Inspection on 08/04/08 for 2 Princess Close

This inspection was carried out on 8th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

2 Princess Close 01/04/09

2 Princess Close 13/06/07

2 Princess Close 12/01/07

2 Princess Close 11/01/06

2 Princess Close 26/09/05

2 Princess Close 03/03/05

2 Princess Close 26/08/04

2 Princess Close 11/03/04

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 HOMES FOR OLDER PEOPLE Princess Close 2 Princess Close Keynsham Bath & N E Somerset BS31 2NG Lead Inspector Paula Cordell Unannounced Inspection 8th April 2008 09:30 X10015.doc Version 1.40 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 Princess Close DS0000008176.V361626.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 Older People. 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. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Princess Close Address 2 Princess Close Keynsham Bath & N E Somerset BS31 2NG 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 9077222 0117 9699000 www.brandontrust.org The Brandon Trust Ms Heather Hinton Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2007 Brief Description of the Service: 2 Princess Close is a detached house, situated in a quiet cul-de-sac, in a residential area of Keynsham. The house has been extended to provide accommodation for five people with learning disabilities. There is one vacancy. There is an agreed variation in the conditions of registration permitting the accommodation of a named service user under the age of 65. On the ground floor there is a lounge, kitchen and dining room. Also on this floor are two bedrooms, a toilet, utility area, and a walk in shower. There is a stair lift to the first floor where there are three bedrooms, a large fourth room currently used as a staff sleep-in/meeting room and a small office space. There is also a bathroom with specialist bath and separate toilet. At the rear of the property there is a patio and small garden that can be accessed by means of a ramp. The home is within easy access of local amenities that include a leisure centre, shops and a park. There are accessible transport routes to Bath and Bristol by both bus and train, and there are bus routes to other local areas. The Brandon Trust operates the home with the day-to-day management being cascaded to the registered manager Mrs Heather Hinton. The statement of purpose clearly details the staffing levels as two staff working during the day with one member of staff providing sleep in cover at nights. Charges range from £682.60 to £931.91 Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit as part of a key inspection process. The purpose of the visit was to monitor the progress to the requirements and requirements from the last inspection in June 2006 and to review the quality of the care provided to the people living at 2 Princess Close. There have been no complaints received by the Commission for Social Care Inspection since the last visit in June 2007. However, there has been a safeguarding referral made to the Bath and Northeast Somerset Council in respect of an allegation of abuse raised by an independent advocate and a person who lived in the home. This has been fully investigated by the Brandon Trust and was found to be unsubstantiated in relation to the allegation. The inspection methods used during this visit included record checks, case tracking, and discussion with the manager, three staff, and people who use the service. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service. These were used as a focus for the site visit, along with comments from the returned questionnaires from people who use the service (2), relatives (1), staff (2) and visiting professionals (2). The visit was conducted over a period of six hours and ended with structured feedback. What the service does well: What has improved since the last inspection? Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 6 Individuals benefit from the contract of service being user-friendlier. An individual’s plan of care has been reviewed in relation to the use of restraint with a more positive approach being adopted. This was in consultation with a visiting specialist. Individuals are assured that they are protected from the risk of scalding with all radiators now having guards. The organisation is in the process of completing a review of its policies and procedures to ensure that they are still current following some changes in the underpinning legislation. Individuals are assured their safety in the event of a fire with staff having their competence routinely checked via training and drills. What they could do better: Individuals must be assured that their plan of care is reviewed, ensuring that it is current and meeting their changing needs. Individuals must be protected by the home’s medication systems and practices in respect of storage and prompt disposal. Individuals would benefit from the staff team being more innovative and creative with the activities that are provided in consultation with the people living in the home. Individuals must be assured that staff have appropriate training to support them for example mental health. Individuals must be assured that confidentiality is maintained in respect of conversations conducted in the communal areas. Individuals should be assured that the staff are following the organisational financial policy. Two staff signatures must support financial expenditure. Where individuals living in the home sign for their financial expenditure staff should consistently encourage this. The home should review the funding arrangements for the motability car ensuring that it is equitable. Individual’s belongings should be protected by the home maintaining an inventory. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 7 The staff and the manager should review the list of chores and activities that staff undertake on a daily basis to ensure that it blends with person centred planning and is not inflexible. 