CARE HOME ADULTS 18-65
198 Rossendale Road 198 Rossendale Road Burnley Lancashire BB11 5DE Lead Inspector
Mrs Marie Dickinson Unannounced Inspection 19 & 23rd April 2007 10:00
th 198 Rossendale Road DS0000060125.V334231.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 198 Rossendale Road DS0000060125.V334231.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. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 198 Rossendale Road Address 198 Rossendale Road Burnley Lancashire BB11 5DE 01282 425668 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) Voyage Limited Mark James Bunce Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Physical disability (13), Sensory of places impairment (13) 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission. The staffing levels in the home must at all times consist of a minimum of 1 staff member to 2 service users during the day, on average, and 1 waking watch and 1 sleep in staff member at night. With no more than 10 people sharing a staff group. The home is registered for a maximum of 13 service users to include: Up to 13 service users in the category of MD (Mental Disorder, excluding disability or dementia) Up to 13 service users in the category of PD (Physical Disability) Up to 13 service users in the category of SI (Sensory Impairment) Date of last inspection 25th July 2006 3. Brief Description of the Service: 198 Rossendale Road is registered with the Commission for Social Care Inspection to provide personal care and accommodation for thirteen people. The home is operated specifically as a specialist provision for adults who have an acquired brain injury. Voyage Limited, which is part of Paragon Healthcare Group, owns and operates the home. Accommodation offered is in thirteen large specially adapted single occupancy bedrooms. All rooms are en suite, and some include a small kitchen and dining area. Specialist equipment required to support service users in daily living is provided in all rooms. There are several spacious lounges and dining and kitchen facilities. Specialist modern bathing facilities are also provided. The upper floor can be accessed by a passenger lift. Staff support is based on individual needs of service users living at the home. Information about the service is available from the home. Cost of stay at the home is individually assessed due to service users complex needs requirements and may range from £1250 upwards. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took place on the 19th and 23rd April 2007. The inspection involved getting information from staff records, care records and policies and procedures. It also involved talking to people living at the home, staff on duty, the manager, and a senior representative of Voyage. People who use this service and care staff also gave their view of the services provided in written comments sent direct to the Commission. Six responses were returned to the Commission from people living in the home and six from staff who gave their personal view of the services provided. The inspection included a tour of the premises. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Younger Adults. What the service does well:
Before any person is admitted they visit the home and stay for a trial period to help them decide if they would benefit from living at the home. Admission to the home was planned giving people enough time to settle in and find out how their support would be provided. They were also given a written contract so they knew what was expected from agreeing to stay there. People living in the home were given information such as the homes policies and procedures that helped them understand for example, what to do in the event of a fire, how to keep safe and the homes ruling on smoking, alcohol and drugs. Staff had written directives for ‘getting to know service users’ which helped staff to give them a ‘personal touch’ when providing care. Staff also knew how to help people take reasonable risks safely in everyday living that helped people make decisions about what they did each day. Written comments showed how staff listened and acted on what they said. Such as ‘Yes they always sit down and listen to what I have to stay’. Everyone considered they could do what they wanted throughout the week and at weekends. People had specialist assessments such as speech, language, and physiotherapy that linked to care plans. These helped staff to support them to improve in these areas. Written information held in the home showed people’s healthcare needs were monitored, and how staff worked with other medical professionals for their benefit. One person who sent written comments said ‘all
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 6 staff treat me with respect’ and all commented ‘staff were always available when they needed them.’ Medication was managed safely. Peoples views about their opportunities to take part in activities was positive. This was because they did what they wanted to do. For example ‘I’m happy with being able to do what I want, see my family at home every weekend, and get to go to bed when I want’. And ‘I go out shopping or go for a meal’. Activities helped people make the most of their skills and included attending College, working, and everyday life skills such as cooking a meal. Some people had enjoyed a holiday and were planning another this year. Staff were supporting people to care for their pets. People knew how to raise any issue of concern they may have or were unhappy. Comments included, ‘I would speak to the manager’ and ‘Fill in a complaints form, which is in a file in my room.’ The overall provision of specialist equipment and the facilities in the home was of a high standard. People using wheelchairs could access their bedrooms via automatic door openers. The home provided a clean, well-maintained, comfortable environment for people living there. People living in the home were generally satisfied with the staff. Comments included ‘the staff are nice’ and ‘the staff are helpful and kind’. Staff working in the home considered they ‘Work well as a staff team. Share information and feedback.’ Staff also felt the home ‘Practice equal opportunities, equality and diversity and always makes sure the service users know their rights.’ What has improved since the last inspection?
