CARE HOME ADULTS 18-65
199 Doseley Road 199 Doseley Road Dawley Telford TF4 3BA Lead Inspector
Rebecca Harrison Key Unannounced Inspection 27th July 2006 09:15 199 Doseley Road DS0000066727.V305637.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 199 Doseley Road DS0000066727.V305637.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. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 199 Doseley Road Address 199 Doseley Road Dawley Telford TF4 3BA 01952 506105 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.dimensions-uk.org Dimensions (UK) Ltd Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: No conditions apply Date of last inspection 6th June 2006 Brief Description of the Service: 199 Doseley Road is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and personal care for a maximum of five adults with a learning disability. The property is purpose built and comprises 5 bedrooms, 2 bathrooms, 3 toilets, a fully fitted kitchen, a lounge, dining room and a sensory room. The home is situated close to the village of Dawley, which offers a range of facilities and amenities. Dimensions (UK) Ltd is the service provider and was registered with CSCI on 3rd March 2006. The responsible individual is Ms Susan O’Loughlin and the manager is Ms Sarah Patten. The manager was unaware of the current range of fees charged per person. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out by two inspectors and lasted five hours. It included talking with service users, the manager and members of staff on duty, case tracking two service users, observing work practices, looking at a number of records and a full tour of the home. Sixteen ‘key’ National Minimum Standards for younger adults were assessed in addition to Standards 1,3,5,14,28,33,36,38,41 and a quality rating provided based on each outcome area for service users. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The key standards assessed and met at the previous inspection undertaken on 06.06.06 were not reviewed on this occasion. The service users, manager and staff on duty were welcoming and co-operated fully throughout the inspection. No complaints have been referred to CSCI since the last inspection. One referral has been made under adult protection procedures since the last inspection. What the service does well: What has improved since the last inspection?
This is the second inspection undertaken under the new registered provider. Since the last inspection a number of improvements have been made. A Service User Guide has been developed although requires further work to fully comply with Regulation 5, of the Care Homes Regulations. It was reported that an independent advocate has recently visited the home in relation to representing service users with the development of the terms and conditions of residency. The provider has started to develop and implement new support plans. One of the support plans seen was detailed and completed in a person centred format. A person centred plan (PCP) has recently been completed with one service user with the manager’s assistance. The service user reported that he enjoyed doing his plan. The other plan reviewed was not yet complete.
199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 6 A number of new risk assessments have been developed however further work is required to support individuals with taking responsible risks in relation to action and control measures required. A new recording format for activities has been introduced and these records are now completed after each activity. Records seen evidence service users continue to have active lifestyles and activities are now realistic and offer more flexibility. Since the last inspection people are being encouraged to eat more healthily and ‘treats’ restricted to one a day. A meals and drinks monitoring form remains in place. Monitoring forms seen for two individuals evidence that service users are now being provided with alternative healthier options. The manager reported that the home is in the process of changing over supplier to Boots Chemist as they have recently visited the home and can provide a better service using the monitored dosage system. It was reported that individual medication cabinets are currently on order and these will be fitted in service users own rooms. The complaint procedure for the new provider has since been obtained and placed in the reception and made accessible to service users, families and visitors. A number of improvements have been made to the environment since the last inspection to provide people with a more safe, clean and comfortable home to live. The conservatory has been cleared and a new suite purchased providing additional living space. The former snoozlem and room divider has been removed to provide a large lounge, which has recently been redecorated in addition to the redecoration of the kitchen and two bathrooms. New carpets for all ground floor areas have been ordered and are due to be fitted on 31.07.06. A new lounge suite is due to be delivered on 02.08.06. The lawns have been mowed and cleared of some garden equipment although the garden is still in need of tidying up and equipment put away. A new bed has been purchased for staff when undertaking sleep-in duties. Environmental Health Officers and an Infection Control Nurse have visited and made a number of requirements and recommendations, which the provider appears to be working towards. The manager reported that staff would be provided with in-house training on infection control shortly. Staff deployment has changed and the manager reported that there is now a minimum of three staff per shift throughout the day. It was reported that although staff are working long shifts, more support is now available to provide opportunities for day trips out. The manager has started to develop historical staff training records to assist with in the development of a team training and development plan. Since the 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 7 last inspection staff have undertaken some mandatory training in safe working practices and training has been booked for any outstanding staff. Visits as required under Regulation 26, continue to be undertaken by the organisation and a report forwarded to CSCI. The most recent report received for the visit undertaken on 28.07.06 identifies improvements in a number of areas and that the home was tidy but in need of homely touches. A pictorial staff rota has been developed to assist service users identify staff on duty. