Inspection on 18/12/07 for 16 Kings Road

This inspection was carried out on 18th December 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

16 Kings Road 04/12/08

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 16 Kings Road 16 Kings Road Lee On Solent Hampshire PO13 9NU Lead Inspector Laurie Stride Unannounced Inspection 18th December 2007 09:45 16 Kings Road DS0000070002.V353275.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 16 Kings Road DS0000070002.V353275.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. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 16 Kings Road Address 16 Kings Road Lee On Solent Hampshire PO13 9NU 02392553068 02392556081 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caremanagementgroup.com Care Management Group Ltd Amanda Irvine Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: 16 Kings Road is owned and managed by the Care Management Group Limited. The building is a large older style property that had originally been refurbished by the company to provide independent supported living accommodation. The decision was subsequently made that the home is to be used as a residential care home and the service was registered on 11/06/07 to provide accommodation, care and support for up to 6 adults who have a learning disability. The home is situated in a quiet road, close to the sea front and shops at Leeon-Solent. The current range of fees is £1,166.50 - £1,612.80 per week. This information was obtained at the time of the inspection visit. Members of the public may wish to obtain more up-to-date information from the care home. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection visit, which lasted approximately eight hours, during which we (the commission) spoke with the home’s registered manager, the deputy manager, three of the staff on duty and met the people who use the service. The four people who live in the home were unable to or did not wish to speak to the inspector, but two returned postal survey questionnaires, which they completed with assistance from the staff. Five staff members also returned postal survey questionnaires. Further evidence for this report was obtained through the service’s annual quality assurance assessment (AQAA) and looking at samples of the home’s records. What the service does well: What has improved since the last inspection? What they could do better: Information such as the statement of purpose needs to be completed to enable prospective service users to make decisions about accessing the service. All service users should be issued with a statement of their terms and conditions to promote their rights and responsibilities. More work is needed on person centred care plans to help promote individual service users’ wishes and aspirations. Medication administration records must be fully and accurately completed and all staff administering medication should receive training to do so. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 6 Staff should receive comprehensive training to ensure they can meet the needs of all people using the service both prior to admission and once they are living at the service. The registered manager needs to have sufficient time to ensure she can fulfil her role within the service. 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. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service and their representatives do not have all the information they need to choose a home that will meet their needs. Individuals have their needs fully assessed before coming to live in the home, but the service needs to ensure that all staff members are suitably trained to meet all the assessed needs. EVIDENCE: The home does not currently have a Statement of Purpose containing information specific to the service. The registered manager said that she had made a draft of the document but that the final version had to be authorised by the head office. This needs to be completed so that people have the required detailed information about what the home provides, but as it is work in progress a requirement has not been made on this occasion. There is a Service User Information Handbook available in a standard format to service users and their representatives, which gives an overview of what the home offers. The files of all the service users were seen and each contained copies of the organisations initial assessment and additional information obtained from the relevant health and social care professionals. The assessment information was 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 9 comprehensive and there was some evidence of reviews of the individuals’ progress during the transition period following admission. Assessments of individuals indicated that support is required from suitably trained staff and this was not fully in place in all cases. For example staff had not all received training in relation to Autism. The registered manager had identified this as a training priority (see also the section on Staffing). From observations made on the day of the visit, the basic health and welfare needs of individual service users were being met. The Service User Information Handbook contains a blank sample copy of the service user contract or agreement, setting out the terms and conditions of residence. A partially completed version was seen in one service users records, although this had not been signed and dated and was not in a format that service users would find easy to understand. Agreements were not available for the other service users and the registered manager said she would follow this up to ensure the agreements were put in place, therefore a requirement has not been made this time. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home supports people who use the service to make decisions about their lives and explores new ways to do this. Care planning and risk assessment systems are in place, which will be enhanced by the further development of person centred plans and measurable objectives for all individuals. EVIDENCE: We saw that care and support plans had been developed from the initial assessments for each service user and the registered manager reported that more work was planned in this area. For example, the manager showed us an individual person centred plan (PCP) that was being drawn up with one service user, providing a more personalised support plan. The standard format care and support plans had not all been signed and dated and were not in a format that each person could easily understand. The care planning process, whilst meeting needs, has not yet been fully developed to identify clear measurable objectives for all individuals, which can 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 11 then be used to further inform the process. Goal plans were seen for one individual, showing that a short-term goal had been achieved and a longerterm goal and timescale identified. We saw evidence that reviews of the care and support for people were generally taking place within the home, although the record of two multidisciplinary reviews held in November for one individual were not available and a similar review for another person was overdue. The homes’ annual quality assurance assessment (AQAA) stated that staff in the home are working with the local community speech and language team on photo boards and communication books, enabling service users to reinforce their communication methods using pictures and language. We saw a picture communication board being used with one individual and similar work is planned with other service users in line with their assessed needs. From discussion with two members of staff it was clear they had a good understanding of peoples’ general needs and staff were seen to interact appropriately with people who live in the home. The home has a key worker system and we observed this working well during the visit, staff members were clearly supporting people to make decisions and developing relationships of trust. The registered manager said that the home has to date not been able to identify any advocates locally, who could further assist people to make independent decisions. We saw that people are supported to manage their personal money, based on support planning and risk assessments. Risk assessments and behaviour guidelines were in place for all individuals who live in the home, for example in relation to accessing the community, attending healthcare appointments, using the home’s vehicle, medication and personal care. Individuals are enabled to take responsible risks to lead as independent lives as possible, for example managing finances and accessing college. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home actively promotes a variety of activities for individuals and opportunities to maintain relationships with family members. People who use the service are provided with a balanced and healthy diet that suits their needs and preferences. EVIDENCE: The homes’ annual quality assurance assessment (AQAA) states the home is working towards more involvement in the local community and encouraging appropriate leisure activities to ensure service users enjoy a wide and varied lifestyle. We saw that for two of the people who use the service, an overview of activities had been recorded. The registered manager told us that individuals had chosen the activities with support and information from their key-workers. Although initial assessments indicate the need for structure and routine, some 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 13 individuals do not like to stick to planned activities and the home has adopted a flexible approach in such instances. The registered manager said that more work is needed in relation to finding activities to suit one individual, which have to be organised on a daily basis. The person had recently tried swimming and a visit to Portsmouth’s Spinnaker Tower on public transport. A member of staff showed us a file containing information about local facilities and activities that he has been gathering to assist people to find things they want to do. The member of staff had also been developing an activity booklet, containing photographs of activities undertaken that enable people to pick the activities they like the most. We saw that the home had commenced a system of monitoring the activities an individual chose and recording the outcomes and any issues, but discontinued this when the individual was admitted to hospital. The registered manager said that the process was to be re-started. Daily diaries also contained information about activities people had taken part in. The registered manager and staff were observed supporting people with tasks and activities that were recorded in the support plans. One individual is interested in artistic and creative pursuits and this had been encouraged through in-house sessions and trips to the sea front to take photographs that are then painted. The persons’ room had been personalised with the results of these activities. Another person had expressed an interest in doing a life skills course at college and was now attending four days a week. This person finds outside work therapeutic and a member of staff told us that they had made enquires about allotments. The home is also looking at the possibility of the person getting a bicycle and risk assessing this, which could open up further possibilities for the individual. At the start of our visit, three of the four people who live in the home had gone out. The other person spent some of the morning painting and planning the day with staff, then went out in the afternoon. The home has a vehicle although not all the service users are able to travel together in it, so staff members negotiate with individuals when trips are undertaken. The registered manager said that six of the thirteen staff members are licensed to drive the vehicle. This is taken into consideration when planning the shift rota. The home supports one person to attend a place of worship as and when required. The home operates an open visiting policy and supports individuals who wish to keep in touch with their relatives through regular telephone calls. The home also uses sends a monthly newsletter to relatives and care managers. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 14 People who use the service are involved in some of the daily routines of the home. Individual support plans include doing domestic tasks, if this fits with the persons assessed needs and wishes. One person is supported to keep a guinea pig as a pet. The door to the kitchen is locked when staff members are not available to supervise. This had been risk assessed in relation to specific individuals. Another service user was observed being able to access the area during the day. We saw there is a varied menu and records of the meals people have eaten are kept, demonstrating that choice is offered and enabling the home to monitor that people are eating healthily. One person requires a special diet and this is catered for sensitively. The fridge contained fresh vegetables and fruit is made available. 