CARE HOME ADULTS 18-65
15 Pentire Crescent East Pentire Newquay Cornwall TR7 1PU Lead Inspector
Lynda Kirtland Unannounced Inspection 2 September 2008 9:30
nd 15 Pentire Crescent DS0000028263.V367874.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 15 Pentire Crescent DS0000028263.V367874.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. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 15 Pentire Crescent Address East Pentire Newquay Cornwall TR7 1PU 01326 371000 01326 371099 mail@dcact.org 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) Spectrum Mr Jonathan Richard Staley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 15 Pentire Crescent DS0000028263.V367874.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 either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users that can be accommodated is 3. Date of last inspection 5th September 2006 Brief Description of the Service: 15 Pentire Crescent is a home providing accommodation and personal care for up to 3 adults with a learning disability. The home is run by Spectrum, an organisation that provides care for people with autistic spectrum disorders. Spectrum employs a manager and a team of care staff to provide care to people who use the service on a day-to-day basis. The aim is to provide them with the support they need in a homely, domestic-style environment. The home is located in Newquay and as such people who use the service are able to access all the facilities of a small town with the added advantage of ready access to several local beaches. The house is a detached, two-storey building, with a large garden. People who use the service are provided with their own bedrooms, one of which has an ensuite bathroom. There are two additional bathrooms. All the bedrooms are on the ground floor of the house. The home has an office and a separate sleeping in room for staff. There is a domestic-style kitchen with open plan dining room a conservatory and a separate laundry/store room downstairs. There is also a workshop that people who use the service are able to make use of. On the first floor of the building there is a large, comfortable lounge, with TV, Video, music centre and a computer with internet access. The home does not specifically provide accommodation for people with physical or sensory disabilities, but could readily adapted to meet special needs, if required. The home’s statement of purpose, which informs service users about the services the home provides, is kept on the home’s notice board. Copies of previous inspection reports are available on request. Fees range from £1052.00 to £1447.00 per week. There are additional charges for personal items such as toiletries, newspapers and magazines, according to the information provided at the time of the inspection.
15 Pentire Crescent DS0000028263.V367874.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 was an unannounced key inspection, which took place on 2 September 2008. It lasted for approximately six hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. The registered manager completed the Annual Quality Assurance Assessment and information from this was incorporated in the inspection process. The purpose of the inspection was to ensure that people who use the service needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved talking with people who use the service and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of the people who use the service and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the registered manager. The principle method used was case tracking. This involves examining the care notes and documents for a select number of residents and following this through with interviews with them and staff working with them. This provides a useful, in-depth insight as to how people’s needs are being met in the home. At this inspection, all of the people who use the service were case tracked. What the service does well:
There have been no admissions since the last inspection and therefore the People who use the service know each other well. If a new person was to move into the home then the registered manager would follow Spectrums guidance on admissions and ensure that detailed assessments were undertaken to ensure that the placement would be suitable for them. People who use the service are encouraged and supported to develop their skills and independence in many ways. They draw up their own care plans and maintain daily care records for themselves, for example. Staff are available to provide support where necessary, but in ways that do not place undue restrictions on the people who use the service who need less support. People who use the service are encouraged to participate in activities they enjoy and value, with due consideration of any risks involved, so that they can do so safely. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 6 This includes access to a wide range of activities in and out of the home, with due consideration of their individual needs, interests and backgrounds. Examples include access to voluntary work, support to pursue their leisure interests, support to attend church services and day trips to places of local interest. The home has a workshop that they can access, People who use the service are able to keep pets, with Spectrum’s agreement and they have a shared lounge with TV, Video, DVD and a computer with Internet access. People who use the service confirmed that they are actively supported to maintain valued relationships with their families and friends. People who use the service are informed of their rights and responsibilities so that they are clear about what is expected of them and what they can expect as residents of the home. This information is provided to them in their individual contracts and care plan reviews. All of the People who use the service said that they are satisfied with the food provided to them. The home has an ordinary, domestic Kitchen and they participate fully in shopping for food, planning, preparing and serving meals, so that they develop skills, confidence and independence. They are supported and encouraged to eat healthy and nutritious meals so that they enjoy their meals and stay well. People who use the service have good access to healthcare services when they need them. There are generally safe systems in place to ensure that they receive any medicines they need and are protected from medication errors. People who use the service are encouraged to make their views known and are taken seriously, so that the home is run in their best interests. There are systems in place to protect them from abuse and keep them safe, including checks on staff to make sure they are suitable to work with vulnerable adults in a care setting. The physical environment of the home is suitable for the people living there. It provides them with an ordinary, domestic setting so that they can develop their skills and independence comfortably. It appeared clean and tidy throughout at the time of the inspection, which was unannounced and People who use the service were observed assisting staff with cleaning tasks, as part of their agreed activity plans. People who use the service were complementary of the staff working in the home, saying that they are ‘kind’ and ‘ and helpful’. They were observed interacting with People who use the service respectfully and appropriately at all times during the inspection. They are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and in accordance with equal opportunities so that People who use the service can have confidence in them. The home is generally well run, for the benefit of People who use the service and generally good standards have been maintained. Some risk assessments
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 7 are in place to ensure that safety factors are taken into account and adequately managed. What has improved since the last inspection?