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective service users and their representatives are not provided with sufficient information on what the service has to offer in order to make an informed choice about the home. EVIDENCE: There have been no new admissions or discharges since the last inspection undertaken on 06.06.06. One service user is due to be discharged shortly as the home is currently unable to meet his needs. Discussions held with the service user indicated that an alternative placement has been sought, trial visits are underway and that he is looking forward to his move. Four requirements were made at the previous inspection in relation to this outcome group. The manager reported that the Statement of Purpose and terms of conditions is still being developed and was not available for inspection on this occasion. The Service User Guide has been developed and a copy of this was seen during the inspection. Further work is required for the guide to fully comply with Regulation 5, of the Care Homes Regulations. It was reported that advice is being sought from an independent advocate regarding the guide and the terms and conditions before service users are provided with a copy.
199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 10 Although records have improved there continues to be insufficient evidence to demonstrate the capacity to meet service users needs at the time of this inspection. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although improving, the new care planning systems do provide staff with sufficient information for the delivery of care. Decision-making processes are improving however people living at the home are not fully protected by the risk management strategies currently in place. EVIDENCE: Three requirements were made as a result of the last inspection. The same files of the two people case tracked at the previous inspection were reviewed again on this occasion. It is positive to report that since the last inspection the new provider has started to develop and implement new support plans. One of the support plans seen was detailed and completed in a person centred format however the other was incomplete and did not provide staff with sufficient detail as to what level of assistance the individual required in relation to personal care tasks for example, shaving.
199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 12 A person centred plan (PCP) has recently been completed with one service user with the manager’s assistance. The service user reported that he enjoyed doing his plan. A new proactive management plan was seen on one file and included in the support measures was to ‘offer some form of distraction’. How staff was to achieve this was not evidenced in order to provide consistency and continuity of support for the individual concerned. It was reported that an independent advocate has visited the home since the last inspection in relation to representing service users with the development of terms and conditions of residency and that work is still being developed in this area. The manager stated that the advocate is also visiting one service user who currently has no social worker or family representation. Observations made indicate that staff respect service users rights to make decisions however the daily records seen continue to be minimal and do not record instances when decisions have been made by others and reasons to support this. A metal gate is in place on one service users room to prevent him leaving his room at night. The manager was requested to review this as it restricts his freedom of movement and a risk assessment to support its use was not available. Other safety measures are in place to include the door being alarmed and the home providing a waking night member of staff. It is positive to report that since the last inspection a number of new risk assessments have been developed. Both of the inspectors reviewed the assessments and considered that they continue not provide staff with sufficient information to support individuals with taking responsible risks in relation to action and control measures. Two risk assessments had been completed for transporting service users in a vehicle however the information differed in relation to action and control measures, which was acknowledged by the manager at the time of inspection. A new file for risk assessments has recently been developed however it was evident that not all staff was familiar with the location of risk assessments. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Leisure plans are more realistic in providing people with opportunities in the community. Service users are now being provided with a more varied diet in accordance with their personal preferences, taking into account healthy alternatives. EVIDENCE: Key standards 12,13,15 and 16 were reviewed and met at the recent inspection of this service and were therefore not reviewed on this occasion. Four requirements were made as a result of the previous inspection in relation to leisure activities and meals. The manager reported that a new recording format for activities has been developed and this was shared with the inspector. These are now completed after each activity. Completed activity records seen evidence service users continue to have active lifestyles and activities now undertaken are realistic and offer more flexibility.