Everyone living at the home had been given a contract. They also had up to date information they could understand about policies and procedures for everyday living, such as ‘house rules’, on smoking, alcohol and drugs. This helped avoid any misunderstandings about living at the home. A person has been employed to keep the outdoor areas pleasant for people living in the home and for general maintenance. The home had some decoration and new floor covering fitted. New dining tables allowed people in wheelchairs sit at the tables in comfort. Before new staff work in the home written references are obtained relating to the persons last place of employment. Staff benefit from supervision and meetings to support them in good care practice. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 7 What they could do better:
Assessments should be more detailed to help plan care for people living in the home. Every person must all have a care plan that they understand and agree. This will help to make sure their needs are met in the right way. Care plans must also be reviewed so that peoples changing needs are identified and changes can be made to the level of support they need. They should also have the opportunity to agree short-term goals that will support them to reach their desired long-term outcome. Where people cannot express their wishes, they must have someone who will act on their behalf to make sure they get the best care. In the case of people with poor memory, they should be assisted to recall life experiences helping them to know they live life to the full of their potential. People living in the home should have the opportunity to discuss life in the home, and bring about any changes they may wish to make. The use of pre paid post cards for people living in the home to alert senior management of Voyage regarding sensitive issues, such as not being happy should have the opportunity to keep their personal information kept confidential. Staff must be formally trained in adult protection procedures to help them recognise abuse and keep people using the service safe. Sufficient staff must be employed to make sure peoples needs are fully met. Recruitment of staff must be completed properly so that the right people are employed to look after people living in the home. Induction records should be kept up to date to show staff have had the necessary training. Other training records should be kept up to date and used as a means of identifying shortfalls in staff training, and copies of qualifications attained should be kept on file. Staff must all be trained in first aid, food hygiene, moving and handling, infection control, and other essential topics to protect themselves and the people they care for. All people living in the home must be formally consulted and have their say about the services and facilities offered as part of quality assurance. This will help make sure the home is run in their best interests. The Commission must be given a copy of the report. A manager should have a recognised management qualification. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information and opportunities to visit and have a short stay were given to people that helped them decide if the facilities and services could meet needs and preferences. Contracts issued, informed them about the terms and conditions of living at the home. Assessments were not always completed properly which potentially meant some essential details were not known to help plan the right care. EVIDENCE: A revised statement of purpose and service user guide specific to 198 Rossendale Road had been completed and was available for people making enquiries about the home. The aims and objectives included independence, choice, inclusion, rights, dignity, fulfilment, and privacy. Various formats were available. To make sure the right format was given, the manager said for each person the type issued would match their capacity for understanding. The home offers permanent placements to adults with ‘Acquired Brain Injury (ABI). Additional information was available about the service in the organisations production of ‘Voyage’ homes and services. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 11 The specialist service of the home does limit peoples choice. Social workers involvement with family often influences placement, as people may not be aware of their needs because of brain damage. Since the last inspection three people had been admitted . Care management assessment of needs briefly recorded past history, present needs and support required in residential care. This assessment included for example communication, physical and mental health needs as a result of an brain injury. Before a place was offered a member of the management team had visited the person requiring a placement and independently assessed their needs. This procedure is carried out for all new referrals. The standard of assessment however was not always detailed sufficiently to inform staff when planning care. as some people had complex needs. The manager said before anyone is admitted, they can spend time in the home on visits. They can look at the facilities, meet with staff and other people who live there. A short stay of three months is offered followed by a review when everyone involved meets together to discuss if living at the home is satisfactory and the care given is suitable. Voyage agrees a contract with placing authorities regarding individual care packages requested. People living in the home were given a contract with the terms and conditions of residence from Voyage Ltd. 198 Rossendale Road DS0000060125.V334231.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): 6,7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A lack of consistency in the care planning process meant that staff were not always provided with information they needed to meet peoples needs. Adequate risk assessments and management strategies potentially reduced the risk of harm to people living in the home. People were consulted and given information which assisted them to be involved in day to day routines and know confidential information was handled right. EVIDENCE: Where good assessments had been made, information recorded was used to write peoples care plans. Not all people who used the service benefited this and one person living in the home had no care plan to follow. Other specialist assessments, for example speech and language, physical disability and psychiatric, helped make sure all these special areas of need was considered and people had access to the correct support.
