Inspection on 08/01/07 for 1-3 Robin Close

This inspection was carried out on 8th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-3 Robin Close 14/12/09

1-3 Robin Close 09/11/07

1-3 Robin Close 13/04/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 2-3 Robin Close Westbury On Trym Bristol BS10 6JG Lead Inspector Sandra Gibson Key Unannounced Inspection 8 and 9th January 2007 09:30 th 2-3 Robin Close DS0000063643.V319733.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 2-3 Robin Close DS0000063643.V319733.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. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 2-3 Robin Close Address Westbury On Trym Bristol BS10 6JG 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) 0117 9494942 www.unitedresponse.org.uk United Response Mr Simon Charles Phillimore Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (2) of places 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 7 persons aged between 18-65 with learning disabilities May accommodate 2 named persons aged over 65 with learning disabilities Planned alterations to House Number 3 will be completed by the end of November 2006 Planned alterations to House Number 2 will be completed by the end of April 2007 13th April 2006 Date of last inspection Brief Description of the Service: Numbers 2 and 3 Robin Close provide placement for 7 people, three in number 3 and four in number 2. Both properties are identical, are two storey and are approximately 15 years old. Until July 2005, the properties were owned and run by the National Health Service. At this point, the houses transferred to Golden Lane Housing Association with the care services being provided by United Response, a Chippenham-based service. Number 1 Robin Close remains with the NHS. The properties are located within their own gardens but these are currently under-developed. The home offers placement to both male and female residents aged between 18-65 years with a learning disability. The Primary Health Care Trust pays for the current residents to live at the house. Extra charges are made for chiropody, hairdressing, toiletries etc. This information is provided in the service users’ guide. United Response has produced a Statement of Purpose and this will inform any prospective residents about their service. This is the second inspection of the service since it registered with The Commission for Social Care Inspection in 2005. 2-3 Robin Close DS0000063643.V319733.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 conducted midweek which took place over two days between the hours of 11am and 4pm and 10am and 12.30pm. Evidence was gathered from: Examining previous correspondence with the home including Regulation 37 (Death, illness, other events notifications), inspection reports, information from pre-inspection questionnaire, relatives comment cards (1), observing residents, talking to the manager and nominated responsible individual, talking to and observing staff, case tracking two residents, examining records, policies and procedures. What the service does well: What has improved since the last inspection? Information produced about the home has improved considerably since the last inspection. The information in place will now enable any future resident or their representative, to make an informed choice about moving to the home and that current residents are fully aware of their rights and how to raise any concerns they may have. The opportunities, for each resident to develop to their full potential have improved slightly since the last inspection following the reassessment of residents’ individual needs. Individual residents currently enjoy a small range of activities. This range of activities must be developed further so that all residents are supported to live as fulfilling life as possible both in and out of the home. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 6 The home’s assessment processes have improved considerably since the last inspection. The system in place now ensures that residents will be looked after as they wish and get the care they need. Following the last inspection there have been considerable improvements in the care planning system. However further development is required to ensure that all aspects of personal, social and healthcare needs are met and that residents’ health and safety is promoted at all times. Following the last inspection there have been improvements in the medication administration system and practice. The system in place now ensures that residents and staff are fully protected. Following the last inspection there are now strategies in place to enable the residents and their representatives to raise concerns, be listened to and have their concerns acted upon. Following the last inspection methods of finding out residents and their representatives ’ views are in the process of being set up. This information will ensure that the home is run in the best interests of residents. What they could do better: The safety and comfort of the home has deteriorated since the last inspection. Planned changes to the living arrangements have become more urgent. These changes will provide residents them with a safer and more comfortable physical environment that will meet their individual needs. Due to the delay in the arrangements for the refurbishment work to take place, this home is currently in breach of the registration conditions laid down when the home was registered by The Commission for Social Care Inspection in July 2005. Evidence confirmed that arrangements are in place for this work to take place in the next few months. Consequently enforcement action will not take place at this time. However any further delay may result in enforcement action in the future. The majority of the staff team are, on the whole, skilled and knowledgeable and therefore residents can expect to be well cared for. However opportunities for staff to develop further are not satisfactory. Opportunities to pursue appropriate vocational training must be provided to ensure that all staff are fully competent to meet residents individual needs 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 7 Support to care staff is not satisfactory. There has been deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staffs that are appropriately supervised. The system in place to promote the health safety and welfare of residents and staff has improved since the last inspection. However, minor improvement is necessary to ensure that all staff are adequately trained in fire safety. 