16 Kings Road DS0000070002.V353275.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The healthcare and personal support people receive is based on their individual needs. Improvements have been made to the medication system and practices within the service to promote independence and safety, which will be further enhanced by the home keeping up-to-date records of staff training in medication issues. EVIDENCE: The homes’ annual quality assurance assessment (AQAA) states that personal support is provided in the way in which each service user requires. Independent choice is promoted over times to get up and go to bed, and when individuals have a bath or undertake other activities. We observed staff members responding to service users in a respectful, friendly and supportive manner. One person chose to get up later in the morning and personal support and activities for the individual were then organised in a flexible way by the manager and staff. Information about personal healthcare needs is recorded in service users files. The home is also working on Health Action Plans for each person and there is 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 16 regular contact with a local GPs surgery. Medical appointments and the outcomes are recorded each time a person accesses the GP or other healthcare professionals. Records showed and staff members confirmed that training and guidance has been provided so that staff have an understanding of diabetes and how to control blood sugar levels appropriately. Notifications we had received from the home over the previous four months had reported a number of medication errors. We discussed these with the registered manager and looked at the homes’ systems for managing people’s medications. The registered manager explained how the storage of medication was now more secure and we saw that there is a designated person on each shift who is responsible for ensuring medication is managed correctly. Arrangements had also been made for a weekend medication pack that service users can take when they go home, to prevent errors occurring. Night staff members maintain a running record of the amounts of each medication held in the home. The home uses a monitored dose system (MDS) and there are also loose boxed medications and these are stored appropriately. There is a fridge supplied by the pharmacy for keeping Insulin and a list of the staff who are trained to administer this. Each service user has a written medication profile that shows when any changes are recorded. There are medication policies and procedures, including the use of ‘as required’ (PRN) medication and the manager explained that the use of this has decreased through the improved understanding and management of service users’ behaviours. Information about each medication being used and its possible side effects was also on file. We saw a sample of medication administration recording sheets and these were correctly filled in, except for one gap on 16/12/07. The registered manager checked this and found that the medication had been given although the record had not been completed. The registered manager is qualified to provide medication training for staff. The manager reported that the training records needed updating, therefore it was not possible to ascertain how many of the current staff had up-to-date medication training. 16 Kings Road DS0000070002.V353275.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are systems in place to ensure that individual concerns are listened to and acted upon. People who use the service are protected through the homes’ policies and procedures, this will be enhanced by all staff attending relevant training prior to working with people whose behaviour can be challenging. EVIDENCE: The home has a written complaints procedure that is on view to all who visit the home explaining what to do. There is also on display a whistle blowing policy to enable people to complain without victimisation. A Complaints Book is stored in the office and there is also a record kept of positive feedback from people, which contained comments from people who use the service and their relatives. The complaints procedure is explained during service users’ induction period and recorded in their files. Each individual has a copy of the complaints procedure kept in their room. This is a new service and the registered manager confirmed that there have been no formal complaints reported to the home. There have also been no complaints reported to us. The annual quality assurance assessment (AQAA) states it is the homes’ aim to improve the service by having appropriately trained staff who can deal with challenging situations in a calm manner. It says physical and verbal aggression is understood and dealt with in a calm and dignified manner and 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 18 physical interventions have reduced as a direct result of this. The AQAA states concerns were raised over staffing levels and training needs, but that these are gradually improving due to in-house specific training. The registered manager is qualified to provide training for staff in relation to protection of vulnerable adults (POVA) and plans to do more of this. There were gaps in the training records and it was not possible to ascertain how many of the current staff had up-to-date POVA training. The manager said that the organisation had scheduled training for the day before the inspection visit, but staff had not been able to attend this as the training did not fit with the homes’ staffing and shift requirements. Three of the staff had completed training in understanding and managing challenging behaviour and this was another training priority the manager had identified. The manager said that while most staff had completed training in the use of physical interventions, there were three staff members whose records were not clear about this. Incident forms are used to record and monitor when challenging behaviour occurs and the home’s responses. One of the staff members spoken to said they thought that it would have been beneficial for them to have had more training prior to working with individuals whose behaviour can be challenging. The home supports people who use the service in dealing with their personal money and we saw a sample of the records relating to this. Each person’s money and records of transactions were kept separate and in the sample we saw the amount held matched the balance recorded. Where appropriate and based on risk assessment, individuals are supported to control their own money. 