Inspection on 20/06/06 for 2 Littlefield Gardens

This inspection was carried out on 20th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 Littlefield Gardens 17/11/06

2 Littlefield Gardens 15/06/05

2 Littlefield Gardens 14/12/04

2 Littlefield Gardens 02/08/04

Similar services:

Lyncol House

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Littlefield Gardens (2) 2 Littlefield Gardens Ash Guildford Surrey GU12 6LN Lead Inspector Sandra Holland Unannounced Inspection 20th June 2006 10:20 Littlefield Gardens (2) DS0000013462.V295479.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 Littlefield Gardens (2) DS0000013462.V295479.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. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littlefield Gardens (2) Address 2 Littlefield Gardens Ash Guildford Surrey GU12 6LN 01252 318968 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) Atlas Project Team Limited To be confirmed Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be 30 - 50 years 22nd November 2005 Date of last inspection Brief Description of the Service: Littlefield Gardens is a small care home accommodating three service users who have learning disabilities and whose behaviour is challenging, and are aged between 30 and 50 years. The home is situated in quiet residential cul-de-sac in Ash, near Guildford. It is managed and staffed by Atlas Project Team. T.A.C.T. (Thames and Chiltern Housing Association owns and manages the property). The building is single storey and comprises a communal lounge, dining area, kitchen and bathroom. There are three single bedrooms, one with an en-suite bathroom and a Snoozelam, relaxation room. Externally there is an enclosed rear garden with small patio and a garage to the front, which is used mainly for storage. A limited amount of parking space is available on the driveway and to the front of the property. The home is close to local amenities, including shops, library and pub and is well served by public transport. The fees at the home range from £1708.29 per week to £2688.31 per week. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first “key” inspection to be carried out in the Commission for Social Care Inspection (CSCI) year, April 2006 to June 2007, and was carried out under the CSCI’s Inspecting for Better Lives programme. As the inspection was unannounced, no-one at the home was aware that it was to take place. Mrs Sandra Holland, Lead Inspector for the service and Ms Marianne Barham, Regulation Inspector, carried out the inspection over five hours. Mr Brian Davies, Claire Heath and Emma Partridge, House Supervisors were present representing the service and were able to provide most of the required information, in the absence of the deputy manager. As no management staff were present at the time of the inspection, it was not possible to review staff files. A follow up visit was made to the home on 12th July 2006, by Mrs Sandra Holland and the staff files were seen. Mrs Penny Davey, Regional Manager providing management cover at the home was present. All areas of the premises were seen and a number of records and documents were examined, including service user’s individual plans, medication administration records (MAR), service user financial records and policies and procedures. A pre-inspection questionnaire was supplied to the service and this was completed and returned to CSCI within the requested timescale. Some of the information from the questionnaire will be referred to in this report. The inspectors met with all three service users. As the inspectors do not share the communication methods of some of the service users, their responses were assessed by observation of their facial expression and body language. The inspectors thanks the service users and staff for their hospitality, time and assistance. A meeting was held prior to the inspection with the providers of the service at Littlefield Gardens. This was arranged to discuss long-standing issues relating to the management of the service and requirements from previous inspections. Mrs Stephanie Long, CSCI Provider Relationship Manager (PRM), Mr Raj Gokhool, CSCI Regulation Manager and Mrs Sandra Holland were also present at the meeting. What the service does well: Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 6 It is clear that the service users are supported in an individual and person centred way and that their very specific needs are met. The service user’s individual plans contain a very comprehensive and detailed amount of information, which has been regularly reviewed and clearly records outcomes for service users. These provide staff with excellent guidance as to the support needs of the service users. A wide range of assessments of risks to service users have been carried out, to enable service users to be as independent as possible. Service users are supported to be actively involved in their local community. The home is attractively decorated, well maintained and presents as a comfortable place in which to live. Service users are supported to maintain contact with their families. The specific nutritional needs of one service user are very effectively met and monitored and staff are to be commended for their commitment and dedication to this. What has improved since the last inspection? What they could do better: Where service users have limited communication skills and are not able to understand the service users guide, it is recommended that this is supplied to their representative on their behalf. Copies of the contracts stating the arrangements for service users to be accommodated must be made available in the home, to ensure service users (or their representatives) are made aware of the full terms and conditions of their residence. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 7 The complaints policy needs to be made suited to the needs of service users with learning disabilities and supplied to service users representatives on their behalf. A manager must be appointed and the name of the person must be provided to CSCI within the 28 day timescale agreed. The person appointed to be the manager at the home must submit an application for registration with CSCI within the three month timescale agreed. The results of any quality survey carried out at the home must be made available to service users and be supplied to CSCI. Policies and procedures must be reviewed and revised and kept up to date. 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. Littlefield Gardens (2) DS0000013462.V295479.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 Littlefield Gardens (2) DS0000013462.V295479.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, 2 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are fully assessed prior to admission to the home. Statements of the terms and conditions for living at the home need to be made available. EVIDENCE: Staff advised that service user guides are held for each service user but these have not been supplied to any of the service users as they have limited understanding and would not be able to read them. It is recommended as good practice, and in the interests of openness, that the service user’s guide is provided to the service users’ representatives. It would also be good practice to ask them to sign to show they have received it on behalf of the service user. This would clearly indicate that the service user’s representatives have been involved in the support of service users and are fully aware of all aspects of their relative’s residence at the home. The staff stated that the three service users have lived together at the home for a number of years and no vacancies have occurred recently. The current service users are all supported financially by local authorities and were assessed under the care management process, prior to their admission. Staff advised that any prospective service users would be very thoroughly assessed to ensure that their needs and personalities were compatible with the current service users. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 10 A requirement was made at the inspection carried out on 22nd November 2005 that the as the service users are supported financially by local authorities, copies of the agreement with the appropriate authority must obtained and held in the home, to be included in the service user’s guide. A timescale of 20th January 2006 was given and this has not been met. The providers stated at the meeting referred to in the summary, that local authority agreements are held at the organisation’s head office. This requirement has been carried forward to enable the providers to supply copies to the home. Littlefield Gardens (2) DS0000013462.V295479.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 good. This judgement has been made using available evidence including a visit to this service. The assessed and changing needs and personal goals of service users are reflected in their individual plans. Service users are supported to make decisions about their lives and are supported to take risks to enable them to be as independent as possible. EVIDENCE: From the individual plans seen, it was clear that these are person centred, contain all the information required to guide staff to service users’ needs, are clearly written and record the aspirations and goals of the service users. The record keeping was of a high standard, the plans had been continually reviewed and recorded outcomes for the service users. Effective systems are in place to monitor all aspects of the individual plan. Monthly and annual reviews had been carried out by the staff at the home in addition to the annual reviews carried out by care management. It was pleasing to see the detailed report produced for the home’s annual review, which covered all aspects of the service user’s life, including changes to Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 12 assessed needs and progress made to meeting goals. The review recorded the actions in place to meet service users needs and the resources required to meet these. An effective record is also maintained and included in the individual plan, of the support needs and information that would be required in the event that a service user is to be admitted to hospital. Staff advised that service users are supported to make decisions, using their communication boards and by offering choices. Staff have recorded, and are aware of, service user preferences and these are taken into account when assisting service users to decide on social activities for example. The assessments of risks to service users were of good quality, very thorough and provided guidance to staff on managing risks and clear reasoning if risks were not to be taken. Those seen included the risks involved in personal care and bathing, various types of travel, self medication, using the kitchen, holidays and absconding. Littlefield Gardens (2) DS0000013462.V295479.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, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in appropriate activities and are part of their local community. Support is provided to enable service users to maintain contact with their family and friends. A healthy and well balanced diet is offered. EVIDENCE: From speaking to service users and from the information in the pre-inspection questionnaire, it was clear that service users are supported to take part in a wide range of activities and are actively encouraged to be part of their local community. One service user spoke of going for a walk and another spoke of enjoying art work and had artwork displayed in her bedroom. Weekly activity planners are maintained and these indicated that service users go the cinema, shopping, bowling and swimming as well as time spent assisting with household tasks. During the course of the inspection, service users were involved with sorting and folding clothes that had been washed. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 14 Staff advised that service users also attend classes locally to develop computer skills and to enjoy activities including pottery, art and line dancing. The home has a Snoozelem sensory room which service users enjoy for relaxation. This provides a comfortable place to sit or lie, and has a selection of coloured lighting arrangements, soothing music and displays relaxing images on the walls. Aromatherapy sessions are also provided staff advised. Records seen showed that service users had been to local places of interest for days out, including to a steam railway and to coastal resorts. Staff advised that very detailed daily records are maintained and these were seen to record all types of service user activity throughout the day. Monthly activity and progress reviews are used to monitor the frequency of service user activities. These include the day to day involvement in the running of the home, to ensure that service users take part in a full range of activities and no activity is too repetitive. A record is also maintained of service users’ contact with their friends and families and it was pleasing to see that a named selection of photographs of people important to the service users, and their relationship to them, were kept in their individual plans. This enables staff to look through them with service users and discuss those pictured. All three service users have contact with their families to varying degrees staff advised. Two service users make visits their families and one service user has occasional family visits to the home. Families are encouraged to be involved in the support of service users staff stated, and a care management review has been postponed for one service users to ensure the family could attend. From the pre-inspection questionnaire, it was seen that the meals provided are of the service users’ choice and at a time that suits them. Individual plans were seen to include a record of service users’ dietary likes, dislikes and needs. Two service users are able to assist in the preparation of their meals and assessments of any risks involved have been carried out. One service user has very specific dietary needs and these are met with the regular support of the dietician. Staff are to be commended for the dedication and commitment provided to meet these needs, which are frequently very challenging. The service users’ nutritional needs are monitored extremely closely to ensure that they are fully met. It was pleasing to see that staff were even able to meet this service user’s dietary needs at the beach, on a recent outing to the coast. Littlefield Gardens (2) DS0000013462.V295479.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 good. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way that they prefer and their healthcare needs are well met. The system of medication administration is being changed to safeguard service users. EVIDENCE: Staff were observed to interact with service users in an informal but appropriate manner, to offer choices and to give service users time to decide and respond. Service users preferences and their privacy were respected. The service user group and the staff group are of mixed gender and service users’ preferences regarding personal care are accommodated wherever possible. The cultural and racial background of the service users is reflected in the staff team. It was noted that service users’ individual plans very clearly stated the service users’ preferred daily routines. Staff advised that a key-worker system is used to ensure continuity of support for service users. From the individual plans, it was clear that service users’ healthcare needs are very well met and a number of healthcare professionals are involved in the support of service users, including their general practitioner (GP), community nurse, dietician, dentist and clinical psychologist. Other specialists are Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 16 accessed through the GP service if required, such as the chiropodist, community psychiatric nurse (CPN) or audiologist. It was pleasing to see that specialists involved in the support of service users, including their care manager and clinical behaviour specialist attended the care management review. Staff stated that medication is currently supplied by a local pharmacy in filled “dossett” boxes. These are divided boxes, with sections for differing times of day in which the pharmacist places the appropriate medications, but these sections are not individually sealed. These are supplied to the home on a weekly basis with a medication administration record (MAR) sheet, which records one month’s administration. Staff advised however, that from next month medication will be supplied by a new pharmacy using a monitored dosage system, as weaknesses have been identified in the current system. It was noted that for two service users, one dose of medication each, was not present and for another service user one extra dose appeared to be present. A requirement has not been made regarding medication administration as the home has already made arrangements to change the system in use, to better safeguard service users and staff. A requirement has been made at Standard 40 which refers to policies and procedures which need to be reviewed as the medication procedure is included. Littlefield Gardens (2) DS0000013462.V295479.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 good. This judgement has been made using available evidence including a visit to this service. Complaints have been appropriately managed. Staff are aware of their responsibilities in the protection of service users, but need to develop their knowledge regarding local procedures. EVIDENCE: Staff stated that as service users have limited verbal communications, they are not able to directly inform staff or others, if they are unhappy or wish to make a complaint. Service users are observed closely for changes in behaviour, which may indicate that they were unhappy and appropriate action would be taken. In these circumstances, it is strongly recommended that the representative of each service user, is provided with the complaints procedure, on behalf of the service user. It is also recommended that the complaints procedure is reviewed, as the wording is not suited to the needs of people with learning disabilities. Currently the complaints procedure is only available in a written format, which is not suited to the needs of service users with learning disabilities. A requirement was made at the inspection carried out on 22nd November 2005 that the complaints procedure must be appropriate to the needs of service users. A timescale of 24th February 2006 was given and this has not been met. The pre-inspection questionnaire recorded that two complaints had been received during the last year. The complaints record was seen and these complaints had been responded to and dealt with appropriately and a record of the actions taken was made. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 18 In discussion with staff, they made it clear that they would report any concerns they had about the abuse or potential abuse of service users, directly to the person in charge. Staff also advised that they could report any concerns to the regional manager who visits the home on a regular basis. Staff advised that they had received training in the safeguarding of adults and the home has recently obtained an updated version of the Surrey Multi-Agency Procedure for the Protection of Vulnerable Adults. It is strongly recommended that all staff are made fully aware of this procedure, as in discussion with them it appeared that they were not familiar with the policy or the requirement to notify social services or CSCI, in the event of any incident of abuse or suspected abuse. The home’s policy on abuse, referred to as a protocol on “Reporting abuse” was seen on the day of inspection and needs to be reviewed and revised. It states that “if any member of staff becomes aware that a person in our care is being abused they must immediately make a complaint to the home manager or his/her deputy”. Under “What will happen”, the protocol states that “ the complaint will be investigated by myself (the provider, Mr Paul Hewitt) and/or a person(s) designated by myself and you will be informed of the outcome”. The protocol seen does not make any reference to the Surrey (or other local authority) multi-agency procedure, to immediately notifying the police if a criminal act is suspected or to notifying CSCI or social services. At the follow-up visit to the home, the regional manager providing cover at the home explained that a revised protocol had been supplied to the home. As staff are required to refer any incidents of abuse or suspected abuse to a member of the management team, the manager would then make the appropriate referral or notification. The amended protocol will be reviewed at the next inspection. Clear guidelines to staff regarding the management of challenging behaviours are included in service user’s individual plans and staff receive training in safe interventions and distraction techniques to manage these behaviours. Monies held for safekeeping on behalf of service users were checked with the records held and accurately matched. A requirement and a recommendation have been made regarding Standard 22. Littlefield Gardens (2) DS0000013462.V295479.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, 25 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home presents as a comfortable place in which to live and was clean and appeared hygienic. EVIDENCE: All areas of the home were seen and were well-maintained, attractively decorated and comfortably furnished in a homely style, which meets the needs of service users. The garden was equipped with a variety of chairs, tables and gazebos, which enabled the service users to enjoy the garden and their meals outdoors. Staff advised that two service user bedrooms have recently been decorated and all three service users proudly showed their rooms. It was pleasing to see these had been made individual with the service users choice of pictures, ornaments and their own artwork. The home was clean, tidy and appeared hygienic. It was noted that fabric towels are used and it is strongly recommended that paper towels are supplied and used to reduce the risk of infection. This is particularly relevant in the kitchen, as it is not possible to provide a separate hand-washing basin, due to Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 20 lack of space, and in the bathroom which is used by service users, staff and visitors. A recommendation has been made regarding Standard 30. Littlefield Gardens (2) DS0000013462.V295479.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): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by an effective staff team who have received appropriate training. Service users are protected by the home’s recruitment practices. EVIDENCE: From the pre-inspection questionnaire and speaking to staff, it was evident that the home is run by a small team of experienced support staff, who carry out all roles within the home. These include shopping, cooking, laundry and domestic tasks and service users are supported to assist with tasks as they are able and if they wish to. Staff were observed interacting with service users and it was pleasing to see them using appropriate methods of communication, including a communication board and a service user showed the inspectors the communication board as she was using it with staff. Service users were relaxed and comfortable in the company of staff and it was clear that staff have a good understanding of the service users’ individual needs. The pre-inspection questionnaire stated that two of the eight staff have achieved a National Vocational Qualification to Level 2 or above. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 22 In the absence of any management staff on the day of inspection, a follow-up visit was made to the home in order to assess staff files and recruitment documents. All the required records and documents have been obtained and retained, including application forms with full employment histories, two written references and Criminal Record Bureau (CRB) disclosures. Staff training records were seen, which showed that staff have undertaken a range of training to enable them to meet the service users’ needs. These include the home’s induction, a six-month induction specific to staff working with people with learning disabilities and training required by law, such as fire safety, food hygiene and first aid. Other training is undertaken to develop staff skills and knowledge such as specialist communication methods and health and safety. Littlefield Gardens (2) DS0000013462.V295479.