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. 2-3 Robin Close DS0000063643.V319733.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 2-3 Robin Close DS0000063643.V319733.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information produced about the home has improved considerably since the last inspection. The information in place will now enable any future resident or their representative, to make an informed choice about moving to the home and that current residents are fully aware of their rights and how to raise any concerns they may have. The home’s assessment processes have improved considerably since the last inspection. The system in place now ensures that residents will be looked after as they wish and get the care they need. EVIDENCE: The home has a statement of purpose, which has been updated since the last inspection. The manager explained that this document is under review as the home is undergoing major refurbishment work in the next few months, which will improve current residents quality of life. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 10 There is now a service users guide in place. This information is currently in draft form. However, it has been compiled using plain English and is in a picture format. Other formats are also available. The manager explained that minor adjustments are to be made and until this work has taken place current residents or their representatives have not been provided with this information. Evidence in place confirmed that this information is to be provided once these adjustments have been made during the next few weeks Following the last inspection the manager informed the inspector that all residents needs have been reassessed by the United Response staff team. Two residents files were examined. Evidence confirmed that a full reassessment of needs had taken place for both residents. The needs assessment documentation is currently under review with The Commission for Social Care Inspection to ensure that it fully meets the National Minimum Standards. The manager confirmed the proposed admission procedures that would be followed in the case of a vacancy becoming available – this would involve the gathering of information from family, healthcare and social care professionals, and the homes needs assessment. Prior to admission to the home a number of transitional visits would be arranged, so that compatibility with the other residents is measured. This may initially be a “meal time” visit, increasing to a number of hours, to a sleepover and then a weekend stay. 2-3 Robin Close DS0000063643.V319733.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. 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. Following the last inspection there have been considerable improvements in the care planning system. However further development is required to ensure that all aspects of personal, social and healthcare needs are met and that residents’ health and safety is promoted at all times. Confidentiality safeguards are in place, which safeguards resident’s interests. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 12 EVIDENCE: Two of the residents’ files were looked at and evidence indicated that following the recent reassessments of needs staff were now in the process of compiling detailed care plans which are called “My Plan”. Evidence confirmed that these care plans are currently being developed for all residents from the new needs assessments, previous background information and that residents and their representatives / health care professionals are involved where possible. Discussion with the manager and some of the care staff confirmed that the permanent staff team have an in-depth knowledge of the individual resident’s care needs and the social and life style support required for individual residents to take risks as part of an independent lifestyle. Three residents accommodated have sensory impairments however, there was no evidence of specialist training provided to staff. This needs to be addressed by the management team. The home have on file, a number of risk assessments for each of the residents, and evidence confirmed that these have improved following the recent completion of needs assessments and the commencement of the new care planning processes. Evidence confirmed that staff were reading residents individual risk assessments. However, there was no evidence to confirm that formal reviews of care plans or risk assessments taking place. Evidence confirmed that arrangements are in place to safe guard residents’ confidential information with in the home. A copy of the confidentiality policy was also seen. This information is in the process of being provided to residents and their representatives. It is written in plain English and is in a pictorial format. During the inspection staff demonstrated how they respected individual residents rights for privacy and confidentiality. One relatives’ survey received confirmed that resident’s confidentiality was respected. 2-3 Robin Close DS0000063643.V319733.