16 Kings Road DS0000070002.V353275.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a safe, homely environment for people who use the service. EVIDENCE: A tour of the communal areas of the home was made during the visit and one persons’ bedroom was also seen. The registered manager said that the home had originally been set up to provide a supported living service and some of the fittings, such as blinds on the windows, may not be suitable for a service providing for people who may have challenging behaviours. At the time of our visit the home was well maintained and decorated. Due to the needs of people who use the service, there is a limited amount of decoration in the communal areas, nevertheless the manager and staff members have made the environment homely and welcoming. People who use the service had drawn pictures that were displayed in the dining area, which is also used for activities. Christmas decorations had been put up and the staff and service users were observed interacting throughout the day. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 20 The home has a small office that is not large enough to accommodate a staff team meeting. There is a sliding door between the lounge and dining/activities areas, which also does not provide an ideal space for staff meetings as it would be difficult to discuss confidential matters without people who use the communal spaces hearing. Meetings in these rooms would also restrict access to these areas. The registered manager was aware of these issues and said she was looking into alternative means of holding staff meetings. The bedroom we saw was spacious and comfortable and had been personalised with the occupants’ possessions and artwork. Other vacant rooms were also of a good size and all rooms have en suite facilities. As mentioned in a previous section of this report, the door to the kitchen is locked when staff members are not available to supervise. The registered manager said that one person who uses the service has a key to access the kitchen, another did have a key and this was currently under review. The manager said that the home’s staff survey had indicated that 40 of staff thought that people who use the service can get food and drink when they want. The manager said she was looking into the issues raised by the survey results. The homes’ annual quality assurance assessment (AQAA) states that the home is clean, hygienic, tidy and that health and safety checks are completed regularly. We saw further evidence of this during our tour of the building and through inspecting the home’s records. Two of the people who use the service returned questionnaires stating that the home is always fresh and clean. Washing machines are specific to service needs and hand washing facilities are prominently sited. Chemicals used for cleaning were stored securely when not being used. 16 Kings Road DS0000070002.V353275.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. People using the service are protected by robust recruitment procedures. Consistent and well structured training would ensure that the individual and collective needs of people using the service can be appropriately met. EVIDENCE: During the visit we observed staff interacting with people who use the service in a friendly and respectful manner. Staff we spoke with demonstrated good knowledge of peoples’ general needs and the agreed ways of working with them. The home’s annual quality assurance assessment (AQAA) indicated that 80 of permanent staff have or are working towards National Vocational Qualifications (NVQ) in care and 100 of agency staff have NVQ in care. The home’s AQAA also stated that all staff recruitment checks were carried out and this was confirmed through inspecting a sample of staff files. The three staff members’ files contained evidence of Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks, two written references, completed application forms with employment histories. Records were held on file confirming that agency staff deployed in the home had also undergone appropriate recruitment checks. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 22 Care Management Group has recently implemented a regional training programme, which provides training relevant to the needs of the service user group at 16 Kings Road. However, as mentioned in a previous section of this report, the registered manager said that there have been occasions when training dates and times did not fit with the homes’ staffing and shift requirements. The homes’ AQAA identified that the home had also been shortstaffed at times and this had an impact on the numbers of staff able to attend training. The registered manager was working on updating the staff training matrix as this did not provide evidence of all the training staff had undertaken, as some staff had transferred internally. There were a number of gaps in the records, for example protection of vulnerable adults (POVA), medication and physical interventions training. There were also gaps in fire safety training although staff had received guidance for this during induction; and infection control, which the manager is trained to provide but had been unable to do so previously as she had been filling the gaps in the staff rota. The manager had subsequently identified and prioritised staff training needs, which also included training in Autism, understanding and managing challenging behaviour, keyworkers and roles. The original staff team had been set up to provide a supported living service but the home’s purpose had since changed to provide for people who may at times have challenging behaviours. This had led to a number of the original staff team leaving and, while the home had managed this through