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, 39, 40 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home, although it has not had a registered manager for a long period. The outcomes of quality surveys must be made available. The health and safety of service users is promoted. EVIDENCE: It is clear from the outcomes for service users that the home is well run and is effectively meeting their needs. It is of concern however that the home has not had a registered manager for a number of years. Managers have been appointed to the home, but none have completed registration with CSCI as is required by regulation, and this was discussed with the providers at the recent meeting held, which is referred to in the summary of this report. It was agreed at the meeting, that the provider would advise CSCI in writing within 28 days of the meeting, of the name of the proposed manager for the Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 24 service and that an application for registration for that person would be supplied to CSCI within three months from the date of the meeting. The providers stated at the meeting that a quality survey had been carried out at the home, but the results of the survey have not been made available to service users or their representatives or forwarded to CSCI as is required by regulation. The staff at the home on the day of inspection were also not aware of the outcomes. It was noted that the policies and procedures regarding complaints and medication need to be reviewed and revised. The complaints procedure must be suited to the needs of service users with learning disabilities. The medication procedure states that in the event of a medication error, staff should “contact the area manager as soon as the drug round is completed”. It makes no reference to seeking medical advice. Any delay in seeking medical advice, whilst completing the drug round and contacting the area manager, may be critical to the health of the service user. A number of records relating to health and safety were examined, including the accident record, fire safety records, hot water temperature records, and records relating to the temperatures of the fridge, freezer and hot food served. All were seen to be carried out to the required frequency and were within appropriate ranges. Staff stated that kitchen cleaning is carried out by night staff and a schedule is maintained. Radiators in the home are covered to protect from burning and no hazards were noted. As required the home displays a Health and Safety at Work poster and an Employer’s Liability insurance certificate. Requirements have been made, regarding Standards 37, 39 and 40. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 2 2 x 3 x Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 26 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 YA5 Regulation 5(1)(b) and (3) Requirement Service users must be supplied with (1)(b) a statement of the terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees; (3) Where a local authority has made arrangements for the provision of accommodation or personal care to the service user at the care home, a copy of the agreement specifying the arrangements made must be supplied to the service user. The complaints procedure must be appropriate to the needs of service users with learning disabilities. A written copy of the complaints procedure must be supplied to each service user and to any person acting on behalf of a service user if that person so requests. The registered provider must proceed with the formal appointment of an individual to manage the care home in accordance with the requirements of Regulation 8 of DS0000013462.V295479.R01.S.doc Timescale for action 15/09/06 2 YA22 22 15/09/06 3 YA37 8(1)8(2) 13/07/06 Littlefield Gardens (2) Version 5.2 Page 27 4 YA37 9 5 YA39 24 6 YA40 12 (1) (a) The Care Homes Regulations 2001 (As Amended) and advise CSCI in writing of the name of the person within the timescale agreed. The person appointed to manage the home must submit an application for registration to CSCI within the timescale agreed. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving, the quality of care provided at the home. A report in respect of any review must be supplied to CSCI and made available to service users. The review system must provide for consultation with service users and their representatives. The home’s policies and procedures must be kept up to date and reflect current legislation. Specifically the complaints policy and the medication policies must be reviewed and revised. 15/09/06 15/09/06 15/09/06 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 Refer to Standard YA1 Good Practice Recommendations Where service users have limited communication skills and are not able to understand the service users guide, it is recommended as good practice that this is supplied to their representative on their behalf. It is also good practice to ask the representative to sign to show they had received the service user’s guide on behalf of the service user. In view of the level of the service users’ communication DS0000013462.V295479.R01.S.doc Version 5.2 Page 28 2 YA22 Littlefield Gardens (2) 3 YA30 disabilities, it is strongly recommended that the representative of each service user is provided with the complaints procedure on behalf of the service user. It is strongly recommended that paper towels are supplied and used in the home to reduce the risk of infection. Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 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 Littlefield Gardens (2) DS0000013462.V295479.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!