Inspection on 10/07/08 for 136 Grovelands Road

This inspection was carried out on 10th July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

136 Grovelands Road 19/02/08

136 Grovelands Road 28/02/07

136 Grovelands Road 25/01/06

136 Grovelands Road 07/09/05

136 Grovelands Road 25/01/05

136 Grovelands Road 04/08/04

136 Grovelands Road 09/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 136 Grovelands Road Reading Berkshire RG1 7LP Lead Inspector Stephen Webb Unannounced Inspection 10th July 2008 09:45 136 Grovelands Road DS0000011064.V366924.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 136 Grovelands Road DS0000011064.V366924.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. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 136 Grovelands Road Address Reading Berkshire RG1 7LP 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) 0118 939 3628 Prospects For People With Learning Disabilities Care Home 3 Category(ies) of Learning disability (0) registration, with number of places 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 3. Date of last inspection 19th February 2008 Brief Description of the Service: 136, Grovelands Road is a small care home that offers a service for three adults, who have varying degrees of learning disabilities. It is a domestic semi-detached house in a residential area of Reading, approximately ten minutes from Reading town centre. The home has an enclosed landscaped back garden accessible from patio doors in the lounge. On the ground floor there is a small lounge, a kitchen-diner, a toilet and one bedroom. On the first floor there are two further bedrooms, an office/sleep-in room for staff, and a bathroom with a toilet. The home is on a public transport route and there are local amenities within a short walk of the home. The current scale of fees is £529.69 per week. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection included an unannounced site visit from 9.45am until 6.00pm on the 10th of July 2008. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager and the local area Service Manager. Residents provided some verbal feedback but the inspector also observed the interactions between residents and staff at various points during the inspection. An inspection survey was completed by each of the residents, two of whom were supported by a staff member, to do this. The recorded responses were all positive, with regard to the care and support provided. No additional comments were made. Verbal feedback during the inspection was also positive, with no issues or concerns being raised. The inspector examined the majority of the premises, including two of the resident’s bedrooms, with their consent. The recently appointed temporary acting manager had, with the support of the service manager, addressed a range of issues and developments and had provided a consistent and positive focus for the team to move forward. The ongoing success of the home will depend on the recruitment of a competent permanent manager to continue the work that has begun, and sustain the recent improvements. What the service does well: An appropriate assessment process is in place to identify the needs and wishes of a prospective resident, and identify whether they can be met, within the context of the service, and the needs of existing residents. The home is able to meet the needs of residents of the Christian faith within its Christian-based ethos. All staff are required to be practicing Christians. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 6 Residents are supported to take appropriate risks to enhance the quality of their lives. Each has been given a key to their bedroom door. Residents’ links with family and friends are well supported to help them maintain contact and build positive relationships. The rights and responsibilities of residents are recognised and promoted, and they are supported to be involved in all aspects of daily life as much as possible. Though none of the residents is able to manage their own medication, the service has appropriate systems in place to manage this on residents’ behalf. Residents are aware of how to complain, should they be unhappy about something, and the home has appropriate systems in place to safeguard them from abuse. The provider’s recruitment and selection policy provides appropriate protection to residents. What has improved since the last inspection? The improvement plan arising from the last inspection in February 2008 has largely been addressed, though some aspects remain in progress. The recently revised care plans are much improved and better reflect the individual needs and wishes of residents to enable the support provided to be more individualised and in accordance with residents’ wishes. Residents are being more encouraged to make day-to-day decisions about their lives and to be involved in the daily tasks in the home. The level of resident involvement in activities and events in the community has been improved, providing them with a more fulfilling lifestyle. Residents’ involvement in menu planning, food shopping and the preparation of meals, is being more actively encouraged and supported by staff, in order that meals meet both their needs and preferences. Improvements have also been made in the way the service meets the healthcare needs of residents. Significant improvements have been made to the standard of décor and homeliness within the home. Changes have also been made to the layout of one resident’s bedroom in response to their wishes. The staff team has, more recently, received the leadership and guidance necessary to enable them to deliver a more consistent and focused level of care to meet the needs of residents, in accordance with the improved care 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 7 plans. Improvements in staff deployment have enabled residents to benefit from more flexible support from staff. 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. