Inspection on 05/09/07 for 14 Coronation Road

This inspection was carried out on 5th September 2007.

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

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

Other inspections for this house

14 Coronation Road 15/01/07

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

CARE HOME ADULTS 18-65 14 Coronation Road Sunniside Gateshead Tyne and Wear NE16 5NR Lead Inspector Mrs Elsie Allnutt Unannounced Inspection 5th September 2007 09:30 14 Coronation Road DS0000067740.V349093.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 14 Coronation Road DS0000067740.V349093.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. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 14 Coronation Road Address Sunniside Gateshead Tyne and Wear NE16 5NR 0191 4886521 0191 4889743 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.c-i-c.co.uk. Community Integrated Care Nicola Jane Mould Care Home 2 Category(ies) of Learning disability (2), Physical disability (1) registration, with number of places 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD, maximum number of places: 2 2. Physical Disability - Code PD, maximum number of places: 1 The maximum number of service users who can be accommodated is: 2 15th January 2007 Date of last inspection Brief Description of the Service: Coronation Road is a care home owned and run by Community Integrated Care, a registered charity that provides care services for people with learning disabilities. Coronation Road is registered to provide 24 hour care for 2 people who have a learning disability, one of whom has a physical disability. The home is pleasantly situated in a quiet part of Sunniside within close proximity to health care facilities, local shops, pubs and surrounding countryside. There are frequent bus services to Gateshead and Newcastle and the Metro Centre. Service users are able to use the facilities of their choice within the community with support from a trained staff team. The service users also have use of a car. Coronation Road is one of several bungalows in the area. It has been adapted to divide the bungalow into 2 separate living environments both consisting of a lounge, dining room, bathroom, toilet, kitchen and bedroom. This provides separate living accommodation for each service user. The building is surrounded by extensive well kept gardens. The service has developed a Service User Guide that informs service users and other interested parties of their aims and objectives of the service. A copy of the recent inspection report is available in the home for anyone to read. The weekly charge to the service user is £62.35 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took 6 hours over one day in September 2007. The judgements made are based on the evidence available to the inspector during the inspection. Discussions took place with 2 service users and five members of staff. The service users’ satisfaction of the service was also interpreted through the observations of body language, interaction with staff, discussions with staff and the examination of records. This demonstrated that both were satisfied with the service, the care and support given by staff. A tour of the building took place, and a sample of staffing and service users’ records was inspected. The inspector took a light lunch with service users. Evidence was also gained from information provided by the manager about the service in the Annual Quality Assurance Assessment (AQAA) and during discussions with health care professionals who work with the service users and staff giving professional advice and guidance. What the service does well: Service users who use or are interested in using this service are given detailed information in the Statement of Purpose and the Service User Guide. These are brochures that explain what to expect when living at Coronation Road. The service users needs were assessed before they moved into their new home to make sure that this was the right place for them to live. Plenty of time was given for the service users to get to know the care staff before they moved into their new home and this is something that made the move successful. The service users are fully involved in everything that goes on in the home and staff support them to make choices and decisions for themselves. Service users are supported to take part in a variety of activities in the local area and have become accepted members of the local community. The success of this is due to the level of support available. Staff support service users to do their own shopping and make their own meals and this helps them to develop independent living skills. So that the dignity and privacy of the service users is promoted and protected any help needed with their personal care is given in a sensitive way. Service users get to see their doctor quickly if they are ill. They also see other people such as occupational therapists so that if they need any special equipment this is sorted out for them. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 6 There is a nice atmosphere in the home and staff listen to what the service users tell them. If this involves something about poor care practises, staff do not hesitate in reporting this to the manager. Each service user lives in their own home supported by their own staff team. Both houses are homely and well maintained and have lovely spacious gardens. There are good recruitment procedures so that only the right people are employed to work at Coronation Road. Staff are given lots of training to help them do their job well. There are also lots of policies and procedures so that staff know what they should do in many different situations. The manager has lots of experience and gets on well with the service users and the staff. What has improved since the last inspection? Many improvements have been made to this service since the last inspection. Each service user now has a contract in place that tells them what the service will provide, what their rights are and what is expected of them. It also provides clear information about the full amount of money charged by the home for their care and the amount of money they need to pay. It also explains how the rest of the money is paid and by whom. The way care plans are written has improved and they have been developed in a different way with up to date information about the person. They are now written in a way that allows service users to direct their individual care and they tell staff in plenty of detail the amount of support needed by the individual service user. The manager has put a safer system in place for the storage and administration of medication. Staff now follow clear instructions when supporting service users with their medication. Service users’ relatives have been given a copy of the home’s Complaints Procedure so that they know what to do if they are unhappy about something. A lot of effort has been made to make sure that service users are kept safe. Arrangements have been made so that staff learn about the action to take if they see or hear about service users being treat in a bad way. New instructions have been written down for staff to follow when supporting service users’ with money. Clear records must be kept for this and the manager checks to see that they are kept well. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 7 All of the staff now get a regular private meeting with their manager, (known as a supervision), to make sure they continue to do their job well. The manager now carries out more checks, daily, weekly and monthly to make sure the service users are getting a good service. Staff are now given more regular fire instruction so they know what they should do if there is a fire and one member of staff is responsible for checking the fire fighting equipment and the fire alarm system to make sure they are working properly. Records such as staff files and the accident book are now kept up-to-date. What they could do better: So that the service users can be supported following the best possible guidance the professional advice given to staff must be acknowledged and respected and any guidelines put in place should be followed. So that the service user has the appropriate aids to safely support them when bathing, grab rails must be fitted in the bathroom. The medication procedures followed by the home must follow those set out in the Royal Pharmaceutical Guidelines. This will make sure that medication is ordered, recorded, stored and administered in the correct way. All staff must follow the new procedures put in place regarding service users’ finances, so that it is clear that service users are being safely supported to deal with their money. All staff should record in the care and health plans in the same way so that service users receive the same standard of care and the same standard of recording is met. The wall separating the two houses should be sound proofed so that the two service users can have more privacy. So that the gardens are maintained to the same standard as the building they should be tidied up and kept in an attractive state. This will also help project a positive image of the people who live and work inside the building. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 8 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. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 9 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 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 10 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): 1,2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service users are provided with sufficient information on which to make informed decisions about whether the home will meet their needs, which were fully assessed before moving to Coronation Road, to ensure that the care offered is appropriate to meeting their needs. Contracts are in place so that the service users are aware of the fees to be paid for their care and the terms and conditions agreed with the home. EVIDENCE: The service has developed a comprehensive Statement of Purpose and a Service user Guide that provides the service users with information including the aims and objectives of the home, the type of services that are provided and specific information on key policies and procedures. The Service User Guide is available in an accessible format with large print and pictures, in order to meet the diverse communication needs of the service users. The needs of both service users were fully assessed before they moved into Coronation Road. This process involved a multi disciplinary team of social and 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 11 health care professionals who worked closely with staff in the initial stages of moving into the home. The assessment process is ongoing and the changing needs of both service users are reflected in the current care plans. Each service user has a contract that describes the home’s terms and conditions and the full fees charged. A clear breakdown of the fees informs service users or their representatives of the contribution they need to pay and how the rest of the fees will be paid. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans guide staff to appropriately support service users’ care needs and enable staff to support service users to make choices about their lives. Service users are supported to develop their independence while at the same time they are supported to take risks safely. EVIDENCE: Care plans are in place for each service user living at this home. The information recorded in them is current and clearly guides staff to effectively address the individual service users’ personal, social and emotional care needs. The care plans have recently been updated and further developed to reflect service users’ changing needs. The information in the old care plans has been reviewed and important information has been transferred. For example the challenging behaviour guidelines that were developed by a Community Psychiatric Nurse continue to be in use for one person. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 13 More guidelines have been developed for staff to follow in relation to the complex and diverse needs of the service users and the manager encourages staff to follow these so that a consistent approach is given. The result of such practice has meant that the service users have now settled into their homes well and have developed good and trusting relationships with the care staff team. Service users are empowered to lead their care plans that are written in a person centred way and are focussed on the individual, their strengths and aspirations. Staff have received training regarding Person Centred Planning. The individual care files are well organised and are therefore easily accessible. The individual plans that are supported with pictures, are divided into different care areas that describe the goal, the steps to take to achieve it, a progress log and the outcome. The outcomes are regularly reviewed. To encourage one service user to achieve their goal, how they will celebrate when they achieve it, is also recorded. This is particularly successful and motivating for the individual concerned. It was good to note that the aspirations for one service user that was discussed at a Person Centred Planning Meeting prior to moving into this home are now a reality of their life. The person has a house that is not shared by other service users, personal space and owns a pet cat. Staff respect the service users’ right to make decisions and to be in charge of their lives. For example, staff encourage service users to take the lead in all daily tasks including opening the front door to visitors, offering visitors a cup of tea, cooking and preparing meals. The service users’ independence is encouraged and to promote this safely, risk management strategies have been developed and are an integral part of each plan of care. For example guidelines are in place to reduce the risks for one person when taking a bath regarding the possibility of seizures happening at the same time. 14 Coronation Road DS0000067740.V349093.