Inspection on 27/09/06 for 15 Hulse Road

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

15 Hulse Road 27/01/06

15 Hulse Road 19/08/05

15 Hulse Road 11/03/05

15 Hulse Road 10/09/04

15 Hulse Road 01/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hulse Road (15) 15 Hulse Road Salisbury Wiltshire SP1 3LU Lead Inspector Tim Goadby Key Unannounced Inspection 27th September & 9th October 2006 14:10 Hulse Road (15) DS0000028695.V309965.R02.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 Hulse Road (15) DS0000028695.V309965.R02.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. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hulse Road (15) Address 15 Hulse Road Salisbury Wiltshire SP1 3LU 01722 326490 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) H5M049Piper@mencap.org.uk H4037@mencap.org.uk Royal Mencap Society Tracy Piper Care Home 6 Category(ies) of Learning disability (6), Physical disability (2) registration, with number of places Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users in the age range 18 to 64 years who may be accommodated in the home at any one time is 6 No more than 2 service users in the age range 18 to 64 years may have both a learning disability AND a physical disability The Commission must be advised of any circumstances when named service users are unable to access first floor communal space. The Commission must be consulted if it is decided to use the communal space area for staff sleeping in and give prior approval for such a change. 27th January 2006 Date of last inspection Brief Description of the Service: 15 Hulse Road provides care and accommodation for up to six adults with a learning disability. Up to two service users may also have a physical disability. The service is operated by Mencap. This is a national voluntary organisation working in the learning disability field. They have a number of care home and supported living facilities throughout Wiltshire. The home is located within level walking distance of the cathedral city of Salisbury. It is close to a range of amenities. These include shops, a cinema, a theatre, and a leisure centre. The building is an older property, located in a residential area. It has been extended on the ground floor. Service user accommodation is arranged over three floors. There are four single bedrooms, and one that is shared. Three of the bedrooms have en-suite facilities. Ground floor accommodation is available for any service users with some degree of physical impairment. There is no lift in the home. Fees charged for care and accommodation vary between £581 and £1459 per week. They are based upon the assessed needs of service users. The lower fee does not include the service user’s own contribution, which must be paid from allowances received. The higher figure relates to an individual who has some additional hours of one to one support funded as part of their overall care package. Information for prospective service users is given when they visit the home, Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 5 and through discussions with Hulse Road’s manager and other involved professionals. Copies of service documents, such as the statement of purpose and service user guide, are made available. CSCI reports are also available in the home, and are discussed when meetings are held with service users and relatives. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed in September and October 2006. The evidence gathered included information provided by the service, and surveys completed by four service users, with support, and five staff. Two visits were carried out to the home. The first took place at short notice, to ensure that someone would be present when we called. A shorter second visit was arranged by appointment, to conclude the inspection and give feedback. This fieldwork section of the inspection included the following: observation of care practices; sampling of records, with case tracking; discussions with service users, relatives, staff and management; and a tour of the premises. What the service does well: The service promotes a good quality of life for its users. There is a focus on maintaining and developing skills, enabling service users to be as independent as possible. A range of experiences and opportunities are offered, including regular access to community activities. Service users appear settled and confident in their surroundings. Interactions with staff on duty are friendly and relaxed. Service users contribute fully to all aspects of daily life in the home. Choice and consultation are promoted for service users, enabling them to have autonomy and influence in all areas of their lives. Appropriate communication systems are used to help each individual make their views known. The wishes of service users underpin the goals that have been set, both for their own care, and as wider service development targets. Care plans and associated documents are clear, informative and up to date. They set out the service user’s perspective on the key issues for that individual. They describe the support to be given and explain the reasons for it. They show who has been involved in reaching these decisions. They are kept under regular review. Even very recent changes in needs are included in detail. Where goals are set, there is evidence that these are met, making the process meaningful and beneficial for service users. Health care is provided effectively, enabling service users with some significant difficulties to receive the best possible advice and treatment for these. The service works diligently on behalf of its service users to promote their rights to such support. Families and other relevant professionals are kept involved at all stages. Guidelines on key health issues are set out clearly to help ensure that the right support is given when necessary. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 7 The service is proactive in adapting to changes in the needs of its service users. Over recent months this has included increased health care needs for some individuals, addressed through devising appropriate guidelines and accessing suitable staff training. It has also involved responding to the loss of some external activities for service users, by changing the programme of support at Hulse Road, and altering staff rotas to enable this. The effective response to changes helps to ensure that service users continue to benefit from a service which meets their needs. Service users benefit from a well run home, under the leadership of an effective manager who has suitable knowledge, skills and competencies to ensure that the service continues to meet their changing needs. Staff commented positively on the atmosphere created in the home, and the direction in which it is being taken. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hulse Road (15) DS0000028695.V309965.R02.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 Hulse Road (15) DS0000028695.V309965.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are fully assessed prior to admission, and reassessed when necessary to ensure that resources are in place to meet all of their needs. EVIDENCE: There have been no new admissions to the home since April 2005. Before this, there were two admissions within twelve months, both of which were carried out very effectively, to the benefit of the service users concerned. Relatives of one of these individuals were present during this inspection, and commented how well their family member has done since moving to Hulse Road. Around the time of this inspection a service user had to spend a short period in hospital, due to some significant concerns over their health. The home took appropriate steps to ensure a reassessment of needs, with input from relevant professionals, and put suitable resources such as new care plans and associated staff training in place before the service user returned. Staff cover was also adjusted for the first week, to help ensure safety when the service user came back. The home worked with the hospital to delay the discharge date until they were confident they had all the necessary resources in place to meet the service user’s needs. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area was excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have their abilities, needs and goals reflected in their individual plans. Service users can make choices and decisions in their daily lives. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: Two sets of service user records were sampled during this inspection, including one for an individual known to be going through a period of significant developments regarding their care and support needs. Plans covered all relevant areas, and were fully and clearly updated regarding even the most recent changes. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 11 Service users have input to their own care plans. They sign these documents, if they are able to. Plans are written in the first person, and use pictures and symbols alongside text, to make them more accessible. Goals are focused on service users’ own wishes, and progress towards these is reviewed at least once a month. There is evidence that goals are actually achieved, giving service users a sense of achievement and empowerment. The home works with its service users to promote their independence and autonomy. Any limitations are clearly linked to assessments and care plans. Service users have regular opportunities to make their views known. They can discuss issues relating to their own care in meetings with their allocated staff keyworker. There are also house meetings every two weeks, which allow topics affecting the whole household to be talked about. Service users are also surveyed periodically as part of the service’s quality assurance system, and their feedback is incorporated into the resulting development plan. Choice for service users is addressed specifically within their individual care plans. Various communication methods are used to promote the involvement of all service users. These include the use of signing, symbols and pictures. Staff receive training in these techniques. The support given by the home to service users in completing CSCI surveys for this inspection indicated respect for their views, and insight into the issues arising from their impairments. Records of any complaints raised by service users show that these are taken seriously and responded to appropriately. Again, these can help to identify areas in which the service can make improvements, in line with the wishes of the people living there. There is a clear process for risk assessment. These are carried out for a range of topics. Risk taking is promoted where appropriate, with any necessary safeguards in place. Information about safety issues is clearly set out in records, with an explanation of the reasons as well as a description of what to do. Risk assessments are linked to care plans, showing why they are relevant to the service user. Any restrictions placed upon a service user are agreed with input from all relevant persons, and records contain clear evidence of this. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: Communication styles and abilities vary amongst service users. Some are able to use speech. Others rely more on signs, symbols and pictures. Various Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 13 information is presented in ways that are accessible to the different individuals. Staff receive training to enable them to communicate as effectively as possible with each service user. Around the time of this inspection one staff member was working on updating and expanding the pictures used to enable choice in areas such as menus and activities. Skills assessments are documented. These show service users’ abilities and needs in key areas of daily living, such as personal care, cooking, cleaning, and money management. Service users are regularly involved in these tasks, which are allocated on a rota basis. They participate fully in cleaning, cooking, washing up, and ironing. They also answer the door, and phone calls. The maximum degree of independence is promoted, with some monitoring and support from staff if this is assessed as necessary. Service users attend various facilities outside the home on weekdays, such as day centres and clubs. However, access to external opportunities has reduced greatly in recent months, due to closure of college courses and cuts in other services. This means that most service users are now spending more of their time at home. The service has adjusted its staffing arrangements to reflect this, and to ensure that service users continue to receive structured support throughout the week. When they do not have programmed activities outside the home, they are supported by Hulse Road’s own staff to