The registered manager application was successful and Mr Staley has now been legally managing the home since February 2008, but worked at the home since 2006 and therefore knows the home and People who use the service well. He has addressed the previous requirements identified at the last inspection in 2006, which include improving the persons care plans. Via the Person centred Planning process they now set them more detailed and specific goals so that they are clear about what they need to achieve to fully maximise their skills and independence. People who use the service are actively involved in this process. Written guidance about the safe management of medicines in the homes is now available so that staff can refer to them should the need arise in the aim that this would reduce risks of medication errors adversely affecting people who use the service. The registered manager believes that the following improvements have been made. People who use the service have more opportunities to expand their interests and attend activities in the community. People who use the service also confirmed this. He also felt that with the recent decision to increase the staff team from a minimum of one person on duty to two, due to recent changes for people who use the service, that this has had a positive impact on all that live and work at the home. This has resulted in people who use the service having the opportunity to attend more external community activities and at times on an individual rather then a group bases. Staff also echo the value in increasing staffing numbers in that there is now more opportunities for people who use the service to engage in activities they wish to do. This minimum staffing increase is yet to be made official by headquarters and would be a concern to us if this was not agreed. Fifty percent of staff have achieved a minimum of NVQ level 2 in care so that people who use the service can be fully confident of their competence to work in a care setting. The registered manager has commenced supervision of staff, which they confirmed but this needs to be documented. The home is fully staffed and the registered manager stated it is a stable staff team. The staff team stated they worked well together and cover for each other’s absences. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 8 The décor of the home is to a good standard and some rooms have been recently refurbished. The registered manager has plans to redecorate other rooms in the home. What they could do better:
Three statutory requirements were identified at this inspection: The Responsible Individual must write to the Commission to inform them why training for staff has been cancelled for at least the previous four months and when it is to resume. This is to ensure that staff are kept up to date with their knowledge and skills. In addition an immediate requirement was identified due to concerns of fire safety in the home. It was observed that there were no fire doors in the home, doors were wedged open which posed a risk of fire, no fire signage was put in place and a window had been screwed shut for example. Therefore an immediate requirement was issued for the registered manager to contact the fire authority within 24 hours to arrange an inspection of the premises and then must contact the Commission within 7 days to update on the situation. At the time of writing the report we are aware that the registered manager has contacted the fire authority and has arranged to visit the premises. The registered manager must notify the commission of all incidents in the home as per regulation 37 of the Care Standard Act as this has not occurred. This is to ensure that all incidents affecting the welfare and safety of people who use the service are notified to the relevant authorities. Recommendations to improve practice further have also been identified. Theses are that the presentation of the Statement Of Purpose and Service Users guide should be reviewed so that it is presented in a more meaningful format to People who use the service. It is recommended that improvements to medication systems be made as follows: that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. In addition the registered manager should ensure that all medication in the home is accounted for and accurately recorded to prevent medication errors. The registered manager should ensure that staff are aware of what procedure they are to follow when managing medication so that they are accountable for their actions. Administration time must be incorporated in the staffing rota for managers, and care staff to enable them to undertake the administrative duties of their work. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 9 Care staff should be provided with regular formal supervision with records maintained so that People who use the service can be confident that there is effective monitoring and management of the staff working with them. Regulation 26 visits should occur monthly so that care and management practices can be overseen as per the Care Standards Act regulations. The registered manager and directors need to speak with the People who use the service about the current issues in living together as a group so that the people who use the service feel that their voice is being heard and are aware of what action is being taken. We would like to thank People who use the service, staff and the registered manager for their kind assistance during this inspection process. 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. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 10 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 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 11 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. The Statement of purpose and Service Users guide would benefit from review to ensure that it clearly explains the services and facilities that Pentire crescent provides. The presentation of these documents would benefit from review so that they are more meaningful to the People who use the service. People who use the service needs are assessed prior to their admission so that they can be confident it will meet their health, personal and social care needs EVIDENCE: People who use the service have lived at Pentire for some years and know each other well. In the main they told us that they are ‘happy’ at the home. The home’s Statement Of Purpose and Service Users guide has been updated to reflect current management and staff changes in the team. However the Statement Of Purpose needs expanding to ensure that it covers all the issues outlined in Schedule 1 of the national minimum standards. The presentation of the Service Users guide document would benefit from review so that it is more meaningful to People who use the service and their representatives. People who use the service have a contract that outlines the expectations of the placement, their fees and their contributions. 15 Pentire Crescent DS0000028263.V367874.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): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples care plans address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds. All People who use the service have a up to date care plan which accurately reflect the individuals current care needs and inform staff what interventions are needed to provide consistent care for the individual. They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence EVIDENCE: People who use the service said that they know about their care plans and that they regularly attend reviews so that they are aware of the purpose of their placements in the home and are able to contribute to the ongoing care planning process. The care plan, which service users draw up for themselves with support from staff has specific headings to address their health, personal and social care needs, including their individual and diverse needs. Personal Care plans provide people who use the service with specific goals to work towards, and