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The opportunities, for each resident to develop to their full potential have improved slightly since the last inspection following the reassessment of residents’ individual needs. Individual residents currently enjoy a small range of activities. This range of activities must be developed further so that all residents are supported to live as fulfilling life as possible both in and out of the home. Visitors are made very welcome and meals are satisfactorily managed and provide daily variation, and good nutrition for people. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 14 EVIDENCE: None of the current residents attend any educational courses or engage in any occupation. However, following the recent reassessment of all the residents’ individual needs evidence confirmed that residents and their representatives are now beginning to be consulted about skills they would like to develop. One resident attends local authority day services each weekday but at other times any activities are arranged on an “ad-hoc” basis and are dependent upon staff and transport availability. Another resident attends Brandon Trust day centre The other residents have minimal Activity Plans – two hours day care twice a week. Whilst the residents do use some of the community facilities such as outings to pubs, local shops and the public library so far there is very little opportunity for them to participate in any new experiences. Residents are encouraged and assisted to pursue their own interests and hobbies such as cooking, making puzzles, keeping scrapbooks etc where these have already been identified. Some residents enjoy aromatherapy, which is provided in the home, and others have access to a hydrotherapy pool. Evidence confirmed that following the last inspection each resident has a meaningful plan of weekly activities that they have chosen to participate in. As discussed at the last inspection the manager is fully aware of the need to address this shortfall and sees this as a priority, in order to enhance the lives of the residents. Residents are encouraged to maintain contact with family, and staff will assist with making any of the necessary arrangements. Residents are consulted before anyone goes into their private room – each room is lockable and the resident is able to choose whether to have a key or not. Residents were observed moving about in the home independently and staff were conversing with them appropriately. The residents in one of the houses need to have 1:1 support during mealtimes. The home has a well-balanced four-week menu plan. No choices are recorded at each mealtime, however residents can have an alternative if necessary. There is no record kept of food offered to evidence this. Due to the communication difficulties of the residents, it was not possible to obtain their views on the meals they are provided with, or to ascertain whether they have been involved in deciding what meals are prepared. 2-3 Robin Close DS0000063643.V319733.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. Residents receive adequate help with their physical and emotional health needs, they are monitored effectively and action is taken promptly when concerns arise so that residents may be confident that their needs will be met. Following the last inspection there have been improvements in the medication administration system and practice. The system in place now ensures that residents and staff are fully protected. EVIDENCE: The manager and staff team demonstrated a working knowledge of the resident’s specific healthcare and personal needs. All residents are registered with the same GP and psychiatrist (people with learning difficulties). The doctor visits the home on a weekly basis and liaises with other health professionals as required 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 16 The manager explained that these arrangements are part of the agreement between United Response and the Primary Care Trust. Evidence confirmed that residents have access to health professionals such as opticians, chiropodist and dentists as needed and that staff support individual residents to attend appointments including hospital appointments as necessary. Evidence confirmed that the residents are able to get up and retire to bed, at their preferred time. Five of the seven residents were observed, at different times of the day moving about the home, or being given guidance where necessary. The residents were each well dressed and looked clean and well cared for. When required, they were helped to change their clothing. This activity was done in a discreet manner by the staff involved. The home keeps a record when healthcare professionals are consulted about the health of the residents. Prior to the last inspection the homes medication procedures had given great cause for concern and the CSCI pharmacist visited the home to carry out an inspection and advise the manager. Evidence confirmed that strategies have now been put in place to increase the number of medication audits (now done each evening) and reduce the number of staff who administer medicines. Evidence confirmed that staff involved in medication administration have received training in safe medication administration and that additional training is also planned for the future. 2-3 Robin Close DS0000063643.V319733.