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 13 Other people who use the service had benefited from being involved in how they wanted staff to care for them. This included written instructions for staff to follow when providing care. The standard of these directives for some people who had lived in the home for a while was good. People using the service had a member of staff (key worker) to help them on an individual basis. There was no evidence to show a full key worker role and their contribution to care planning in place. There was little evidence to show how long term goals were being managed. Some goal setting as part of case tracking did not include agreed long term goals and support needs, including details of the process needed to reach these goals. The manager said the format used for individual plans were to be reviewed. The review of care plans also needed to be recorded better, with staff input for those people who cannot express themselves fully. Essential information such as policies and procedures for people using the service was included in their own handbook. This was very good although the actual format and language used was not consistent in being user friendly. People using the service were observed being involved and consulted about day-to-day matters, such as meals, mealtimes, and going out. People using the service did not have ‘house meetings’. The manager and staff viewed risk taking as being part of everyday life. This was recorded and detailed on how to manage identified risk. Risk analysis showed how some people who use the service were involved in decisions on risk management. Records were mainly kept confidential and a signed agreement reached with people about sharing information with other professionals. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home had a degree of independence, which meant they had opportunity to take part in chosen activities; were given opportunities to live a fulfilling lifestyle; access community resources, and keep in touch with families and friends. The meals provided were sufficient in providing for their tastes, choices, and diet. EVIDENCE: The manager said people living in the home were given opportunities for personal development. This was individuaised and was discussed as part of care planning. However as care planning was not always clear about long term goals with short term achievements not being recorded, progress made was not easy to judge. Review of care plan or peoples development was not always carried out. In one instance a monthly review sheet was left blank because of
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 15 communication difficulties. This meant decisions were made without any imput from the person concerned. Peoples views about their opportunities to take part in activities was positive. This was because they did what they wanted to do and what they were comfortable with, making use of community facilities such as going to day centres, to the pub or just going out for shopping. For example ‘I’m happy with being able to do what I want, see my family at home every weekend, and get to go to bed when I want’. And ‘I go out shopping or go for a meal’. Staff offered support where needed. One written comment stated ‘If I want to get some fresh air, a member of staff will always take me for a walk.’ People had weekly planners of personal activities they followed that included for example, Monday to Friday, morning, afternoon, and evening. Activities included college, help make own lunch, physiotherapy in own bedroom, beauty session, maths and english, go out for walk, food shopping, menu planning and painting. People had had different interests. One person worked voluntary at the RSPCA dog walking, and others at Freshfields gardening. Some people had been to Flamingo Land. The resort offers facilities for disabled people. The manager said those who went on holiday enjoyed themselves. Support should be given to help people with memory problems remember the activities they did and prevent them living life in the present moment only. Some people had pets and staff supported them to care for them properly. The service user guide states the aim of the home is to make sure people are given maximum choice on matters relating to their daily lives including opportunities to take reasonable risks. Included also is a recognition of ‘individual ethnic, religious and social needs that are characteristic of service users and care to be provided appropriate to these.’ People living in the home were given opportunities for personal development, although this could be evidenced better. However care programmes showed how additional help such as physiotherapy programmes were in place to help people with complex multiple disabilities. Staff who gave written comments for the inspection thought there was not always time to follow these programmes through. The home was managed in a manner to avoid any institutional routines. Letters were delivered unopened and observations made of staff working in the home showed they treated people living in the home with respect. All bedrooms had locks on their doors and people managed their own keys. Relatives and friends were made welcome to the home. People’s rights were respected in their daily lives. Some people had made it quite clear what staff should and should not do, and how they wanted staff to speak to them. This information was recorded in their care notes. Everyone spoken to was pleased with how the staff respected these wishes. Written comments from people who