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. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals have sufficient information to enable them to make a decision on whether to move to 2 Princess Close. Information is accessible. Individuals can be confident that the conducts an assessment prior to them moving to the home. EVIDENCE: The home has a statement of purpose and a service user guide. These met with the National Minimum Standards and the Care Home Regulations. The Service User Guide was available in plain English and contained photographs making it more accessible to the individuals living at Princess Close. One person during the visit had a copy of a service user guide and it was evident that they liked looking at the pictures. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 10 There have been no new persons admitted to the home in the last two years. One person has moved on since the last visit. There was documentation in place that evidenced that the home had completed a thorough assessment including obtaining the local authority assessment and care plan of the individuals prior to them moving to Princess Close. Information about the assessment process is made available to individuals in the statement of purpose and in the organisational policy. According to this documentation individuals would be offered a trial period prior to making a decision on whether to move to the home permanently. Care documentation identified that individuals are referred to specialist services if required. From talking with the manager it was evident that where individuals needs have changed then the placing authorities are contacted. Individuals have a contract of care. This has been reviewed and is now in an accessible format suitable for people with a learning disability. The documentation includes symbols and photographs. The home does not offer an intermediate service for people. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Individuals personal and health care needs are being met, however a formal review is lacking. Safe medication practices are being compromised by medication not being stored and disposed of promptly as per the home’s policies and procedures. Individual’s privacy is being compromised by conversations of a confidential nature being discussed in the communal areas. EVIDENCE: Two care plans were looked at as a means of determining the processes the home goes through to support the individuals living at the 2 Princess Close. Individuals have a service user plan containing valuable information about the person to enable the staff team to support them. The files were logical. Lacking was a formal monthly review by the care staff working in the home. Care plans were dated July 2007 with no evidence of a formal review. The manager stated Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 12 she was unaware that there was an expectation that this would be done monthly as detailed in the National Minimum Standards for Older persons. The manager stated that she was in the process of changing the present care planning processes, which would ensure that it was clear how the home was supporting the individuals with clearly defined goals being devised. Staff training was being organised by the Brandon Trust for the team on the new care planning processes. This will be followed up at the next visit the home. The home operates a key worker system (a named worker allocated to a specific person receiving a service). Staff and the individuals living in the home confirmed this. One of the key worker roles was to complete a summary of the month’s events. This was informative and covered aspects of daily living including general health, social and contact with friends and family. However, this had not been completed consistently for one person since December 2007. The manager stated that this was due to a change of the named key worker for the person and that the previous key worker only worked part-time. Risk assessments were in place covering a wide range of activities in the home and the local community, including falls. During the last visit a concern was raised in relation to the use of a restraining belt that was in situ when one person uses the toilet. An occupational therapist had advised the home that it was not suitable in March 2007. The manager confirmed that this was removed and the risk assessment and care documentation had been amended to reflect the change shortly after the visit in June 2007. Following an incident the home liaised further with a professional to seek advice and support on how to ensure the safety of the person. The home has now installed an aid to ensure the safety of the person in consultation with a member of the community learning disability team. This was clearly documented in the person’s care plan. The home has demonstrated compliance to a requirement from the last visit. People have a Health Action Plan detailing their support needs. Evidence was provided that individual’s personal and health care needs were being met. Individuals are supported to attend appointments with doctors, dentist, chiropodist, opticians and other health related appointments. Concerns were raised during a safeguarding meeting that the home over relied on the services of the community learning disability team (CLDT). The manager was very concerned about this statement. It is strongly advised that contact is made with the team manager for the CLDT. This will enable the manager to discuss the referral process and other concerns that were raised. Again at this visit it was noted from two visiting professional comment cards that they were concerned about confidentiality and that personal information was conveyed in the main lounge in front of the other people receiving a Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 13 service. The manager stated that meetings can be conducted in private in the office upstairs and this has been conveyed to the staff team. However, staff