undertake alternatives. The weekly timetable for each service user is on display in the kitchen, and these are being updated regularly as further changes occur. One service user has a monthly calendar in their own room, and showed the inspector how they refer to this to remember what events are coming up in the near future. One service user has recently begun a new employment opportunity on one day each week, with support from a staff member. Service users can fill their leisure time in a variety of ways at home. They also have active social lives. Individual interests and preferences are recorded within care plans. Regular outings include the cinema or theatre, shopping, or going out for a meal. These are supported by staff, as necessary. Service users either walk, use public transport or take a taxi. Service users all receive the opportunity to have an annual holiday. They are involved in choosing the destinations for these. Various photographs are displayed in the home, showing the places people have visited. Two service users had recently returned from a holiday, which they had enjoyed. Wherever possible, the home actively supports service users to maintain contact with family and friends. Visitors are welcome to Hulse Road at any reasonable time. Some service users regularly go to see their families. Staff support them to send presents and cards for family birthdays. A service Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 14 development target is to hold meetings with service users’ relatives occasionally, which will give them a chance to comment on general issues to do with the home. Relatives of one service user were visiting Hulse Road during the first of these inspection visits. They confirmed their satisfaction with the service provided to their family member, and spoke about positive developments since the service user moved to the home. They felt happy about being able to visit at any time, and to observe how settled their relative is. The atmosphere in the home was said to be welcoming at all times. An especially successful event during 2006 had been the service user’s attendance at and participation in a family wedding. Relatives were very grateful and complimentary about the preparatory work that the home had put in to make this such a success. A number of service users have close friendships with people they lived with in the past. Care plans include information about key relationships for each individual, and how they maintain these. The home is also trying to widen the circle of friends and acquaintances for its service users. One service user had a birthday party the day after the first of these inspection visits. Each service user is given the opportunity to choose how to celebrate their birthday. Some may prefer to go out. Others like to invite people to Hulse Road. Service users are provided with keys to the front door, their own bedroom, and a lockable space, if they wish to have these. The home has an agreed no smoking policy. Anyone wishing to smoke may only do so in the garden. All service users participate in meal planning and preparation. They assist staff in shopping for ingredients, and with cooking. On the first of these inspection visits service users were involved in making a shepherd’s pie. On the second occasion, a service user spoke about the meal of liver, bacon and onion that they were due to prepare later that day. Menus are chosen by the service users, usually a day in advance. Pictures are used to help make choices, and are in relevant sections to help make this process simpler. Staff work with service users to encourage a balanced diet. Information about each individual’s likes and dislikes is contained within their care plans. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area was excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported to address their personal and health care needs effectively. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The amount of personal support required by service users varies. Descriptions are contained within care plans. Staff tailor their approach accordingly. Independence is promoted wherever possible. Service users choose their own clothes, during shopping trips with their allocated staff keyworker. The majority of staff are female, but some male relief and agency workers have been used, to ensure male contact for the one male service user. Evidence on sampled service user files showed that there is effective support Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 16 for a range of health needs. All service users are registered with their own GP. When needed, they attend appointments in the normal way. Other healthcare support is accessed as required. Records are kept of all such contacts. One service user has a number of health issues, with significant recent developments in some of these. The home has acted promptly and effectively to secure all necessary medical treatment and advice, and continues to pursue all relevant steps to help the service user. The service user’s family and the local team of learning disability professionals are closely involved. The CSCI has also been kept informed of all notifiable events. This service user’s care records contain clear, detailed and up to date information about the range of health issues being addressed. They explain the nature of emergencies which might occur, and what action must be taken in response to particular situations. All the service users at Hulse Road need support in the management of their medication. Staff receive relevant training, and are observed until they are assessed as competent to carry out this task. There are suitable arrangements for the secure storage of medication. Records are also maintained appropriately. Errors which occurred earlier in 2006 were reported to the CSCI at the time, and appropriate actions were taken to minimise the risk of similar mistakes in future. Service users’ individual records contain information about medication they are prescribed. This includes details of specific ways in which they prefer to take it. Consent to staff administering medication for them is also shown. Steps to take if a service user refuses medication are set out. Some medication is prescribed to be given ‘as required’. Where this is the case, there are suitable guidelines which set out how a decision would be reached. If two staff are on duty, they need to agree the necessity. When only one staff member is present, they can contact an on-call manager for advice. Records show that the use of such medication is very infrequent. One service user’s medication was under review around the time of this inspection, due to changes in the nature of their epileptic activity. A community nurse was involved in developing suitable protocols with the home, and in delivering training to staff about a special technique for administration of medication, which might be needed to help the service user. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are safeguarded by the service’s policies and procedures for complaints and protection. EVIDENCE: Mencap’s organisational complaints arrangements are appropriate. Information is clearly displayed within the service. It includes symbols and photographs, to help make it more accessible to service users. All service users and their families are provided with information about the complaints procedure, and a service development target is to ensure that they are regularly reminded of the relevant arrangements. Records show that service users have been confident to speak out when they have been concerned about any aspect of service delivery. There is awareness of local procedures for the protection of vulnerable adults. When necessary, issues are referred to this process. The CSCI is notified of relevant matters. The input of other agencies helps to develop suitable strategies to manage risk factors between particular service users. All Mencap staff attend training on abuse awareness and protection, as part of their core induction and foundation. This is updated every three years. Information about service users’ behavioural needs forms part of their overall care plans and risk assessments. Clear strategies are developed to manage such needs. Information covers both how to minimise the risk of difficulties Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 18 occurring, and also what to do if such situations do arise. All staff receive training about how to respond safely without the use of physical interventions. One concern had arisen about staff conduct around the time of this inspection. Prompt and appropriate action was taken within Mencap’s procedures to ensure the protection of service users whilst the issue was resolved. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a clean, comfortable and safe environment, which is suitable to meet their needs. EVIDENCE: 15 Hulse Road is located at the end of a quiet residential street, close to the centre of Salisbury. The accommodation is over three floors. The premises are domestic in scale. They are attractively decorated, and appear well maintained. Responsibility for most maintenance issues lies with the housing association that owns the property. Bedrooms are provided on all three floors. There are two ground floor rooms, with en-suite showers and toilets. There is a shared bedroom on the second floor which has an en-suite toilet. The remaining two bedrooms are on the first floor. Rooms are decorated and furnished to the tastes of their occupants. In addition to the en-suite facilities, there is a bathroom on the first floor. There are also toilets on both ground and first floors. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 20 The home’s main lounge and dining area are at the rear of the ground floor. The kitchen also has space for a table with seating. There is a smaller second lounge on the first floor. The office, which doubles as a sleep-in room, is also on the first floor. There is a large garden at the rear of the property. This has a patio and an area of lawn. One of the service users is particularly involved in helping to maintain the garden, and spoke about the various work that has taken place since the previous inspection. The home is registered to care for two people who may have physical impairments, in addition to a learning disability. The possibility of offering ground floor accommodation enables this aspect of care to be provided. Various adaptations and equipment have been provided within the home. Examples include fitting grab rails by the bath; and having lever handles on taps, for easier operation. Appropriate professionals, such as an occupational therapist, have advised on obtaining items which are appropriate to the needs of particular service users. Staff at the home are responsible for the cleaning. Service users also participate, in keeping with their abilities and wishes. The home was found to be clean and hygienic in the areas seen at this inspection. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported by suitable numbers of appropriately trained staff. Service users are protected by safe systems for the recruitment and selection of staff. EVIDENCE: Rotas are drawn up in line with the weekly routines of service users. Numbers on duty can vary. For instance, only one staff member may be needed if there are fewer service users, such as at weekends, when some may visit their families. Or more staff may be provided, to enable service users to undertake activities. Cover is maintained by the use of relief or agency workers, when necessary. Overnight cover usually consists of a staff member who sleeps on site, and can give assistance to service users if required. Staff cover is adjusted when necessary to reflect periods of particular need. For instance, to support the return to Hulse Road of a service user who had been in hospital, waking night cover was provided for the first week. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 22 Staffing arrangements were under ongoing review around the time of this inspection, due to major changes in service users’ weekly routines. Funding for college courses which some of them used to attend has ended, and attendance at day centres is also uncertain, with sessions often being cancelled at short notice. This means that service users are more likely to be at home for a greater length of time, and Hulse Road needs to increase its staff cover to reflect this. Two service users have elements of one to one support funded. This leaves one staff member to four other service users, if they are all at home. The manager does not consider this sufficient to ensure effective support, and is therefore putting forward a case for increased staffing resources. Comments in staff surveys identified a wish for more time to work one-to-one with service users. Steps already being taken by the home to review its rotas should help to address this. Mencap has a range of procedures, guidance and standard documentation relating to the recruitment and selection of staff. These address all the statutorily required elements, such as the various checks which must be completed on all prospective employees. Two files for recently recruited staff were seen during this inspection, and in both cases showed that all required checks had been completed before these employees took up their posts. The home may make use of staff from an agency to maintain cover. Information is available on file from the agency which is used, confirming the checks they carry out on any staff supplied. Service users participate in the recruitment process. One confirmed that they have taken part in a number of interviews. Other service users also get the chance to contribute their views, as each candidate visits the service to meet with them. Service users then use simple forms of symbol communication to indicate a positive or negative view. Training records detail the courses which each staff member has undertaken. There is also a training and development plan for the year ahead. This shows what sessions are required for which staff, and how these will be provided. All staff undertake the required mandatory training, and a range of courses that are run by Mencap for all its employees. Learning also takes place on some topics which are of specific relevance to the needs of the service users at Hulse Road. Mencap has an organisational system for induction and foundation training for new staff. This is being reviewed to reflect changes to the national standards for the social care workforce. Staff learn through a mix of distance learning, workbooks, external courses and in house instruction. Each employee maintains a record of learning. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 23 New staff are appointed on an initial six month probation period. Satisfactory completion of this is based on the manager’s assessment of their performance against their job description. Staff receive more frequent supervision during this time. The probation may be extended if this is felt to be necessary. The service is above the minimum 50 target for care staff with National Vocational Qualifications (NVQs) in care. Most of the team have already achieved the award, at either Level 2 or 3. Two more recent recruits are just registering to begin studying for it. Some staff surveys commented on difficulties in making time for completion of induction training tasks. The manager responded that this has been linked to increased pressure on staff time recently, due to the changes in service users’ weekly routines. A staff member present during the inspection commented that they received a very good induction to their post, and that they continue to have regular supervision meetings. Staff also commented that there is good teamwork within the service. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area was excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Quality assurance measures underpin service developments, and include actions based on the views of service users. Service users’ health and safety are protected by the systems in place. EVIDENCE: The home’s registered manager is Mrs Tracy Piper. She works as part of the care team, in addition to her administrative and managerial responsibilities. Within the home, she is supported by a deputy manager. Mrs Piper has Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 25 completed the Registered Manager’s Award qualification. Staff commented very positively about her management of the service, with one person saying it was a key reason for them wishing to work at Hulse Road in the first place. Mencap has an organisational approach to quality assurance. There are regional and area development plans, as well as service specific ones. Plans are set out under a number of topic headings, which ensure that all areas of service delivery are considered. There are topics which are particularly focused on service users. Areas for development are identified in various ways. These include internal audits; comments received from service users and others; and the findings of other agencies, such as the CSCI. Mencap has organisational systems for conducting thorough service reviews. Consultation also takes place regularly with service users, and at Hulse Road the process has been simplified to ensure that each individual’s participation is as meaningful as possible. Once an improvement task has been defined, it is made clear who is responsible for addressing this, and in what timescale. The service’s development plan also shows the way in which information about targets and progress is shared. Development targets for Hulse Road include areas specific to service users. These include developing the use of pictures and symbols in communication; identifying more service user friendly venues in which to hold meetings; developing a programme of in house activities; and promoting each service user’s involvement in the management of their own money. Health and safety arrangements are appropriate. A wide range of risk assessments and guidelines are in place. These cover both general topics, and those relating to individual service users. Staff have training on all mandatory topics, updated at necessary intervals. The fire log book was checked during this inspection. All required checks and instruction were recorded as being carried out, and up to date. Procedures clearly set out the response required if a fire is discovered, or the alarm system is activated. Practices are held regularly, and these include service users. A record is kept of how each individual has responded. Some people have hearing impairments, and they have been provided with additional devices to alert them that the alarm is sounding. Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 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 4 4 3 X 4 X 4 X X 3 X Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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 YA33 Good Practice Recommendations There should be continuing review of the staffing arrangements for the home Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hulse Road (15) DS0000028695.V309965.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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