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): 12,13,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported to live appropriate and fulfilling lifestyles both in their own home and the local community. Their rights and independence are promoted, while also successfully supporting them in maintaining relationships with family and friends. Meals are healthy, nutritious and attractive, and are prepared to meet the individual dietary needs of each service user. EVIDENCE: The excellent staffing levels means that service users are able to take part in a range of leisure activities, both at home and in the local community on a daily basis. The service users have activity programmes that are flexible and that can be changed daily after taking consideration of the individual’s needs on that day. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 15 Activities are offered based upon the individual’s likes and interests recorded in the individual care plan. Support plans are in place in relation to outdoor and indoor leisure activities and these are recorded as part of the care plans, with a goal, the steps needed to be taken to achieve it and the outcomes, recorded. This promotes staff to take a consistent approach and for one person, who was originally reluctant to go out of the house, this has been particularly successful as they are now beginning to take the initiative suggesing going out for lunch. A speech therapist has been instrumental in developing guidelines for staff to follow in relation to another service user going out for lunch and independently ordering their own meal. Picture cards are used to order the meal and the person is supported to use their personal money to pay for it and as a result the service user’s independence, self esteem and confidence is promoted. However discussions with staff confirmed that not all staff follow these guidelines. The speech therapist has also set up a daily visual timetable. This demonstrates to the service user the activities to take place that day. This aid is to be completed by staff and if used appropriately will assist the service user to take more control over their life as a result of having information available that they can understand and that informs them about the order of their day. The manager confirmed that this would be put into action. The service has its own transport, which is shared between the service users. This enables the service users to enjoy activities away from the area. For one person, who prior to living in this home had not experienced personal shopping trips or days away, this has meant the experience of visiting the local shopping centres and trips out to the coast. A healthcare professional involved in their care suggested that the person might now benefit from the development of a more varied programme of activities. Photographs neatly displayed around the walls of the houses show various activities enjoyed by the service users. One showed a service user happily helping to make dessert after dinner in the kitchen. The focus of the home is promoting care practices which show respect, privacy and safeguarding the rights of service users. Staff work reflecting this. Service users’ houses are respected as their private space and they move around them with confidence, demonstrating ownership of their environment. However for one service user who currently needs the support of three members of staff this ratio of service user to staff can make this difficult. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 16 Staff support service users to maintain contact with families and friends and a varied nutritious menu is offered that caters for individual preferences and needs. A healthy eating plan is in place for one service user and although difficulties have arisen in relation to this staff are now supporting the service user in a positive way. 14 Coronation Road DS0000067740.V349093.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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal and healthcare needs are met in a flexible but consistent manner, reflecting a healthy lifestyle. The storage, administration and recording of medication is sound, therefore promoting the welfare of service users. However the procedures do not fully follow the Royal Pharmaceutical Society’s guidelines on the handling of prescriptions. EVIDENCE: Service users are supported to register and attend healthcare practices in the local community and to receive advice from other health care professionals who are included in their individual plan of care, for example the psychiatrist, speech therapist and occupational therapist. Visits to and by healthcare professionals are recorded in individual care files with the outcome of the visit. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 18 The home has developed individual Health Plans that are recorded and linked into the Support Plans. The standard of recording by staff in the plans is generally very good and in sufficient detail, however this standard is not consistently maintained. Professional healthcare staff work very closely with the staff at Coronation Road giving advice and guidance in relation to managing challenging behaviours. The guidelines developed by the professionals form an important part of the service users’ support plans. It is therefore very important that all staff follow the guidelines in place, or discuss it further with the appropriate person, so that service users receive support that is consistent and appropriate to them and enables them to individually develop further and enjoy a community-based lifestyle. An occupational therapist is involved in assessing the service users needs for aids and equipment and these are provided to promote maximum independence. Service users’ changing needs are regularly reviewed and it is noted that in a recent review one service user was assessed as needing grab rails fitted above the bath. These have been ordered but they have not yet been delivered or fitted. Service users have recently had the medication they take reviewed. Policies and procedures are in place regarding the safe handling of medication, however it was noted that currently no record is kept of the medication ordered by the home. It is current practice that the prescriptions are sent directly from the GP to the pharmacist. The home does not photo copy these or record separately the medicines prescribed. This is contrary to the guidelines set by the Royal Pharmaceutical Society. A record of the medicines ordered must be kept by the home. The manager agreed to address this issue directly. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to help protect service users from abuse and to seriously address complaints and concerns about the service. EVIDENCE: The home has a comprehensive complaints procedure in place that is in picture format in an attempt to make it more accessible to the service users. As a result of gentle discussions and explanations about the procedure, one service user is now able to tell staff when they are unhappy about something. A Complaints File is in place and complaints are recorded with the details of how they are addressed. Currently they are recorded on ordinary file paper without guidelines in place. A discussion took place with the manager in relation to developing a standard form where complaints can be recorded following the procedures in place. The home follows the local authority’s Safeguarding Adults procedures and most staff have attended training in relation to these. There are plans in place for the remaining staff to attend at a later training session. There is a copy of the local authority’s Safeguarding procedures in the home that staff can refer to if needed. Staff were able to appropriately describe the action they would take if abuse was reported to or observed by them. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 20 The manager discussed an allegation made by a service user. It was evident that the appropriate procedures involving the local authority had been taken and recorded. A record of a visit from the local authority’s Commissioning Team was recorded. During the visit the officers examined various records in the home and when examining the service users’ individual finance records some discrepancies were found. Some of the receipts for items bought did not tally with those recorded on the Expenditure Record. The manager who has now found the missing receipts has since investigated this further and found that some recordings were poor and not accurate. Plans have been put in place to improve the recording system so that any monies spent can be accurately identified. This system has been explained to the staff team and will be monitored by the manager. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The houses are homely, comfortable, clean, safe and decorated and furnished to a high standard. They therefore provide service users with spacious, private and communal spaces in which to live. However the thin wall separating the two houses, could compromise the privacy of either service user. EVIDENCE: Originally the building was one large bungalow that was divided into two separate living environments. The homes were designed to promote individual living accommodation where the service users can benefit from maximum independence, living in an ordinary house as part of the local community. This is excellent practice and meets the specified needs of both service users living here. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 22 Each half of the building has its own lounge/dining area, bedroom, bathroom and toilet and adaptations have been made to meet the individual needs of each of the service users. Each service user has their own private entry to their home and the furnishings and decoration throughout is to a high standard. The cleanliness of the environment reflects effective cleaning routines and all staff have received training in relation to infection control. A particular strength of the environment is the spacious gardens where the service users enjoy sitting in the warm weather, socialising with their neighbours. However both gardens needed attention and staff reported that they were waiting for the gardeners to arrive. There is a small office for staff to use located off one of the kitchen areas. At the initial planning stages of opening this service, after taking into consideration the individual needs of the service users, it was agreed that the dividing wall between the two houses would need some form of soundproofing system to reduce any noise caused by either service user and that might invade the others privacy. However due to fire safety requirements a door, that is not in general use, was built into the wall and due to this it was assessed that any sound proofing system would be ineffective. This means that the level of sound that travels from house to house can be quite invasive. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 23 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): 33,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Excellent staffing ratios mean that the service users’ needs are fully addressed. Robust recruitment & selection procedures, regular training opportunities and supervision sessions, ensure that service users are appropriately supported and protected by a competent and qualified staff team. EVIDENCE: Each service user has a staff team especially recruited to meet their assessed needs. One service user has 2:1 support during the day whilst the other service user benefits from 3:1 support. These staffing ratios were established as a reflection of assessments carried out prior to the service users moving into their homes and it was agreed then that changes to the ratios would only be a result of future assessments and discussions with the Commissioners of the service and the regulatory body, the Commission for Social Care Inspection (CSCI). There are currently five staff vacancies, one new employee is awaiting Criminal Records Bureau (CRB) clearance and another three applicants are waiting to be 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 24 interviewed. The manager and permanent staff are working overtime to cover the vacancies. The manager confirmed that there has been a problem with recruiting new staff for some time and this has meant at times using agency staff. However the manager also confirmed that agency staff are only used as a last resort and when needed