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 good procedures are in place to safeguard residents from harm. Following the last inspection there are now strategies in place to enable the residents and their representatives to raise concerns, be listened to and have their concerns acted upon. EVIDENCE: The home has a complaints procedure in pictorial format, but as the residents are not currently provided with a service users guide, they are not issued with a copy of this procedure. Following the last inspection evidence confirmed that the home now display a copy of the procedure, in a visible area within the premises, to act as a reminder for the residents and their representatives. However, it was noted that one survey response received from a relative stated that they were not aware of the complaints procedure Also, as previously stated three of the residents have sensory impairments and due to the level of the resident’ s individual learning disabilities and communication needs, those spoken with during the course of the inspection, were not able to state that their views would be listened to and acted upon. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 18 The manager demonstrated how the staff team are starting to put strategies in place to ensure that the resident’s wishes and views are sought, in a meaningful way for each individual. Evidence confirmed that the manager makes arrangement to pursue any concerns raised by resident’s representatives. There has been one complaint since the last inspection, which was followed up appropriately as an adult protection investigation. The manager has already demonstrated his ability in ensuring that the residents are protected from abuse, harm or neglect. Prior to the last inspection a significant number of incidences of physical aggression and verbal assaults, occurred between the residents. The manager increased staffing levels, and followed “No Secrets” procedures by involving appropriate local authority personnel. Staff confirmed that they have had training in adult protection issues, and the homes training programme evidenced that the whole staff team have either had, or will have training, in the near future. 2-3 Robin Close DS0000063643.V319733.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): 24,25,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The safety and comfort of the home has deteriorated since the last inspection. Planned changes to the living arrangements have become more urgent. These changes will provide residents them with a safer and more comfortable physical environment that will meet their individual needs. EVIDENCE: Number 2 Robin Close is home for four people. Two of the bedrooms are on the top floor and two are on the ground floor, along with a large lounge, a smaller quiet room, a dining room, a games room, the kitchen and utility area. There is one bathroom and a separate toilet on each floor. A staircase is the only route between the two floors; therefore the home is not fully accessible to anyone with mobility impairment. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 20 Number 3 is home for three people. The building is identical in its facilities however only one person is accommodated on the first floor. Plans are in place for both homes to be refurbished. During the last inspection work was expected to commence in number 3 at the end of the summer2006 and once that work was completed the work in number 2 would commence. The manager explained that this work has been delayed but arrangements are now in place for the work to commence in number 3 in February 2007. Number 3 will be converted to 3 self-contained flats, whilst number 2 will have four bedrooms with ensuite facilities of either a bath or shower unit. These changes will enhance the environment for the residents and also ensure that the home meets the national minimum standards. Due to the delay in the arrangements for the refurbishment work to take place this home is currently in breach of the registration conditions laid down when the home was registered by The Commission for Social Care Inspection in July 2005 Evidence confirmed that arrangements are in place for this work to take place in the next few months. Consequently enforcement action will not take place at this time. However any further delay may result in enforcement action in the future. During the last inspection evidence confirmed that both homes were nicely furnished, well decorated, kept clean and tidy and free from any offensive odours. Information confirmed that all furniture was of a robust design, and electrical items were secured in cabinets. The home also made arrangements for any repairs to furniture, or other environmental damage, as necessary and as promptly as possible. During this key inspection evidenced confirmed that number 3 had sustained a high level of wear and tear particularly of bedroom furniture and that some of the bedroom floors were in need of attention as a result of residents continence needs. Radiators also were in need of attention in respect of covers in place. The manager confirmed that no residents entered any rooms independently where radiators had no safety covers in place and this work will be attended to during the refurbishment. All resident’s bedrooms in number 3 were viewed – each reflected the person’s own personality. The manager explained that where appropriate, the residents will be involved in the “re-designed” of their bedrooms and ensuite facilities. Although the home is primarily for residents with a learning disability, it also cares for those with physical disability. One bathroom is fitted with grab rails to aid a resident and a ramp has been fitted by the patio doors in the lounge to enable access out into the garden. The home currently does not have a call alarm system, however a sophisticated system will be installed in the home, as parts of the works, so that staff can summon help in an emergency. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 21 This will be particularly important in number 3 where the resident and staff member will eventually be working within a closed environment. Each staff member will have a “panic alarm” on their person whenever they are on duty. Each house has a utility room housing a washing machine and tumble dryer plus housekeeping equipment. The manager plans to replace the one domestic washing machine with an industrial model. The residents’ washing is attended to individually and this is good practice. Residents have access to large gardens at the rear of the two houses, which are secure. Unfortunately, they were both observed to be spoilt by litter and debris. The front of the houses were also found to be spoilt by litter and the driveway to number 2 was submerged in water. The inspector was informed by staff that this was due to drainage problems between the two houses, which are going to be addressed in the refurbishment. Arrangements are in place for residents to be accommodated in another suitable registered home on a temporary basis whilst the work is carried out. The Commission will monitor these arrangements for social care Inspection. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 22 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): 30,31,32,33,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The majority of the staff team are on the whole skilled and knowledgeable and therefore residents can expect to be well cared for. However opportunities for staff to develop further are not satisfactory. Opportunities to pursue appropriate vocational training must be provided to ensure that all staff are fully competent to meet residents individual needs Support to care staff is not satisfactory. There has been deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staffs that are appropriately supervised. EVIDENCE: The existing staff team have transferred from NHS employment under protected terms and conditions of service, but a number of new recruits have joined the team. As highlighted at the last inspection the home is using some agency staff to fill some shifts but are actively trying to reduce this usage. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 23 The manager stated that where possible, they use agency staff who know the home and the residents. An agency member of staff seen during the inspection stated that she did regular shifts at the home and explained how she was getting to know the individual residents. The manager has identified the need for more staff to complete the team, and recruitment is already underway. The service manager who was present during part of the inspection confirmed this information and stated that a recruitment day was planned in Bristol. Discussions with some staff members and observations of their practice evidenced that they are knowledgeable of the resident’s specific needs and have the necessary skills to be able to meet them. The decisions they make about the care of a resident, on a day-to-day basis, is based on the long-term relationship, they have already formed. As discussed at the last inspection the majority of the support workers have already attained an NVQ Level 3 in care, but this has been achieved within a healthcare setting. United Response need to look to provide additional training to ensure staff skills are transferred to a social care environment. Some staff indicated that they had not had the opportunity to complete the NVQ level 3 as planned due to the change in employer. Staff said that they felt frustrated that support had not been provided to complete this vocational qualification. However discussion with the management team confirmed that arrangements were being made by United Response for NVQ training to be pursued as soon as possible for all staff. The manager described the staffing levels he has put in place following the last inspection. Evidence confirmed that these arrangements ensure that two staff can take one residents out and still leave sufficient numbers of staff to provide one to one support for any residents left at home. Over night there are two members of waking staff in each house, and their shifts commence at 9pm. One member of staff works also works a shift, which starts at 4pm and finishes at 11pm in number 3. The home follows robust recruitment procedures and ensures that the right people are employed at the home. New staff will complete a Learning Disability Award Framework (LDAF) induction programme at the start of employment and evidence was seen of this having been achieved within 8 weeks of employment for one person. Following completion of this, a foundation course will be started. These arrangements will ensure that all new staff will have the necessary skills and attributes to meet the resident’s needs. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 24 Evidence confirmed that the manager is in the process of arranging for all staff to have an annual appraisal, in which their training and development needs will be identified and incorporated into the homes training plan. Staff supervision is in the process of being arranged for the whole staff team and is shared by the deputy and the manager. Staff supervision is currently no taking place as frequently as it should do 2-3 Robin Close DS0000063643.V319733.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): 37,38,39,40,41,42,43 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has strong leadership and is well run. Following the last inspection methods of finding out residents and their representatives ’ views are in the process of being set up. This information will ensure that the home is run in the best interests of residents. The system in place to promote the health safety and welfare of residents and staff has improved since the last inspection. However, minor improvement is necessary to ensure that all staff are adequately trained in fire safety. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager was present during the inspection visit, cooperated in the process and demonstrated good awareness of the homes procedures and the resident’s needs. He has been in post since the home transferred from NHS retained services to being a Care Home, and has successfully completed the registration process with CSCI. He has previous experience of home management within a United Response social care setting. As discussed at the last inspection his main aim at the current time, whilst continuing to ensure that the residents get the care they need, is to lead the staff team through a period of significant change, to assist in the tenderingfor-works process, and then the subsequent relocation of the residents whilst building works are underway. He is currently undertaking the NVQ Level 4 Registered Managers Award but is unable to say when this will be completed, due to the impending changes. It is part of United Response’s means of assessing their home manager’s performance, that they be appraised, by both senior management and the staff team. Once again the staff spoken with during the inspection were positive about the changes the manager is bringing about in the home and felt he provided a clear sense of leadership, but valued their in-depth knowledge of the individual residents. The home has one deputy manager who is responsible for number 2, and recruitment for a deputy for number 3 is underway. There is currently an acting deputy for number 3. Evidence confirmed that both deputies support the manager Staff meetings are held on a monthly basis. However as discussed in the previous section on staffing evidence confirmed that one to one supervision is not happening as recommended in the National Minimum Standards. One the second day of the inspection the nominated responsible individual was interviewed as part of the inspection. During the discussion this senior manager from United Response demonstrated how the home are in the process of putting in place mechanisms to capture the views and opinions of the residents, or their relatives and any other representatives. As discussed at the last inspection the development of the service has so far been restricted to the changes to the internal arrangements of the houses. However, during this inspection evidence confirmed that the service are now planning to have an effective quality assurance and monitoring system, so they are able to measure their success in achieving the aims and objectives, and statement of purpose of the home. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 27 The nominated responsible individual visits the home at least monthly and carries out an audit (Regulation 26). These reports are sent to The Commission for Social Care Inspection on a regular basis. The organisation have in place polices and procedures to safeguard and protect the health and well being of the residents. Evidence confirmed that staff team inform The Commission for Social Care Inspection in respect of any significant events that affect the well being of the residents. Evidence confirmed that there have been improvements in the maintenance of the homes records including those kept in respect of each resident. Staff personnel records evidenced a robust recruitment procedure for newly appointed staff. A training file is not kept for each staff member that evidences their qualifications and shows the training courses attended. Some of the Health and safety records in the home were examined. Documentation showed that the majority of relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment, emergency lighting. However, it was observed that although fire safety training takes place on a regular basis it is not frequent as recommended by the Avon Fire Brigade for staff that are involved in night duties. There is also an up to date fire risk assessment in place, which is reviewed on a regular basis. 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 28 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 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 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 3 3 3 3 3 2 3 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Timescale for action 09/03/07 2 YA13 16(2) 3 YA24 23(2)(b) Formal reviews of care plans and risk assessments must take place on a regular basis. This review must take place in consultation with the service user/and their representative where appropriate The range of activities and social 09/04/07 opportunities the residents are supported to engage in must be kept under constant review and developed further following consultation with residents and their representatives As part of the planned 09/07/07 refurbishment of house number 2 and number 3 arrangement must be put in place to improve the safety and comfort of the exterior of both homes: • Improved drainage to prevent the flooding of both driveways • All rubbish and debris must be removed from the front and rear gardens 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 30 4 YA32 19 5 6 YA36 YA42 18(2) 23(4)(d) Staff working in the home must have the qualifications suitable to the work that they have to perform and the skills and experience necessary for such work • For example on each shift, 50 of Care staff including agency staff must have obtained NVQ2 Arrangements must be in place for all staff to be appropriately supervised Arrangements must be put in place for all night staff to be provided with three monthly fire safety training as recommended by Avon Fire Brigade 09/12/07 09/05/07 09/04/07 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 Refer to Standard YA6 YA36 Good Practice Recommendations All staff would benefit from specialist training for example working with people with a sensory impairment All staff should have regular recorded supervision meetings at least six times a year 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 2-3 Robin Close DS0000063643.V319733.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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