199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 14 The manager reported that formal menus are used not at the home as each individual is provided with a choice of food in accordance with their personal preferences however since the last inspection people are being encouraged to eat more healthily and ‘treats’ restricted to one a day. A meals and drinks monitoring form remains in place and staff are responsible for maintaining a record of all drinks and food consumed by individuals including snacks. Monitoring forms were seen for two individuals and evidence that service users are now being provided with alternative healthier options. The manager reported that no dietician has been involved since the last inspection however the manager reported that staff have a greater awareness and monitoring of food has improved. 199 Doseley Road DS0000066727.V305637.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems to monitor the personal and healthcare needs of service users require further development to ensure their health needs are being met. EVIDENCE: Three requirements were made as a result of the previous inspection in relation to personal and healthcare support. The requirement for service users’ preferences with regard to their personal care requires further development as identified in standard 6. Support plans, although improving, still lack sufficient information for the delivery of care/support for example support plans do not provide the exact assistance an individual requires when receiving support with personal care, bathing, shaving, dressing etc. This is particularly crucial given the limited communication needs of the majority of the people accommodated to ensure that individuals are provided with consistent support. The broken wheelchair as identified in the previous inspection report has since been removed in addition to the bedrails that were left on the landing. The manager reported that she has sought advice from the local learning disability team and two health practices in relation to developing Health Action
199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 16 Plans for service users and that information received has been very limited. She reported that none of the service users have received any health checks since the last inspection. The medication procedures were reviewed due to a requirement made at the previous inspection for staff to record on Medication Administration Records (MAR) charts when service users refuse medication. MAR charts seen during this inspection were found satisfactory. The manager reported that the home is in the process of changing over supplier to Boots Chemist as they have recently visited the home and can provide a better service using the monitored dosage system. It was reported that individual medication cabinets are currently on order and these will be fitted in service users own rooms. Interim storage arrangements have been agreed with the CSCI in the interim as medication is currently being stored in the new staff office, which has very limited space. Medication found for one service user was dated use by 03/2006 and an unidentified tablet was found in a bottle with a hand written label, which was illegible. A weekly audit record was seen on two service users records and last dated 16.10.05. The signature sheet for staff responsible for administering medication was last updated in June 2006. The homes medication policy was not reviewed on this occasion. 199 Doseley Road DS0000066727.V305637.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their representatives have access to a complaints procedure that enables their views to be listened to and acted upon. Procedures to safeguard service users from potential harm or abuse are in place. EVIDENCE: No complaints have been referred to the Commission for Social Care Inspection (CSCI) since the last inspection. The manager reported that the complaint procedure for the new provider has been obtained and placed in the reception and made accessible to service users, families and visitors. A pictorial complaints procedure developed by the local learning disability team and providing service users with contact information is now also available. The manager had removed the complaints book from the reception area as recommended by the previous inspection for reasons of confidentiality. The manager reported that since the last inspection the home has received one complaint. However discussions held with the manager indicate that the issue may have been better dealt with through the grievance procedure. One compliment, dated 23.06.06 was found recorded in a book held in the reception and stated ‘Every time I have visited Doseley Road, I have always found a warm welcome from Sarah and all her staff and residents…’ Since the last inspection a further referral has been made under the adult protection procedure and a Joint Review Meeting was held on 28.06.06. to discuss the two referrals made under the new provider and previous referrals
199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 18 made under the former registered provider. A further meeting is scheduled shortly. At the previous inspection some staff reported that they had attended adult protection training under the previous provider. The manager confirmed that the four remaining staff are due to attend adult protection training in September 2006. The financial records held on behalf of two service users were reviewed and found an accurate reflection of monies held at the previous inspection and were therefore not reviewed on this occasion. 199 Doseley Road DS0000066727.V305637.