attendance maintained. 23(2)(b) That a plan of redecoration and repair be developed. (Timescales of 20/07/04 and 27/10/05 not met ) 23(2)(e) That communal space is suitable (g)(h) and adequate to meet the needs of residents. 18(1)(c)(i) That staff receive the training necessary to undertake their roles safely and the specialist training in accordance with the needs of the service users accommodated. 18(1)(b) That the number of shifts DS0000060274.V307723.R01.S.doc 30/03/07 30/04/07 30/03/07 30/08/07 30/06/07 30/03/07 Page 27 12 Shenfield Way Version 5.2 7 YA42 23(4)(a-c) covered by agency /relief staff be significantly reduced. That the registered person consult with a Fire Safety Officer to ensure that an adequate fire risk assessment is undertaken and which is frequently reviewed. 30/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA7 Good Practice Recommendations That care plans included residents individual gaols and aspirations and the targets leading to their attainment. That the safety bars across the kitchen work counters either side of the kitchen entrance, be included in the restrictive practice agreements and reviewed regularly to ensure they remain necessary. That the system for recording risks be reviewed to enable easier retrieval of essential information for staff. It is recommended that the manager ensures that the policy the home is working towards is compliant with recent adult protection legislation and guidance. 3 4 YA9 YA40 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 12 Shenfield Way DS0000060274.V307723.R01.S.doc Version 5.2 Page 29 - 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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