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 16 used this service included ‘The staff are helpful and kind even when I am wrong about things’, and ‘Always nice to me’, ‘The staff are always there to help’. And ‘All the staff treat me with respect’. Comments from staff about what the home did well included ‘always makes sure the service users know their rights;’ and ‘ We offer choice and independence’. Menus showed service users were offered variety and choice. The manager said menus were changed every four weeks. Part of learning life skills for individuals involved planning meals, preparing snacks, food shopping and make drinks. Records need to show in more detail how budgeting skills, shopping, preparation, and cooking were managed. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual preferred routines likes and dislikes allowed people to enjoy personal care in a dignified way. Their healthcare was monitored and medication policies and staff training promoted best practice and reduced the risk of errors being made. EVIDENCE: Records showed people using the service were registered with a General Practitioner and that appointments had been made and kept, appointments had also been kept with care coordinators, consultants, and community psychiatric services. Written comments from people living in the home indicate staff treat them well. Such as ‘they always sit down and listen to what I have to say’, and ‘all staff treat me with respect’. Personal care was given according to individuals wishes. People living in the home made it quite clear how staff must treat them and what to expect if
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 18 support was not given the right way. For example ‘I will decide what I want to wear. Every person in the home had technical aids they needed to assist in personal care such as overhead tracking from bedroom to en suite shower. This provision included automatic bedroom door openers for people confined to wheelchairs. Staff were trained in operating equipment provided. Staff worked with other professional people involved in peoples care. A physiotherapist and speech and language therapist was employed on a regular basis for sessions with individuals. Staff had planned programmes to follow, however working to programmes was not always followed through in a consitant way and had been a concern of the therapists. The manager said this was now resolved and staff had sufficient time for these duties. Records of medication was kept for each individual that included information staff should be aware of if someone was not well. People living in the home could self medicate following an assessment to make sure this would be safe. Medication storage was secure and tidy. Medication administration records were up to date, and all staff responsible for this task ad been trained. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure provided guidance on raising complaints that helped people living in the home raise any issue or concern they may have. Not all staff had been formally trained in adult protection; this could result in abuse matters not being properly identified and dealt with. EVIDENCE: People who sent comments to the commission stated they knew who to speak to if they were not happy and how to make a complaint. One person during inspection said he would use the complaints procedure found at the back of his file. Most people said they had no complaints as such and all who joined in the inspection were confident any issue they had would be dealt with. The intention that people living in the home can independently contact head office via a post card is good. However this should be modified to include a prepaid envelope making sure service users confidentiality is not breached. The cards available for people to send to Voyage were prepaid postcards and therefore members of the public could view them. The content of the card were, ‘my name is, I live at and I am unhappy’. The complaints procedure was available for people to use. There had been no complaints received at the home. Staff had a policy directing them to treat people in their care with ‘consideration, dignity, and respect and free from harrassment and
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 20 intimidation.’ One person living in the home was currently being supported by an advocate. Advocacy services were sourced from a variety of places for example ‘headway’. Staff on duty were familiar with adult protection procedures. They had not been formaly trained in protection of vulnerable adults topics although they knew their responsibilities with this. The service user guide explains to people using the service about abuse and protection. Staff have guidleines for safekeeping money and accountability. Protection issues such as wills and gifts were covered in staff terms and conditions of employment. There was evidence that the management considered protection of vulnerable people very serious. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a clean, well-maintained, comfortable environment for people living there. EVIDENCE: People living in the home thought the home was very nice. Written comments received at the Commission were, ‘the home is nicely decorated and very welcoming’, ‘the home is lovely’ and ‘it is cleaned daily’. The grounds and outside of the home had improved from the last inspection, The manager said a handyman/gardener had been employed and had been allocated a budget for garden equipment. Plans were also in place to create a garden for people living in the home to work in. Some people went to Freshfields leaning gardening skills. The rear garden area is quite private and is the site of the proposed service users garden. Parking is on the main road.