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 13 inform and direct staff in how to support the person to achieve this goal to encourage them to fully maximise their skills for independent living. Staff confirmed they were able to understand the care plans and that the detail of how to assist in a particular task allowed consistency of care. Monthly reports are in the main completed which shows clearly the progress a person has made, if needs have changed and what actions the home is intending to take to meet changing needs. It was noted that PCP meetings are held approximately annually and the people who use the service and their representatives are involved in this process. People who use the service participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. Staff were observed supporting those who required it, to make decisions about what to do during the day, while those who needed less support, were able to come and go from the home independently, as they wished, for example. People who use the service written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. Spectrum are reviewing their risk assessment process in the aim that they will be incorporated in the individuals care plans. The risk assessments will then be more detailed and relevant to the individual person. Current risk assessments for people who use the service that are on file had been reviewed. 15 Pentire Crescent DS0000028263.V367874.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): 11,12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy EVIDENCE: People who use the service care plans and daily care records provide good evidence that their interests and abilities are fully considered in planning their daily activities, which are planned with them individually. This includes assisting them to access voluntary employment opportunities, work placements, college, sport activities and church services, for example. People who use the service said that they are satisfied with the activities provided for them. At the time of the inspection people who use the service were engaged
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 15 in a variety of different and appropriate activities in and out of the home i.e. house chores, bus trip, walks, preparing to go surfing and staff support is provided when necessary. People who use the service confirmed that they have regular contact with their families plus records of their contact with their families, including regular visits home, or visits from relatives to them at Pentire were seen. They are able to make telephone calls in private if they wish and have access to the Internet on the home’s computer. People who use the service are informed of their rights and responsibilities through their individual contracts and care plans, which they confirmed they understand. People who use the service manage their own finances with staff support when needed. Therefore the home does not deposit or withdraw monies for the People who use the service. However a monthly audit occurs at Spectrum headquarters. People who use the service are supported and encouraged to eat healthily. They undertake shopping, planning for, preparing and serving meals with assistance from staff. They all said that they are satisfied with the meals provided to them. Nutritional needs and preferences are considered as part of the care planning process. They take it in turns to choose the main meal each day, with alternatives available for those who do not want the main choice. The home has an ordinary, domestic kitchen, which they can access freely, to prepare drinks and snacks when they want them. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 16 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. People who use the service personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. There are systems in place to support them with medication but improvements are needed to fully protect them from medication errors. EVIDENCE: People who use the service individual care plans address their personal care needs. They all appeared to be attractively and fashionably dressed and were well groomed so that they can comfortably take part in community life. The home has suitable bathroom facilities so that they can attend to their personal care in private. People who use the service care plans also consider their healthcare needs. There are separate healthcare records for each of them, which indicate that they access a range of healthcare services, according to their individual needs. Staff interviewed during the inspection and service users’ confirmed this. The registered manager was aware that the medication cabinet should be fixed to the wall and stated he would address this. The home has low levels of medication to administer. From inspection of these records it was evident that
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 17 staff are recording medications they receive, administer and dispose of. With PRN medication (loose medication) the registered manager needs to ensure that the number of tablets in the medication cabinet corresponds to the MAR sheets, as a tablet count occurred and the records did not tally. When medication records are handwritten these need to be witnessed by 2 members of staff to ensure that the entry is written correctly to prevent medication errors. He agreed to address these issues immediately. The up to date medication policy was available for staff to refer to and the majority of staff have attended medication training. But due to the low levels of medication in the home the staff team are not following in detail the policy that Spectrum have issued i.e. key holder accountability. The registered manager agreed that he needed to ensure that the current practice that staff work with when managing medication is written out for them as a appendix so that staff are aware of what is expected of them and they are following specific guidance so that medication errors are prevented. Staff have attended medication induction training and will be booked to attend an external medication course, as are all Spectrum employees. The registered manager agreed to address the medication issues immediately and so no formal requirement will be issued, particularly in light of the low risk of medication errors affecting people who use the service in this home. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 18 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. People who use the service felt that in the main they are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. EVIDENCE: People who use the service were encouraged to speak to the inspector if they wished so that they could make their views known or raise any concerns. They were positive about the care they receive from staff. However two people raised an issue about difficulties in living as a group and felt that this was not heard by managers in the home and in particular at headquarters. Some people who use the service have made formal complaints that were documented. In talking with the registered manager he was aware of this issue and was ‘disappointed’ that the individuals felt this way but said that the matter was ongoing and is still being addressed both at local and headquarter level. Due to this no requirement at this stage has been identified but we wish to be kept up to date with the outcome of this concern raised. People who use the service and their families are provided with written copies of the home’s formal complaints procedure and have formal and informal opportunities to raise any concerns with staff before they become serious complaints. The home has not received any complaints. Spectrum has written procedures to guide staff on what to do if they suspect a resident is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. People who use the service are not isolated in the home, but take part in a range of activities in the local
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 19 community and have relationships with people from outside of the home that they can communicate serious concerns to. Spectrum has a whistle blowing policy. The registered manager has not attended the Multi agency safeguarding training and agreed to apply for this but he did have copies of the multi agency safeguarding guidance. All staff have attended in house adult protection training as part of their induction. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 20 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): 24,30Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment provides People who use the service with an ordinary, domestic setting so that they can develop their skills and independence in a non-institutional setting. It is clean but further infection control practices would benefit all from risks of cross-infection. EVIDENCE: People who use the service showed us around the home and told us that they were involved in the décor and furnishings of their rooms. Rooms were decorated to a good standard and personalised to reflect the individual’s character. The registered manager has plans to redecorate in particular the lounge/ dining area, which has become worn. The home appeared clean and tidy throughout at the time of the inspection, which was unannounced. To promote infection control it is recommended that paper towels be provided in bathroom areas for staff as they are using a ‘house towel’. The bathroom floors would benefit from being impervious instead of cork tiles, and rusty radiators should be replaced. The laundry facilities are in the garage and parts were on order to repair the tumble drier. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff levels have increased to reflect current dependency needs. Fifty percent of the staff team are qualified to the level recommended in the National Minimum Standards so that People who use the service can have confidence that people working with them are competent to do so. Staff are recruited fairly, safely and effectively on the basis that they are suitable to work with vulnerable adults in a care setting. Access to staff training must be improved so that staff skills are kept up to date. Staff are well supported but should be provided with more regular, formal supervision so that people who use the service can be assured that they are properly supervised EVIDENCE: Staff, confirmed in discussion with the registered manager that in the last month due to recent changes with the people who use the service that the staffing levels have increased to a minimum of two people. However headquarters has not made this official. Due to current needs in the home it is imperative that staffing levels are increased to this ratio and we would be concerned if they reduced. This then needs to be reflected in the homes Statement Of Purpose as minimum staffing levels currently state one staff are on duty with one staff member sleeping in.
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 22 Staff stated they felt that with the increase in staffing this gave more emotional and physical support to People who use the service and also allowed them to have more opportunities to access activities on a individual as well as group bases. People who use the service were also pleased with the staffing increase feeling this gave them more choices in what they could do during the day. We discussed with staff and manager that there is a large amount of paperwork relating to the persons care. As staff are being given more responsibility to complete care plans and monthly reviews they need administration time to complete this task which is currently lacking and has led to some documentation not being completed. In discussion with the manager and from records held in the home, 50 of care staff are qualified to NVQ level 2. Care staff have individual training records. The registered manager has an overall training plan for the home. Spectrum headquarters have not supplied staff training for four months due to the need to staff spectrum homes sufficiently. This has meant that staff training is out of date and staff have commented that they are frustrated that training has not been available. We have required that the registered provider write to the Commission to explain the situation regarding staff training. Newly recruited staff files were inspected and demonstrated that appropriate checks had been completed in line with legislation. Staff records confirmed that an induction package is undertaken for all new staff to the home. The registered manager stated that supervision does occur but acknowledged that he is ‘not good’ at writing them up. Therefore it was difficult to evidence that this occurs but staff said they have received ‘some’ supervision but were unclear as to its frequency. The registered manager is aware that all staff should receive a minimum of six supervision sessions per year. 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40, 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is mainly well managed for the benefit of People who use the service There are formal and informal systems in place to ensure that People who use the service views are accounted for in the day-to-day running and ongoing development of the home. Policies and procedures must be up dated so that staff are aware of what is expected of them. Staff training must be resumed to ensure that staff skills are kept up to date. There must be further improvements to the fire systems in the home with immediate effect so that all who live and work at the home are protected from the risks of fire. EVIDENCE: Mr Staley was approved as registered manager of Pentire Crescent in February 2008 but has been in post as manager of the home since September 2006. Mr Staley has to complete his NVQ4 but has completed first aid, food hygiene, medication, health and safety, infection control and is a trainer for the Positive Behaviour Management course.