they are employed to work during the daytime only when established permanent staff are on duty for support and guidance. Two of the more recently employed staff discussed the induction programme they worked through on the IT E-Learning programme. Both members of staff, who showed enthusiasm about their roles and their training programmes, are now working towards NVQ2. A comprehensive training programme is in place for each member of staff that includes all mandatory training. The training programme is aimed at providing a trained workforce that is trained in the appropriate skills and competencies to effectively meet the needs of the service users. Some of the training includes: Managing Challenging Behaviours, Crisis Prevention Intervention (CPI) Techniques, Training around Epilepsy, Person Centred Planning and Equality and Diversity. All staff have recently read and signed the Company’s new Equality and Diversity Policy. Staff confirmed that they enjoy working at the home and all demonstrated their awareness and understanding of their roles. They interact with service users in a respectful and friendly manner. The majority of care staff are either trained in NVQ in care or are working towards it. There are five Registered General Nurses (RGN) included in the staff team and one is on duty to support one of the service users each shift. The nursing duties include specified tasks only, particularly related to seizures; challenging behaviours and administrating identified PRN medication. The community nurses if needed address any other nursing tasks. Minutes are kept of regular team meetings and staff now receive regular supervision sessions that are appropriately planned and recorded. The home follows the robust recruitment procedures and of the files examined completed application forms, 2 references and satisfactory CRB checks were in place. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides good leadership and runs a service that is developing effective monitoring systems that are focussed on the best interests of the service users. However some of the more qualified and experienced staff could initiate and take on board more responsibilities to reflect their competencies and skill, while at the same time support the manager to further develop the service. EVIDENCE: The manager is a qualified nurse (RGN) and has worked for the company for the past fifteen months. She has recently successfully registered with the Commission for Social Care Inspection (CSCI) as the Registered Manager for this service and plans to register for the Registered Manager’s Award (RMA) in the near future. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 26 She is up to date with mandatory training and has recently trained as a Moving and Handling Facilitator. Other training completed includes Health and Safety and an Induction into Management, she has plans to do Level 4 in The Management of Medicines. The manager has an open approach and has developed effective and respectful relationships with both service users and staff. She has been instrumental in developing this service effectively and recently in implementing new policies and ways of working with the people who use this service, while at the same time has professionally addressed criticism and demands made by other agencies. So that the qualifications and competencies of the staff that are qualified as nurses are recognised and effectively applied, the manager is beginning to designate tasks of responsibility to them. This is encouraged so that the manager develops a support system that will share, develop the service further and allow her the time she needs to attend to her managerial role. The Company’s Quality Assurance system is systematically being put in place. Monitoring systems have been developed regarding health and safety and a member of staff has been designated to be responsible for Fire Training and has recently attended a two day training session for Train the Trainer Award. Regular fire drills take place and fire equipment is checked appropriately. A new format has been developed for Service Users Surveys and these are to be distributed soon. Audits are kept regarding service users’ health and behaviour needs and a new format has been developed to monitor these. Incident forms have been further developed and there are clear guidelines for staff to follow when completing them. Key principles that underpin good record keeping are now applied and all staff are directed to read policies and procedures. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 27 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 X 4 X 5 3 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 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 3 X 3 3 X 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 28 No 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 YA18 Regulation 16(1) Requirement Timescale for action 31/10/07 2 YA19 13(1)(b)) 3 YA20 13(2) 4 YA23 12(1) The registered manager must ensure that the grab rails, as assessed by the occupational therapist, are fitted in the identified bathroom, so that the service user is able to access the bath safely. The registered manager must 31/10/07 ensure that all staff follow the guidelines developed by other healthcare professionals involved in the service users’ care, so that a consistent approach is given. The registered manager must 31/10/07 ensure that the home’s policies and procedures regarding medication includes how the medication is ordered and received and that these follow the guidance given by the Royal Pharmaceutical Society. The registered manager must 31/10/07 ensure that the new systems developed regarding the handling and recording of service users’ individual finances are put into practice and followed by all staff. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA41 YA16 YA22 YA24 YA24 Good Practice Recommendations All staff should maintain the good standard of recording in the care and health plans so there is consistency and the good standard is maintained. It is strongly recommended that all staff follow professional guidelines that will help to promote service users independence, self-esteem and confidence. Consideration should be given to developing a standard form on which to record complaints. The wall dividing the two living environments should be sound proofed to ensure the privacy of both service users. It is strongly recommended that the gardens surrounding the home are tidied up and kept in an attractive state. 14 Coronation Road DS0000067740.V349093.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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