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment is improving to provide service users with a homely, clean and safe place to live. EVIDENCE: Seven requirements were made as a result of the previous inspection in relation to environmental outcomes for service users. A full environmental tour of the home was undertaken by both inspectors and a number of improvements noted. The conservatory has been cleared and a new suite purchased providing additional living space to benefit the service users. The former snoozlem and room divider has been been removed and now provides a large lounge which has recently been redecorated in addition to the redecoration of the kitchen and two bathrooms. The manager reported that new carpets for all groundfloor areas have been ordered and are due to be fitted on 31.07.06. A new lounge suite is due to be delivered on 02.08.06. The lawns have been mowed and cleared of some garden equipment although the garden is still in need of tidying up and equipment put away. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 20 A very basic planned programme of maintenance and renewal for the fabric and redecoration of the premises has been developed however this still requires further work, which was acknowledged by the manager. A new bed has been purchased for staff when undertaking sleep-in duties. The Fire Department has not visited the home since the change of provider. Environmental Health Officers visited the home on 07.06.06 and made a number of requirements, which the provider appears to be working towards. An infection control audit has also been undertaken and recommendations made. The manager was also provided with a copy of the Infection Control Guidelines for the Independent Care Sector issued by Shropshire and Staffordshire Health Protection Unit, which also includes guidelines on waste management. During the inspection staff were out purchasing soap and paper hand towel dispensers and waste bins and a staff member was later seen fitting these in all areas requiring them. Plastic fly guards have been fitted above the kitchen doors. Cleaning schedules have been developed and charts to record temperatures of fridge/freezer and food probing are now in place and temperatures recorded. The home was generally found clean with the exception of the hob extractor fan that remains very greasy and a strong offensive odour in the lounge and one bedroom remains evident. Assessments for hazardous substances (COSHH) are now in place and the manager reported that staff will sign to confirm that they have read and understood them. A new cupboard for storing COSHH products has recently been identified. The manager reported that staff will be provided with in-house training on infection control shortly. Hand washing procedures are prominently displayed however the policy for infection control was not readily available. 199 Doseley Road DS0000066727.V305637.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users are supported by a committed staff team who work positively with the people they support and are safeguarded by the recruitment procedures in place. Staff appear happy with the improvements being made however require further opportunities for training, personal development, formal supervision and higher staffing levels to effectively meet the individual needs of the people they support. EVIDENCE: Six requirements were made as a result of the previous inspection in relation to staffing outcomes for service users. Key standard 33 was reviewed at met at the previous inspection and was not reviewed on this occasion. The requirement for the home to have an effective staff team with sufficient numbers to support service users’ assessed needs at all times remains outstanding. The manager reported that six full-time staff are employed and that there is now a minimum of three staff per shift throughout the day. Staff deployment has recently changed with staff now working 2 x 14 hour shifts and 1 x 12 hour shift. It was reported that although staff are working long shifts, more support is now available to provide opportunities for day trips out and staff have four days off a week. Staff on duty considered that six full-time
199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 22 staff was insufficient to support the high needs of the people accommodated and that there continues to be a high level of agency staff used. Under the new registered provider one person (the manager) has been recruited and the personnel file was reviewed by separate appointment at the organisations area office on 21.07.06. The personnel file was well presented and contained the relevant documentation required. It was reported that original CRB disclosures are maintained at the head office although there was evidence from the personnel department that the original document had been seen and disclosure number stated. The area manager reported that an independent advocate and a service users parent was part of the interview panel. The manager has started to develop historical staff training records to assist with in the development of a team training and development plan. Since the last inspection staff have undertaken training in food hygiene and moving and handling. She stated that a number of staff have recently undertaken training in health and safety and that training has been booked for all outstanding staff. No certificates were available for inspection however the manager confirmed that she is awaiting certificates. Staff spoken with confirmed that they had attended some mandatory training however training in fire and infection control remains outstanding. Only one of the three staff spoken with has attended ‘Our Approach’ Dimensions induction training and staff reported that have not been issued with a staff handbook. Staff considered that the team should have received induction training with the new provider by now. One staff member reported that her training is now being updated quite quickly and that Dimensions values are good. The requirement made for staff to receive an annual appraisal and formal supervision 6 times per year remains outstanding. Only one staff out of three spoken with has received a supervision session under the new provider and none of them have received an appraisal. It was reported that the area manager attended a recent staff meeting held on 24.07.06 to address a number of issues within the team. One member of staff stated “Staff morale has improved a little since the last inspection. The team meeting has cleared the air and a number of items brought to the fore that were not being addressed”. 