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 22 The home had been tastefully furnished. Dining room tables had also been provided that were adjustable in height for wheelchair users. The overall provision of specialist equipment for physical disability was to a high standard. Bedrooms were equipped with individual aids and wheelchair users could access their bedroom without the assistance of staff. Bedrooms were furnished to individual taste and need. The rooms with kitchen facilities had been adapted to individual need, such as height, wheelchair, right and left aids, enabling people occupying these rooms to maximise heir independence and work to planned programmes. The overall standard of hygiene observed was very good, although the outside paintwork was in need of cleaning. New flooring in the dining areas meant the floor was easily cleaned after spillages of food and drink. Decoration had been carried out in communal areas and a ‘snoozlem’ had also been created for people to experience sensory stimulation. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Recruitment of staff was not completed satisfactory or allowed people using this service help choose who they would like to care for them. New staff did not complete induction training properly and were therefore not trained adequately to care for people in the home. EVIDENCE: The manager said the current level of staffing was linked to the needs of thepeople living in the home. Prior to people being admitted, better care should be made regarding the level of staff support required, as currently peoples needs are met by the level of staff available. This was a concern of staff. However as assessments had not been completed properly for the most recent admissions, this was difficult to measure. Since the last inspection the home employed a groundsman/handyman who had regular hours. Domestic support in the home was considered by the manager as not required as night staff completed main domestic duties in 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 24 communal areas. Staff supported people to keep their bedrooms clean as part of lifeskills. People living in the home were generally satisfied with the staff. Comments included ‘the staff are nice’ and ‘the staff are helpful and kind’. Staff recruitment procedures were not altogether satisfactory. Application forms had been completed for two new employees, although one staff file had no application form. Contracts held on file were not always signed. Contracts covered job description, conditions of employment, health, and safety at work, type of contract i.e. probationary period, performance, conditions of service, and general issues such as criminal offences and conflicts of interest. A training agreement was signed. Interview notes were not available and in one instance no photograph for identification was kept on file. Induction given to new staff had not been completed in essential areas such as escorting service users, relationships and abuse issues; principes of care such as understanding the needs of service users; maintaining a safe environment, and the effect of the service. There was no evidence of moving and handling etc. People using the service were not directly involved in the interview process. The manager said part of staff selection is for the applicant to spend time in the home with them, and be observed. Staff on duty said they enjoyed their work and the training provided. They worked to a key worker system and this involved helping people with personalised goals such as independent living skills. They were given some supervision and felt they could ‘have their say’, as the manager worked alongside them. They thought the opportunities for training was good and specific for the type of work they did. Other professionals gave them training such as the physiotherapist and speech therapist. This helped them to keep special programmes for individuals maintained. Staff however said they could not always follow these programmes consistently due to time constraints. The manager sais new staff were being recruited. Staff numbers trained National Vocational Qualification in care level 2 and above was very good. Staff said they had supervision. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. No proper quality monitoring meant people’s views were not considered when reviewing the service. Record keeping practices in the home were not thorough to fully protect people, however policies and procedures were up to date. Inconsistency in providing health and safety training for all, potentially placed people at risk of harm. EVIDENCE: The registered manager had resigned his position in February, and an acting manager was in post. An application to register a new manager with the Commission was being processed within the organisation. The manager said she was being very well supported by senior management of Voyage. Since the last inspection the area manager of Voyage had also changed.