stated that this is not always possible when there is only one staff in the home as this would leave the people living in the home unsupported. It was evident from observations that staff discussed people in the dining area of the home. The inspector raised again the concerns about confidentiality with the manager during this visit. Medication Administration met with the National Minimum Standards. Records were complete and contained appropriate information and signatures. It was noted that a bottle of prescribed medication was left on the kitchen side two hours after the administration time. In addition there was medication that was due to be disposed of left on a filing cabinet of the office. This medication belonged to a person who had moved from the home in December 2007. This should be promptly and safely disposed off. Staff competence on the administration of medication was routinely checked and further training was being provided to ensure that staff had the appropriate knowledge. Applications were seen for staff to attend training with a local pharmacist. This will be followed up at the next visit to the home. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are supported to take part in activities however these lacked any innovation or creativity in the planning. The home supports individuals to maintain contact with friends and family. Individuals have a healthy diet, which is varied. EVIDENCE: Information in care records evidenced that individuals were supported to access meaningful activities. One individual attends a day centre three days per week. Four of the individuals have reached retirement age and have a mixture of external day care and college courses. The manager and two members of staff described how it was difficult to find activities for two of the people who live in the home who often refuse to go out. Both individuals apparently prefer to spend time listening to music, watching television and relaxing in the home. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 15 It was acknowledged that the individuals are getting older and may prefer to spend time in their home. However, as discussed at the time of the visit there is a concern that activities appear the same as on previous visits for example trips to the garden centre or to the local park. A member of staff was keen to introduce more in-house activities for example cooking and arts and crafts but as yet this suggestion has not been fully acted upon. A member of staff stated that the home is actively seeking age appropriate activities including luncheon clubs and drop in centres which may be relevant to some of the individuals. However this was noted at the last visit with a lack of any real development in the last ten months except that a member of staff had obtained some literature. Staff stated two of the individuals are supported to attend a local church in Bath and this has been successful. Another individual attends skittles once a month and another individual is offered a weekly pub outing. One of the individuals confirmed the activities were taking place. A member of staff stated that the aim is for all individuals to be given an opportunity to go out on a daily basis. Trips include visits to garden centres or the local shopping centre in Keynsham or the local café. However, this was not fully captured in the daily records especially where individuals decline to go. Two of the individuals were planning a holiday to Blackpool in May for a long weekend. The manager stated that all the individuals would be offered a holiday or day trips based on their preferences. Further short breaks would be made available during the remainder of the year. During the visit a member of staff organised a sing-a-long session. From talking with staff and observations it was evident the individuals enjoyed these sessions. A member of staff said that these are being organised regularly. Links are being built with another Brandon home in the area with supper and musical evenings being organised. The plan is for this to take place every six weeks. It was evident that it was a busy day with staff having good organisational skills to ensure that individuals had opportunities to go out and attend day care. Two of the individuals were supported to go to the local shops for a magazine and another was at a day centre. Staff confirmed that it was difficult some days to balance the personal and social care needs of the individuals and the household chores. One staff stated that the day is dictated by a list of chores that have to be completed. Individuals in the home vary in their ability to communicate. The manager stated at the last visit that a new approach was being implemented for one individual, which would enable them to make a variety of choices using photographs. Two staff were not aware that this was in place. Although later Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 16 the staff referred to, “the book they use for day care”. Another member of staff stated that they were in the process of taking more pictures. It appears that this needs more discussion in the team to ensure that it is consistently applied. A speech therapist had raised a concern that the home did not act upon their advice and staff had not been consistent in their approach at both the last visit and again prior to this visit. Staff were unaware of the term “objects of reference” the tool that the speech therapist mentioned in the completed survey. Staff confirmed that they had received makaton training (a sign language for individuals with a learning disability) to support an individual. A member of staff stated that they were going on a refresher course. However, there was no observation of makaton being used during the visit. Contact with relatives is maintained as evidenced via conversations with individuals, staff and the manager. This was clearly documented in the plan of care. Feedback from a relative prior to the visit indicated