199 Doseley Road DS0000066727.V305637.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management and administration of the home needs to be improved to benefit service users. EVIDENCE: Eight requirements were made as a result of the previous inspection in relation to the conduct and management of the home. Ms Sarah Patten is the manager of the home and was appointed in March 2006. She reported that she has recently submitted her resignation and is due to leave the service on 31.08.06. Following the last inspection Ms Patten has made a number of positive changes and has started to address a number of shortfalls as identified as a result of the previous inspection. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 24 Discussions held with staff indicate that communication between staff and managers could be improved. One member of staff stated “It would be good to see the area manager more frequently”. Visits as required under Regulation 26, continue to be undertaken by the organisation and a report forwarded to CSCI. Since the last inspection reports received identify a number of issues in relation to the environment, staff supervision, staffing and concerns expressed in relation to the high use of agency. The most recent report received for the visit undertaken on 28.07.06 identifies improvements in a number of areas and that the home was tidy but in need of homely touches, which was also evident during this inspection. The manager has not had the opportunity to develop and distribute questionnaires to service users, family, stakeholders etc to seek the views on how the service meets the needs of people accommodated however a timescale of 01.09.06 was set at the previous inspection in addition to the timescale given for an annual development plan. A Regional ‘PATH’ with aims for the forthcoming months has been developed and this was seen displayed in the office. The manager is working towards the requirement made at the previous inspection that all records required by regulation be well-maintained, up to date, accurate and accessible to staff. As evidenced throughout the body of this report a number of records are now available and new service users plans and risk assessments are in the process of being developed. The manager must ensure that staff are made familiar with the location of all records as one staff member was unable to readily access risk assessments. A member of staff stated “Files are getting more organised although communication about where information is stored isn’t very good”. Only key policies are procedures are readily available, and it was reported that others are available on the intranet however there are problems with accessing this as not all staff are computer literate. A requirement was made at the previous inspection for all staff to receive mandatory training in safe working practices. Discussions held with the manager and staff on duty indicate that since the last inspection a number of staff have since attended training on food hygiene, manual handling, health and safety and first aid and the relevant courses booked for outstanding staff. Certificates were not available for inspection however the manager has started to record training on individual staff training records. Training in fire and infection control remains outstanding. As stated in the environmental section of this report a number of improvements have been made and are planned to provide a safer environment for people to live and work, although some garden equipment and clinical waste requires securing. Risk assessment for safe working practices require further development to ensure the safety of service users and staff for example service users travelling in a vehicle. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 25 The Fire Officer has not visited the home since the last inspection and discussions held and observations made indicate that the provider is working towards the requirements made by Environmental Health Officers and recommendations made by the Infection Control Audit Nurse. Records in relation to service maintenance of equipment and appliances were reviewed and found satisfactory at the previous inspection and were therefore not reviewed on this occasion. 199 Doseley Road DS0000066727.V305637.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 x 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 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 x 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 2 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 2 2 2 x 2 2 x 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 27 YES 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 YA1 Regulation 4 Schedule 1 Requirement The registered person must develop a Statement of Purpose for the home (Previous timescale of 17/07/06 not met). The registered person must develop a Service User Guide and provide each service user with a copy (Previous timescale of 17/07/06 not fully met). The registered person must demonstrate the homes capacity to meet the assessed needs of the people accommodated. Timescale for action 18/09/06 2 YA1 5 18/09/06 3 YA3 14 31/08/06 4 YA5 5(c ) The registered person must 18/09/06 develop and agree with each service user and their representative a written contract/statement of terms and conditions between the home and the each individual to include all items specified in NMS 5.2 and each service user be provided with a signed copy (Previous timescale of 17/07/06 not fully met).