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents would be provided with appropriate information to enable them to make an informed choice regarding the suitability of the service, though the information could be made more accessible. An appropriate assessment process is in place to identify the needs and wishes of a prospective resident, and identify whether they can be met, within the context of the service, and the needs of existing residents. EVIDENCE: The service has both a Statement of Purpose and a Service User Guide, which had been reviewed in May 2008, though neither document was dated. However the format of the service user guide remains text-heavy and not especially accessible for residents and would be improved with the inclusion of some appropriate pictures. The colourful section headings with a variety of text effects also were not very clear, and it is suggested would be better in a plain text format. The documents should be dated to enable annual review. References to the NCSC (The Commission’s predecessor organisation), should read the “Commission for Social Care Inspection”. A copy of the service user guide was on each of the two files examined, together with a copy of their placement contract. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 10 The service has an appropriate preadmission assessment procedure in place, (as described within the AQAA preadmission questionnaire), which seeks to identify the needs and wishes of a prospective resident in the context of those of the existing residents, in order to establish that the service would be appropriate to the needs of a prospective resident. However, the three current residents have lived together in the home for a long time and no new admissions are anticipated. Copies of any initial assessments for existing residents had been archived and so were not available, but there was evidence of recent review of the needs of each of the residents whose files were examined, in response to a previous requirement that residents’ changing needs are periodically reviewed. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Having been recently reviewed, care plan documents now better reflect the needs and wishes of individual residents, to enable staff to provide appropriate support where it is needed. Residents are encouraged to make day-to-day decisions about their lives and to be involved in the daily tasks in the home as part of respecting their rights and dignity, and are supported to take appropriate risks to enhance the quality of their lives. EVIDENCE: The case record and care plan formats have been reviewed and revised by the current acting manager, into a twin-file format. The main file is appropriately indexed and contains more recent archived records, healthcare appointment records, daily notes, records of residents‘ finances and correspondence, records or activities, and a new format where 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 12 staff record specific aspects of personal care support or other significant interventions, with respect to the individual resident. Over time these should provide useful information to evaluate the effectiveness of any specific strategies and detail work dome towards residents’ individual goals. At present there is room for further development of residents’ individual goals, but the current manager wants to allow the new systems sufficient time to become established. There are also plans to increase the use of relevant pictures within the care plans, to improve their accessibility for residents. The new care plan file is also indexed and incorporates the needs, personal preferences, likes and dislikes of the individual resident as well as including their specific preferences regarding how and when they wish to be supported. The emphasis is now more towards enabling residents to do as much as they can for themselves with any necessary encouragement or assistance being provided by the staff, rather than staff doing things for them. The care plan file consists of a variety of formats including essential contact information and a pen picture, which the manager is going to ask keyworkers to review with residents to ensure, remains accurate. There are also other documents including an essential lifestyle plan, some of which are quite old but provide extensive information about the needs, wishes and preferences of the resident. One of the new formats is a core care plan detailing the information staff require on a day-to-day basis in order to meet the individual’s needs according to their wishes. The information informs staff how and when support should be offered. The overall care plans have been subject to review with the funding authority recently and dated copies of these reviews were on the two files examined. The care plans include references to individual cultural and spiritual needs and how these are provided for. All three residents attend church weekly. The very individual diet preferred by one resident is also clearly documented. These documents are supported by a series of individual risk assessments, which have recently been subject to an initial review by the new acting manager, who indicated her intent to undertake a more thorough review in due course, in consultation with individual residents. Residents are being encouraged to make day-to-day decisions about their lives and how they wish to spend there time and it was evident during the inspection, that their wishes were accommodated and supported. Residents were seen to be involved in household tasks and two of them take part regularly in meal preparation and cooking for the group and staff. The very specific diet of one resident, does limit his involvement in communal cooking tasks, but he is encouraged to take part whenever possible. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 13 None of the residents is able to manage their own personal allowance, but the service has an effective system in place to do this on their behalf, whilst protecting their funds from abuse, and allowing them appropriate access to their personal money. A small amount of each resident’s money is kept in an individual cash tin in the safe, and any money in or out is recorded in individual account books, where an ongoing balance is maintained to enable periodic checks. Each resident also has a bank account and their cards are also securely stored and accessible only to two of the staff. The expenditure records examined indicate that residents’ money is spent on appropriate items and is not used to fund aspects of their support that would be expected to be covered from within the basic fees. The manager intends to introduce a more unified account book system, which will include details of cash and bank balances within the same book. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The degree to which residents are supported to take part in activities and access events in the community, has been improved, providing them with a more fulfilling lifestyle. The current manager also has plans for further improvements. Residents’ links with family and friends are well supported to help them maintain contact and build positive relationships. The rights and responsibilities of residents are recognised and promoted, and they are supported to be involved in all aspects of daily life as much as possible. Residents’ involvement in menu planning, food shopping and the preparation of meals, is actively encouraged and supported by staff, in order that meals meet both their needs and preferences. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 15 EVIDENCE: The care plan contains information about any activities or interests that are important to the resident and how these are supported. All three of the residents attend local day services daily during the week. The day services include a range of activities and opportunities to access a variety of events in the community as well as for attendance on college courses. Two of the residents currently take part in a pottery course through their day services and various examples of their work were present within the home. The current home manager plans to provide some means for one resident to display her work within her bedroom. One resident has also completed ASDAN vocational courses via day services and the certificates of her achievements were displayed in her bedroom. Another resident works half of the week as a volunteer at a local community coffee shop. One of the residents, who has become blind, is enabled to attend weekly RNIB social events. The physical layout of the home and its furnishings are maintained as consistent as possible to support this resident to mobilise freely throughout the home and her bedroom, and any changes are discussed with and shown to the resident. Within the garden a series of posts also delineate a safe path leading down the lawn. The manager plans to introduce a series of regular monthly outings to places and events chosen by the residents, as well as making opportunities for keyworkers to spend time with individuals, and plans to restructure the staffing rotas to facilitate this. Steps have also been taken to review residents’ funding levels, with their local authorities, to seek funding for additional support hours to broaden opportunities within the community still further. The rotas have already been altered to provide an overlap period with two staff on duty on Saturdays, in consultation with the residents, to enable them to engage in personal shopping trips, and in-house activity sessions have also been introduced on Friday evenings, including writing letters to family, newspaper reading and movie nights. The current manager has introduced a record of individuals’ involvement in social activities and outings to enable the level of activity to be monitored. There are also plans to develop a residents’ notice board to publicise activities and events, and the manager is working on producing collections of photos of the residents enjoying various outings and holidays, for display in the home. One resident has chosen to go on holiday to Bournemouth, to an RNIB venue, designed to meet the needs of blind and partially sighted people. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 16 Another resident went for a short break to a hotel in Windsor recently, and a possible trip to the Isle of Wight, is being planned for later in the year. As noted earlier, residents are also enabled to pursue their spiritual needs and all three of the residents attend a local church on a weekly basis, as well as attending a weekly club run by the church. Two residents also attended a Christian event at a “Butlins” camp. Available evidence suggests that the service is able to effectively meet the cultural a spiritual needs of Christian residents. The service is operated by a Christian-based charity within the Christian ethos. The new care plan files contain the contact details for friends and family and residents are supported to have contact wherever possible. All of the residents has some family contact, with some being in regular contact and going out with or visiting relatives, with support provided by staff where necessary. The staff were seen engaging with residents to support their involvement in daily routines, self-care etc. and also encouraged to make choices for themselves. Residents are expected to take part on household tasks such as cleaning, washing up, table laying, etc. and are supported to be involved as much as possible. Each has their own bedroom door key though they do not all choose to use it. As noted previously, residents are involved in the preparation of some meals and also take part in the food shopping and in choosing the menus. One resident chooses to have a diet of very limited range at any one time, though from time to time some changes are made by way of substitution. This resident tends to do more preparation of his own meals with staff support, while the other two residents will cook for each other and the staff on duty in turn, with varying degrees of support and encouragement from the staff. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive support from staff according to their needs, with due regard for their preferences and rights. Recently, improvements have been made in the way the service meets the healthcare needs of residents. Though none of the residents is able to manage their own medication, the service has appropriate systems in place to manage this on residents’ behalf, which are effective, for the most part. EVIDENCE: The new care plan formats provide staff with the information to enable residents to be supported so as to address their needs as well as any individual preferences, with the emphasis on encouraging residents to do as much for themselves as they can. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 18 The care plans make reference to residents’ wishes and also provide staff with details of how to address identified issues, supported, where necessary with written risk assessments. Where an issue of conflict has arisen between the wishes of a resident and their next of kin, the service has appropriately recognised the rights of the resident to make decisions for themselves, and has ensured that they have been given the information necessary to make an informed decision. There are specific plans in place to address the individual travel needs of one resident, to ensure that staff take these into account when planning journeys. The specific needs arising from one resident’s becoming blind, are also addressed, and the layout of furniture is kept consistent to support her needs. Additional adaptations have also been made to support this resident to mobilise independently. Handrails have also been provided around the edge of the patio, to meet the needs of another resident. Two of the residents confirmed that the staff supported them well and enabled them to do things for themselves. Records of healthcare appointments are kept, which detail significant events or outcomes arising from consultations with external healthcare professionals. The records mostly indicate recent healthcare appointments where appropriate, though some longer intervals are evident prior to the last two months. Specific hearing aid guidance is also in place, for one resident, crossreferenced to appropriate other systems. None of the residents is able to manage their own medication, but the service has an appropriate “monitored dosage” system in place to manage this on their behalf, and there is an appropriate medication procedure in place. The current medication administration record, (MAR) sheets are kept together in one file for ready access by staff, and completed ones are filed individually. Examination of the current MAR sheets indicated several gaps in recording. In most cases this was reportedly linked to late delivery of medication by the chemist, and this is recorded on the back of the MAR sheet, though this did not apply in every case. The manager should remind staff of the importance of prompt and accurate medication recording. The home had previously sought appropriate clearance from the GP for the use of a limited number of “homely remedies”, though this authorisation had not been renewed since 2005. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 19 The manager should ensure that up-to-date guidance is sought from GP(s) regarding any homely remedies in use. The pharmacist last audited the medication system in October 2007. According to the training records provided, three of the staff have received medication training, but one has not attended this training. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are aware of how to complain. The manager was able to evidence that some of the issues raised had been dealt with appropriately, though the absence of the old complaints log meant this was not possible in all cases. The home has appropriate systems in place to safeguard residents from abuse. EVIDENCE: The service has an appropriate complaints procedure, which is available in an adapted leaflet format for residents, though this remains rather complex, and could be further adapted to make it more accessible. The home’s old complaints log could not be located but the manager had already established a new one. The AQAA completed by the previous manager indicates three complaints in the past year. One of these complaints related to a healthcare issue. It led to a safeguarding strategy meeting, which concluded that the home had acted appropriately in the resident’s best interests, whilst also respecting his right to make informed decisions for himself. All three residents completed inspection surveys, (two with support from a staff member), and all indicated they were aware of how to complain if they 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 21 were unhappy about something. Two of the residents confirmed this to the inspector during the inspection. The provider has an appropriate safeguarding procedure and has systems in place to protect residents from abuse. A copy of the latest multi-agency safeguarding procedure was also present in the safeguarding file in the office. There are good procedures in place to protect residents’ finances, where the home manages these on a resident’s behalf. Detailed records are kept of expenditure and of bank account balances, and copies of bank statements are held on file. Residents’ debit cards are kept securely, and only the manager and one staff member, know the associated pin- numbers. All of the staff had received safeguarding training, though for one member of the team, this was in 2004. Regular updates of safeguarding training should be considered for the whole team. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are provided with a homely, comfortable and safe environment, which addresses their needs. EVIDENCE: The acting manager indicated that residents would be involved in decisions relating to the décor and furnishing of the home, and would have input in the choice of colour. The manager described how one resident had recently been assisted to rearrange the layout of her bedroom, at her request. The resident told the inspector how much she liked the new layout. Redecoration of some areas had taken place since the last inspection. The lounge and kitchen/diner were homely and appropriately furnished. Corridors had also been decorated and the hall stairs and landing carpet replaced. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 23 Bathroom and toilet facilities were satisfactory and appropriate for the current needs of residents, though the toilet seat in the bathroom was loose and required tightening. Residents’ bedrooms had been personalised and residents had a key to their bedroom, though not all choose to use it. The manager indicated that she was exploring ways for one resident to display her pottery college work in her room. Patio doors lead from the lounge to a patio area, of which part is covered, and railings have been placed along the side of this area to meet the needs of one resident. The garden is pleasant and secluded, and includes an area of lawn, a path and a separate gravel area with some seating. The manager described various plans for improvements to the garden, including relocating the benches and having the swing seat cleaned and brought back into use. There is a line of vertical posts leading down the lawn along a path, to support one resident who is blind. The manager is hoping to be able to widen this path, as it is currently quite narrow. An old pond is also going to be removed, and the manager would like to replace it with a herb bed, and to involve the residents in planting this up. Laundry facilities are in line with a small home for only three residents. The drier is in a separate utility area, but the washing machine is located in the kitchen. The home was clean and odour free, and a cleaning schedule had been established by the manager, in response to the previous Improvement Plan for the home. The provider is still trying to resolve the situation regarding a crack in one of the walls, via their insurers, but some temporary repairs have been undertaken. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team have, more recently, received the leadership and guidance necessary to enable them to deliver a more consistent and focused level of care to meet the needs of residents, in accordance with the improved care plans. Improvements in staff deployment have enabled residents to benefit from more flexible support from staff. Records indicate adherence to the provider’s recruitment and selection policy, which provides appropriate protection to residents. There is a need to ensure that all staff have received the required mandatory training and any necessary updates, in order to help ensure that they have the necessary and up-to-date skills and knowledge to meet the needs of residents. EVIDENCE: Staffing at Grovelands Road is such that lone working by staff is the norm, though there are periods of overlap to increase flexibility and provide cover for specific events and appointments. The manager also provides some care hours to enable this, for example covering one evening a week to enable two 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 25 residents to go out to a club, while another remains at home. Routine tasks such as food shopping have also been rescheduled to improve staff flexibility and availability, and increase resident involvement. The current manager is revising the rotas in consultation with the staff to try to maximise opportunities for further one-to-one time for residents and staff out in the community. At the time of inspection the home had three permanent staff, (all part time), plus the current acting agency manager. The staffing complement for the home includes one more part time post, and these hours were reported by the manager to be used flexibly through the use of in-house bank staff, to maximise flexibility. No agency staff, (aside from the manager), had been used in the three weeks leading up to the inspection, though some had been used previously. The manager indicated that she asked for a skills profile, including NVQ status, when seeking an agency worker to supplement staff cover. The provider’s policy is to work towards all staff having an NVQ qualification or equivalent. At the time of inspection, one staff member had attained NVQ level 3 and one had their NVQ level 2, and the manager had NVQ level 4 and the Registered Manager’s Award. One further staff member was working towards an NVQ award, and one was undertaking a Diploma in Social Care. Staff were observed to interact positively with residents during the inspection and to encourage their involvement in household tasks. The residents were seen to approach the staff freely and communicate with them in a relaxed way. Since the recent appointment of a temporary agency manager, the staff have received the on site support and leadership necessary to support the delivery of consistent care in accordance with the improved care plans. Examination of a sample of two staff recruitment records indicated that an appropriately rigorous recruitment system was in place and copies of the required evidence were available for inspection. The acting manager was aware that the provider has a policy of involving residents in the recruitment and selection process. Examination of the most up to date staff training information available indicated that although the provider offers an appropriate mandatory training programme, not all of the current staff had attended all of the necessary training and or received relevant updates to core training. The training shortfalls had been identified via a training audit, and were starting to be addressed. Some further training courses were already booked 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 26 for specific individuals, and links with local authority training departments were being explored in addition to an independent training agency. The provider must address any remaining shortfalls in mandatory training as a priority. Staff were already receiving more regular supervisions and the acting manager had begun to undertake a cycle of staff appraisals. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the acting manager has effectively managed and developed the quality of the service to the benefit of residents, the provider needs to recruit a suitably qualified permanent manager capable of doing so on an ongoing basis, to ensure that standards are maintained in the future. At present the provider does not have appropriate quality assurance system in place to provide for effective consultation with residents and other interested parties about the conduct of the service. The health, safety and welfare of residents is promoted, for the most part, by the systems and safeguards in place within the service. EVIDENCE: 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 28 At the time of inspection, the provider had recently appointed an agency manager to manage the service until a permanent appointment could be made, following an unsuccessful recruitment round. A further advertisement had already been placed for the permanent manager post with a July deadline. It was evident from discussion with the acting manager and the regional services manager, who attended for part of this inspection, that a lot of work had been done to address the shortfalls identified at the previous inspection in February 2008. All of the elements of the improvement plan arising from that inspection had either been addressed or were in hand and being progressed. The agency manager had addressed a lot of relevant issues within the home and had clearly provided the on-site leadership, guidance and support to staff, that has been lacking in the period during which the home has been without a permanent manager in post. With the support of the services manager, improvements have been made to the consistency and quality of care, the care plans and other supporting documents, resident involvement and staff deployment, which have been of benefit to the residents. In the long term, the success of the service in maintaining these observed improvements depends on the successful appointment of a permanent manager to the post, who has the skills and qualities to continue the work started by the current agency manager. The service did not have an active quality assurance system in place at the time of this inspection, though one was reported to be in the early stages of development. An undated copy of a service user questionnaire was seen on the notice board but there was no evidence of these having been used. An effective quality assurance system which seeks the views of all interested parties is an essential element of the planning and review cycle in operating an effective and responsive service which listens to staff, service users and their representatives. The provider must establish an appropriate quality assurance system as a priority to ensure that the views of relevant parties are taken into account in the future planning of the service. There is also no annual development plan in place at present, though in reality the improvement plan arising from the previous inspection has functioned in this capacity in the period since February 2008. Once a quality assurance system is established this should be linked to an ongoing annual development plan cycle as described in the National Minimum Standards. The acting manager proposed to produce a development plan, based on the groundwork now in place, to support the permanent manager, when 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 29 appointed, to take the service forward. She also plans to introduce weekly residents meetings, and a request list for residents to ask for activities and outings they would like to access, in the interim. Regular Regulation 26 monthly monitoring visits on behalf of the provider have been re-commenced from March 2008, in accordance with the Improvement Plan, and copies of the resulting reports were available to the inspector. The format is comprehensive and includes reference to seeking the views of residents and staff on a monthly basis. Examination of a sample of health and safety-related service certification indicated that most servicing had been undertaken with appropriate frequency. However, no up-to-date certificates for servicing of fire extinguishers and emergency lighting could be found. Evidence of a recent service of these appliances should be provided to the Commission. The home has an appropriate accident recording system in place, and completed forms are filed collectively and copied into individual files as appropriate. There had been no recent recorded accidents, with the last one being recorded in October 2007. The fire risk assessment for the home had been reviewed in June 2008, and the most recent fire drill had taken place two days prior to this inspection. The drill had led to discussions with two of the residents about the need to evacuate immediately on hearing the fire alarm. The fire alarm is now also tested weekly when residents are out of the home, to minimise disruption. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 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 2 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 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 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 Score 3 3 2 X 2 X 2 X X 2 X 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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. 2. Standard YA20 YA35 Regulation 13 18 Requirement Timescale for action 10/08/08 3. YA37 8 4. YA39 24 The homely remedies consent from the GP must be updated, in order to safeguard residents. The provider must ensure that 10/10/08 all staff receive all of the mandatory training and appropriate updates, in order to ensure their knowledge and skills are kept up-to-date at all times. The provider must make 10/11/08 continued efforts to appoint an appropriately skilled and qualified permanent manager to manage the service on an ongoing basis. The provider must develop an 10/11/08 appropriate quality assurance and annual development planning system, in order to take proper account of the views of residents and other interested parties, with regard to the operation of the service. 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Consideration should be given to how the format of the Service user Guide could be made more accessible for residents, and the document should be dated, to enable its review on an annual basis. The provider should consider regular training updates on safeguarding to ensure that all staff remain aware of the issues and confident in the use of the procedure. Evidence of a recent service of the fire extinguishers and emergency lighting should be provided to the Commission. 2. 3. YA23 YA42 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 136 Grovelands Road DS0000011064.V366924.R01.S.doc Version 5.2 Page 34 - 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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