using agency staff, recruiting new staff and transferring staff internally, the home had lacked a consistent and suitably trained staff team in relation to the assessed needs of the people who use the service. The manager reported that the organisation had arranged for it’s clinical psychologist to provide training prior to people moving in, but this person had left the service before the training was provided. The manager told us that the organisation had employed two agency staff and paid for them to receive training in physical interventions in relation to one of the people who use the service. The current rota showed that the home used the same agency staff whenever possible to ensure a level of continuity. We saw that the home uses a basic induction checklist to orientate new and agency staff into the way the home works. The organisation does have a full staff induction programme that is based on the Skills for Care Common Induction Standards. However the manager said she has not yet been briefed on the use of this and she will now be liaising with the manager of a neighbouring home in order to implement the programme. We saw some written evidence of formal staff supervision taking place. The registered manager confirmed that not all staff had received up-to-date regular recorded supervision, but that she was available to give guidance on a more informal basis and that staff members could request formal supervision if 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 23 needed. Recent improvements in staffing numbers should facilitate the development of formal supervision for all staff. 16 Kings Road DS0000070002.V353275.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Increased time and attention to the management functions within the service and a fully developed quality assurance process would ensure the service is run in the best interests of those using it and promote and protect their health and well being. EVIDENCE: The home’s registered manager has an NVQ level 4 in social care and has requested that she be put forward to undertake the level 4 Registered Manager Award (RMA). Mrs Amanda Irvine also has other qualifications in mental health and health and social care. A deputy manager was recruited at the beginning of December 2007 and is now supporting the registered manager in the day-to-day running of the home. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 25 The service is continuing to seek to recruit support staff in order to provide a consistent and stable staff team. The registered manager also receives support and supervision from the regional operations manager. Through discussion with the registered manager and looking at the home’s records, we saw that through the early stages of the services’ development the manager had been working mainly in a ‘hands-on’ capacity supporting people who use the service. This was due to the staffing issues described in the previous section of this report, which had led to some of the day-to-day management functions being given a lower priority. Examples of this are given throughout this report, including care plans, staff training and record keeping. The ongoing recruitment of staff and the recent employment of a deputy manager should now begin to reduce the impact of these limitations. Care Management Group conduct their own quality audit of its services. The organisation has recently re-vamped the way that regulation 26 visits by the providers representative are carried out and reported. The new format report states when action has been taken and any identified objectives have been achieved. The registered manager told us that the home is still working on a suitable quality assurance survey questionnaire for people who use the service and also plans to use a relatives’ questionnaire to ascertain people’s views. A survey of health and social care professionals who have involvement with the home had been sent out about a month ago but there had been no response to date. Five of the staff had responded to a staff survey in October. The manager said that quality assurance surveys are part of the organisations’ continuous development plan. The home keeps stakeholders informed by sending out a monthly newsletter to people’s relatives and care managers. We saw evidence that demonstrates safe working practices are promoted and maintained within the service. For example fire safety and food safety checks, service user alarm tests, medication cabinet checks and room temperatures are all recorded in the health and safety file that is completed daily. There are also monthly health and safety checks, environmental and infection control risk assessments and up-to-date food handling guidelines. The fire logbook was up-to-date regarding equipment tests and staff drills. The home had information relating to chemicals used for cleaning. 16 Kings Road DS0000070002.V353275.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 2 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 3 x 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 27 N/A 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 YA20 Regulation 13(2) Requirement Timescale for action 31/01/08 2 YA35 3 YA37 The manager must ensure that systems put in place to reduce medication errors are monitored and adhered to ensuring that records are fully maintained. 18(1)(a)(c) Staff employed within the home must be trained to meet the collective and individual needs of people using the service. This must include training in medication administration, understanding and managing challenging behaviour and training specific to individual needs such as autism. 12(1)(a) Sufficient time must be allocated to ensure the registered manager is able to fulfil the management functions within the home so as to ensure records are properly maintained and the well being of people using the service is promoted. 29/02/08 31/01/08 16 Kings Road DS0000070002.V353275.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 YA6 Good Practice Recommendations Service user plans should be developed to be person centred and show individual goals and objectives to ensure individuals are fully supported and their needs are met in the way that suits them. 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 16 Kings Road DS0000070002.V353275.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!