DS0000066727.V305637.R01.S.doc Version 5.2 Page 28 199 Doseley Road 5 YA6 15(1)17(1) 6 YA7 12(3) 7 YA9 13(4)(b) 8 YA18 12(1)(b) 9 YA19 12 13(1)(b) 10 YA24 23 The registered person must ensure that there is an individual plan for each service user, (drawn up with the service user/representative and relevant agencies) which sets out how the needs of the individual are to be addressed by the home and provides effective individualised procedures for staff to follow (Previous timescale of 07/07/06 not fully met). The registered person must provide service users with the information, assistance and communication support they need to make decisions about their lives and clearly demonstrate how choices have been made (Previous timescale of 17/07/06 not fully met). Service users must be enabled to take responsible risks within a risk assessed framework, which is a comprehensively recorded and regularly reviewed and updated. Action must be taken to minimise risks and hazards (Previous timescale of 07/07/06 not fully met). The registered person must ensure that service users’ preferences with regard to their care are identified and respected and any aids and adaptations required are maintained in safe working order (Previous timescale of 07/07/06 not fully met). Service users health must be monitored through annual health checks and outcomes recorded (Previous timescale of 07/07/06 not fully met). A planned programme of maintenance and renewal for
DS0000066727.V305637.R01.S.doc 18/09/06 18/09/06 31/08/06 18/09/06 18/09/06 18/09/06 199 Doseley Road Version 5.2 Page 29 11 YA24 23(4)&(5) 16(2)(j) 12 YA30 13(3) 16(2)(j) 13 YA33 18(1)(a) 14 YA35 18(1)(c ) 15 16 17 YA35 YA36 YA37 18(1)(c) 18(1) (c) 8,9 18 YA38 12(5) 19 YA39 24 the fabric and redecoration of the premises must be developed and records kept (Previous timescale of 17/07/06 not fully met). The premises must meet the requirements of the environmental health department and fire department. Policies and procedures for the control of infection to include the safe handling and disposal of clinical waste; dealing with spillages must be available and adhered to. The home must have an effective staff team with sufficient numbers to support service users’ assessed needs at all times and kept under review. A training needs assessment must be carried out for the whole team and a staff training and development plan developed. Staff must receive induction and equal opportunity training. Staff must receive an annual appraisal and formal supervision 6 times per year. An application to register an experienced and skilled manager must be submitted to CSCI. The management approach of the home must create an open, positive and inclusive atmosphere with a clear sense of direction and leadership. An effective quality assurance system must be developed in addition to seeking the views of service users/relatives and significant others and results published (previous timescale given brought forward).
DS0000066727.V305637.R01.S.doc 31/08/06 31/08/06 18/09/06 18/09/06 18/09/06 01/09/06 01/10/06 31/08/06 01/09/06 199 Doseley Road Version 5.2 Page 30 20 YA39 24 21 YA41 17 22 YA42 13 (6) 23 (4) (d) 23 YA42 12,13 An annual development plan for the home must be developed (previous timescale given brought forward). The registered person must ensure that all records required by regulation are well maintained, up to date, accurate, accessible to staff and available for inspection (Previous timescale of 07/07/06 not fully met). All staff must receive mandatory training relating to safe working practices and these be updated at the required frequency (previous timescale of 01/08/06 partially met). Risk assessments must be carried out for all safe working practices and staff made familiar with these (Previous timescale of 07/07/06 not fully met). 01/09/06 31/08/06 18/09/06 31/08/06 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 Refer to Standard YA7 YA9 YA20 Good Practice Recommendations It is recommended that the use of a gate on a service users bedroom be reviewed, based on a risk assessment, as it restricts the persons freedom of movement. It is recommended that risk assessments for service users be retained on their own file with their support plan. It is recommended that medication procedures be more closely monitored. 199 Doseley Road DS0000066727.V305637.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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