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 24 Staff and People who use the service spoke positively regarding Mr Staley’s support and felt that he was approachable if they had any concerns or ideas for improving the service. The registered manager is aware that he needs to complete an annual quality assurance and said that he will commence this. The findings of this audit and any actions the home are intending to take must be forwarded to the commission. The registered manager did send in late his AQAA. Regulation 26 visits occur to oversee the quality of the service, but these have not been monthly, for example 25 Jan 2008 and then 12 June 2008. In the last visit certain management and care practices were raised and the registered manager has been requested to draw up an action plan, which to date has not been done. However the registered manager stated that he only saw this report on the day of inspection and said he was therefore unaware of the regulation 26 report findings. In addition the Spectrum compliance officer who undertook the regulation 26 visit noted, as did we that the registered manager has not been notifying the commission of incidents under regulation 37 and yet incidents have occurred. These must be reported to the Commission and regulation 26 visits must be done monthly to oversee practice. The registered manager and directors need to speak with the People who use the service about the current issues in living together as a group so that the people who use the service feel that their voice is being heard and are aware of what action is being taken. Records are stored confidentially. The registered manager is aware that policies and procedures need to be kept up to date. Spectrum headquarters have not supplied staff training for four months due to the need to staff spectrum homes sufficiently. This has meant that staff training is out of date and staff have commented that they are frustrated that training has not been available. We have requested that the registered provider writes to the Commission to explain the situation regarding staff training From inspection of the premises it was evident that fire regulations were not adhered too: fire doors had not been installed, doors were wedged open posing a fire risk, the velux window in the upstairs lounge (which is also a means of escape) was screwed down and we were told had been for the last 8 months, there was no fire signage in the building to name a few issues. The registered manager said he had highlighted concerns regarding fire to headquarters but had not had a positive response. An immediate requirement was issued to contact the fire authority within 24 hours to inspect the premises and to ensure that appropriate fire systems are in place. At the time of writing this report we are aware that the registered manager has actioned this and a fire officer is visiting. At this visit it is recommended that the fire risk assessment be reviewed to ensure that it meets current legislation.
15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 25 15 Pentire Crescent DS0000028263.V367874.R01.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 2 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 4 12 4 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 2 3 1 X 15 Pentire Crescent DS0000028263.V367874.R01.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. 1 Standard YA35 YA42 Regulation 18(1) (c)(i)(ii) Timescale for action The Responsible Individual must 30/09/08 write to the Commission to inform them why training for staff has been cancelled and when it is to resume. This is to ensure that staff are kept up to date with their knowledge and skills. Requirement 2 YA42 23(4)(a)(b) The registered manager must 03/09/08 (c) contact the fire authority within 24 hours to arrange an inspection of the premises and then must contact the Commission within 7 days to update on the situation. This is a immediate requirement 17(2) 26 The registered manager must notify the commission of all incidents in the home as per regulation 37 of the Care Standard Act 30/11/08 3 YA42 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 28 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 The presentation of the Statement Of Purpose and Service Users guide should be reviewed so that it is presented in a more meaningful format to People who use the service. It is recommended that when transcribing medication two staff members to prevent errors in handwriting medication instructions witness this. In addition the registered manager should ensure that all medication in the home is accounted for and accurately recorded to prevent medication errors. The registered manager should ensure that staff are aware of what procedure they are to follow when managing medication so that they are accountable for their actions. Administration time must be incorporated in the staffing rota for managers, and care staff to enable them to undertake the administrative duties of their work Care staff should be provided with regular formal supervision with records maintained so that People who use the service can be confident that there is effective monitoring and management of the staff working with them. Regulation 26 visits should occur monthly so that care and management practices can be overseen. The registered manager and directors need to speak with the People who use the service about the current issues in living together as a group so that the people who use the service feel that their voice is being heard and are aware of what action is being taken. 2 YA20 3 YA31 4. YA36 5. 6 YA39 YA39 YA22 15 Pentire Crescent DS0000028263.V367874.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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