198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 26 Part of the manager’s role was training staff. Comments received from staff included ‘Work well as a staff team. Share information and feedback.’ Staff also felt the home ‘Practice equal opportunities, equality and diversity and always makes sure the service users know their rights.’ The manager said she was improving and developing systems that monitor practice and compliance with policies and procedures of the home such as regular supervision of staff. Staff and people living at the home considered the manager to be approachable. They felt that the home could improve by ‘having adequate staff on shift. By better communication, by making the home look more presentable and tidy, by employing a cleaner (desperately). People living in the home said the manager was the main point of contact should they have any concerns. Staff said they had meetings, and had the opportunity to discuss work issues at these. They considered relevant training was provided and felt the manager was supportive in this area. Confidential records were locked away, and sharing of information with relevant people had been agreed with each person living at the home. Record keeping and filing systems need to improve as notes and information required for reference was in several files and not easy to locate. All files must be kept up to date, relevant, and accurate with confidential information not shared. Staff had written policies and procedures to work to and people who lived in the home had their own copies that were made available in suitable formats. People living in the home generally felt ‘staff listened and acted upon what they said’, however more effort to make sure every person can have their say was required. Formal quality monitoring was needed. Health, safety, and welfare of people living and working in the home is a shared responsibility between Voyage and the manager. Weekly checks on the environment safety were carried out for example water temperature checks, fire alarms and emergency lighting. The health and safety manual however needed completing such as fire and environment checks for any identified risks. Voyage had arrangements with contractors for maintenance beyond everyday management such as electrical appliances, legionnaires disease control and fire safety appliances. Training in health and safety was also provided for staff to help them at work, such as moving and handling, first aid and food hygiene. Not all staff had benefited from this. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 X 2 3 2 2 X 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation Requirement Timescale for action 31/05/07 2. YA11 3. YA23 4. YA32 5. 6. YA33 YA34 15(1)(2)(a)(b) All people living in the home must have a care plan that they understand and agree to make sure their needs are met in the right way. 15(2)(c) Care plans must be reviewed to make sure peoples changing needs are identified and changes to their care can then be organised to help them. Where people cannot express their wishes they must have someone who will act on their behalf to make sure they get the best care. 13(6) Staff must be formally trained in adult protection procedures to help them recognise abuse and keep people using the service safe. 13,19 Staff must be formally trained in adult protection procedures to help them recognise abuse and keep people using the service safe. 18(1)(a) Sufficient staff must be employed to make sure peoples needs are fully met. 19 Schedule 2 Recruitment of staff must be completed properly to make
DS0000060125.V334231.R01.S.doc 31/05/07 31/05/07 31/05/07 31/05/07 31/05/07 198 Rossendale Road Version 5.2 Page 29 7. YA39 24(1)(5) 8. YA42 18 sure the right people are employed to look after those persons living in the home. Previous timescale of 17/08/06 not fully met All people living in the home must be formally consulted and have their say about the services and facilities offered as part of quality assurance. This will help make sure the home is run in their best interests. The Commission must be given a copy of the report. Previous timescale of the 30/09/06 not met Staff must be trained in first aid, food hygiene, moving and handling, infection control, and abuse to protect themselves and the people living in the home. 31/05/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA2 YA6 YA8 YA11 YA22 Good Practice Recommendations It is recommended assessments are more detailed to help plan care to meet assessed needs. Service users should be given the opportunity to agree short-term goals that will support them to reach their desired long-term outcome. It is recommended people living in the home have the opportunity to discuss life in the home and bring about any changes they may wish to make. It is recommended people with poor memory be assisted to recall life experiences helping them to know they live a full life. The use of pre paid post cards for people living in the home to alert senior management of Voyage regarding sensitive issues such as not being happy should consider confidentiality for the person using this method of
DS0000060125.V334231.R01.S.doc Version 5.2 Page 30 198 Rossendale Road 6. 7. 8. YA33 YA35 YA37 communication. Induction records should be kept up to date to show staff had the necessary training. Training records should be kept up to date and used as a means of identifying shortfalls in staff training with copies of qualifications attained. It is recommended the manager obtain a management qualification. 198 Rossendale Road DS0000060125.V334231.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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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