that generally they were happy with the home although they did state that there could be improvement in the stimulation that is available for their relative. Care planning documentation included information on the support needs of individuals during meal times. Risk assessments were in place minimising the risks of choking. A specialist service has also been involved in advising staff of a safe system of supporting people. However, it was noted from the professional’s correspondence when they recently completed a review that they were concerned that their advice had not been incorporated in to the plan of care. However, this had been addressed since with a copy of the professional’s advice being attached to the risk assessment and plan of care. The menu demonstrated that individuals had a varied and healthy diet. A large fruit bowl was available to individuals living in the home. Throughout the visit individuals were being offered a choice of refreshments. Staff stated that the menus are planned around the preferences of the individuals living in the home. A daily record is maintained of meals prepared, which demonstrated that there was an element of choice. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that concerns would be listened too. Funding of the vehicle is not equitable with one person covering the majority of the costs. People’s belongings are not being protected, as their inventories are not being kept up to date. EVIDENCE: The home has an organisational complaint policy that indicates the time scales to respond to complaints. This is available in an accessible format. A relative stated that they were aware of the complaint procedure and was happy the home would respond to concerns. It was difficult to determine if the individuals living at 2 Princess Close could fully comprehend how to make a complaint. Although staff gave reassurances that where an individual uses non-verbal communication this is monitored and staff would act appropriately if individuals were distressed. There have been no complaints since the last inspection. However there has been one adult safeguarding referral. This initially led to the police being involved but no criminal offence had been committed, which then led the Brandon Trust to complete an internal investigation. The allegation of abuse Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 18 was unsubstantiated and the suspended member of staff has returned to work. An action plan was developed for the team. One of the persons living in the home was moved to alternative accommodation. The Brandon Trust worked closely with the agencies involved during the investigation and the Commission for Social Care Inspection were kept informed of the actions taken. Policies and procedures relating to the protection of vulnerable adults were seen at previous visits and linked with the Department of Health’s policy on “No Secrets”. The manager stated that lessons have been learnt about the safeguarding issue, which includes sharing information more quickly and much clearer documentation. The manager and staff spoken with described the content and the procedure to follow in the event of an allegation of abuse. From training records it was clear that staff have attended training on safeguarding within the last two years. The home has policies and procedures relating to the financial affairs of the individuals as seen at previous visits to the home. All money held in the home corresponded with the records, with receipts being maintained for all financial transactions. However, there was a lack of two staff signatures to support the financial transactions in line with the Brandon Trust’s policy. In addition it was noted that one individual had signed for two out of the ten transactions and this was not being consistently applied. The home has responded to a previous recommendation to ensure that the funding of the vehicle is clearly documented. The home’s contract and a transport agreement are now in place detailing what contributions are being made. However, as discussed with the manager during the previous visit it is debateable whether the individuals could consent or have the full understanding of the financial implications. However there remains a concern that one person is paying for the vehicle whilst the others pay a minimal amount for petrol, this does not appear equitable or within the agreement of the motability car scheme. This system of funding a home’s vehicle should be reviewed to ensure that it is equitable and that a third person independent of the home and the organisation assists with the agreements. Inventories, which are a document to protect the individual’s belongings, have not been updated for two people in a number of years, one person since 2004. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 2 Princess Close provides a safe, clean and homely place for people to live. EVIDENCE: The home is in keeping with the local neighbourhood and is near to local shops and amenities. There are bus routes available to neighbouring Bath and Bristol. The home provides a suitably furnished environment that meets the needs of the individuals however this needs to be continually reviewed, as the individuals get older. Great attention has been taken to personalise the home. All areas of the home were clean, hygienic and odour free. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 20 Suitable aids and adaptations were available to assist the individuals with their personal care including a walk in shower (wet room) and a high low bath with built in hoist. Evidence was provided that equipment was routinely checked and maintained. Occupational therapists had been involved in the assessment of equipment as evidenced in care records. It was noted that the lounge area could be quite busy when everyone is sat in the lounge including all the walking aids. The manager stated that a plan has been developed to build additional space on the ground floor in the form of a conservatory. This would be beneficial for the people living in Princess Close. Especially as this would provide additional private space for meetings with professionals and a quiet area for people to sit and relax. Each person has a single bedroom, which has been decorated and furnished to reflect the taste of the individual. There are two ground floor bedrooms. There is a chair lift to assist people reaching the first floor. Routine maintenance records evidenced that there was a prompt response to repairs. Routine checks on the electrical equipment, the stair lift, gas and fire detection were taking place ensuring that the home was a safe place to live and work. The home has responded to a requirement to ensure that all radiators are covered ensuring safety of the people living in the home. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate and competent staff support the individuals living at 2 Princess close. This will be enhanced with the training that is being provided on developing the team and building on the person centred planning initiatives. The organisation provides a good rolling programme of training for staff. There has been an improvement in the recruitment of staff with less reliance on bank staff to cover the shortfall. EVIDENCE: The home is staffed with two members of staff during the day and one member of staff providing sleep in cover at night. This was evidenced in the home’s duty rota and conversations with staff. Staff stated that additional staff work in the home to enable individuals to go out for example on a Sunday when two people are supported to go to church. As the needs of the people living in the home change due to the ageing process this must be kept under review. Staff stated that all the people living in the home require support on a one to one basis including accessing the community. Three out of the four people living in the home need staff support due to mobility issues when accessing the community. Staff said that it is rare for all the people to go out together due to staffing levels and this sometimes Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 22 can be restrictive. A member of staff said that some staff do not feel comfortable being left on their own when working in the home when the other member of staff is out in the community supporting people. The manager should ensure that staff are clear about their roles in relation to supporting the people living in the home. In addition this should be explored as a team to alleviate some of the anxieties that staff may have in relation to lone working. At the last visit to the home it was noted that there was a recruitment issue in the home with a shortfall of 90 hours, which was being covered with bank staff. The manager and the staff stated that this has now been addressed. Two staff have transferred from another home in Brandon. The manager stated that there is now a shortfall of 25 hours, which will shortly increase due to a member of staff leaving. However, it was evident that a recruitment initiative was being completed to fill the vacant hours. Staff said that a part-time cleaner was being employed to assist with the household chores which would enable more activities to be completed with the people living in the home. This would be beneficial to the people living in the home. Recruitment information is held at Brandon Human Resource Department and will be subject to an inspection to ensure that an appropriate and thorough recruitment process has taken place. The manager was aware of the checks that needed to be in place prior to a new member of staff taking up a position within the home. The home has an organisational induction, which includes elements of health and safety training, aims and values of the service and protection from abuse. This was seen on the file of one of the staff that had recently transferred. In addition newly appointed staff complete the Learning Disability Qualification. Staff confirmed that they had read key policies and procedures and care planning information as part of their induction. Once staff complete their induction they progress to complete a National Vocational Award in care. Three staff presently have a National Vocational Qualification (NVQ) at level 2 in Care, with a further member of staff in the process of completing this. The home is working towards the government target of 50 of the workforce having an NVQ 2 or equivalent in care. The training matrix provided evidence that all staff have attended their statutory health and safety training, including first aid, food hygiene, annual fire training and manual handling. Other areas of training included epilepsy, communication, person-centred planning, supporting the older person and understanding dementia. Training has been identified for the forthcoming year and applications have been made to attend training with the local council for individual members of staff. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 23 Brandon Trust have available to staff a prospectus of training. The manager said that this has only recently been received and staff will be encouraged to attend appropriate training. A professional commented in a survey that staff had not attended training in ‘supporting people with eating and drinking’. At least half the team have made applications to attend this training. As yet the home has not received confirmation that individuals have got a place. This will be followed up at the next visit to the home. It was noted that one person had a clear diagnosis of mental health support needs in addition to their learning disability. During the course of the visit the person was experiencing some distress, which could have been due to their mental health. The manager advised the person to go to their room where it was quiet. From reviewing the training records and speaking with three staff including the manager it was evident that none had received any training in mental health to enable them to support and understand the individual. This must be addressed. As part of the safeguarding issue it was identified that the team need to explore and develop the culture of the home and build on person centred planning. The manager said that this was initially planned for April but has been postponed to May 2008. The manager stated that some of the delay was to wait until the new staff had become established within the team. This will be followed up at the next visit to the home. Policies relating to recruitment, employment and equal opportunities were seen on previous visits. The manager said that Brandon is in the process of systematically reviewing all policies and procedures. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 2 Princess Close is a safe place to live. There are clear lines of management and accountability. However systems in place may not allow for staff to be innovative and creative in their day-to-day approach. EVIDENCE: Mrs Heather Hinton is the registered manager. Mrs Hinton has a social work background and qualification and has completed her NVQ 4 in care and the Registered Managers Award. Ms Hinton is an NVQ assessor. Evidence was provided that the manager is attending appropriate training to her role. This has included training on the Mental Capacity Act and Equalities and Diversity. In addition Mrs Hinton has been attending training on leadership and Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 25 Management. It was evident from talking with the manager she was looking at ways to develop her management role within the home. From discussions with staff and observations of her interactions with people who use the service she is open and inclusive. Mrs Hinton is evidently a ‘hands on’ manager and works alongside her staff team. Good practice would be for Mrs Hinton to have some additional management hours so that this does not impact on the day-to-day care of the people living in the home. Staff stated that they liked working in Princess Close and spoke positively about the people they support. Staff stated that the manager was supportive and met with them regularly on a one to one basis. The manager said that she was introducing a new recording system for supervisions and that these were going to take place monthly. The records seen provided evidence that staff have received at least two supervisions since January 2008 for full time staff. The manager said that it has been difficult to complete supervision for one member of staff who works part-time. Staff said that meetings were taking place monthly. Generally staff communication was good, with daily handovers, six to eight weekly supervisions and monthly meetings. Minutes of the meetings were not viewed on this occasion. One member of staff said that the planning of the day was very much dictated to them in relation to household chores and activities, which did not always enable a more flexible day to be planned. An opportunity was taken to view the list of chores and this did echo what the staff described. The manager said that if the list were not in place then areas would be missed. In light of the staff’s comments and the manager’s this could benefit from discussion within the team. From reading the fire logbook it was evident that the appropriate checks were taking place on the fire equipment. Fire training and routine drills were taking place for staff. The home has demonstrated compliance to a previous requirement relating to this. As seen at the last visit risk assessments were in place for manual handling, fire and substances hazardous to health (COSHH) and had been periodically reviewed. Other areas that demonstrated that health and safety was paramount, was the routine checks on aids and adaptations, the landlords gas certificate, electrical equipment testing and the routine environmental checks. Staff complete routine checks on hot water supplies and food temperatures. These were satisfactory. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 26 The provider is completing the monthly visits in respect of regulation 26 and copies are being sent to the Commission for Social Care Inspection. In addition the home is informing the Commission for Social Care Inspection of events that affect the wellbeing of the individuals living in the home. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. 2. Standard OP7 OP9 Regulation 15 (2) (b) 13 (2) Requirement To ensure the plan of care is kept under review at least once per month. Ensure medication is stored securely and in accordance with the Royal Pharmaceutical Guidelines. Ensure that medication is disposed of promptly and safely. To review the activities that are regularly taking place to ensure they remain suitable for the people living in the home. For staff to have mental health training. To review where staff conduct meetings, handovers, telephone calls and general conversations ensuring that individual’s confidentiality is not breached. Timescale for action 08/05/08 08/04/08 3. 4. OP9 OP12 13 (2) 16 (2) (m) 18 (1) (c) (i) 12 (4) (a) 09/04/08 08/05/08 5. 6. OP30 OP10 08/06/08 08/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 29 No. 1. 2. 3. 4. Refer to Standard OP18 OP18 OP18 OP32 Good Practice Recommendations Two staff to sign for all financial transactions. Where individuals living in the home sign for their financial expenditure ensure consistently applied. To review the funding arrangements for the motability car ensuring that it is equitable. To update individual’s inventories in line with the Brandon Trust’s financial policies. Review the list of chores and activities that staff undertake on a daily basis to ensure it lends itself to person centred planning and is not inflexible. Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Princess Close DS0000008176.V361626.R01.S.doc Version 5.2 Page 31 - 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. 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