Inspection on 04/05/06 for 20 Windlesham Road

This inspection was carried out on 4th May 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 but made no statutory requirements on the home.

Other inspections for this house

20 Windlesham Road 20/04/07

20 Windlesham Road 13/10/05

20 Windlesham Road 15/04/05

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 20 Windlesham Road 20 Windlesham Road Brighton East Sussex BN1 3AG Lead Inspector Jenny Blackwell Key Unannounced Inspection 4th May 2006 11:45 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 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 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 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. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 20 Windlesham Road Address 20 Windlesham Road Brighton East Sussex BN1 3AG 01273 735322 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) Brighton & Hove City Council Mrs Lillian Fafoutis Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: 20 Windlesham Road is a semi-detached property in a quiet, residential road in Brighton. It is possible to walk to the shops, and public transport systems are within close proximity. The service is for up to four adults with learning disabilities. At the present time there are four service users who are supported 24-hours a day. Single bedroom accommodation is provided on the ground and first floor. There is one bathroom upstairs and toilets are located on both floors of the home. Meals are prepared by the staff with the people being supported to participate in the preparation. The home is domestic in scale and consists of lounge, a kitchen with a dining area. A rear garden provides a safe area for the people to spend time in. The fee information for 20 Windlesham Road is yet to be passed to the Commission. As the home is run by Brighton and Hove City Council specific set fee amount had not been calculated. This information will be required for the next published report. More detailed information about the services provided at 20 Windlesham Road can be found in the home’s Statement of Purpose and Service User Guide – copies of these documents can be obtained directly from the Provider. Latest CSCI inspection reports are kept in the homes office. Two of the relatives spoken to said they were not aware the report was available to them in the home. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at 20 Windlesham Road have are referred to as “people” or “person”. People working at the home will be referred to as “staff” or by their job title. This report reflects a key inspection based on the collation of information received since the last inspection, feedback from representatives and visiting professionals and an unannounced and follow up announced site visits which lasted a total of nine hours on Thursday 20th April and Saturday 22nd April. The site visits included a tour of the premises and an examination of medication, care and staffing records. Throughout the inspection process, the Inspector spent time with all of the four people, one person individually and observed the way the people were supported in communal areas. Telephone conversations were held with two relatives and two professionals. Written feedback was received from two people filled in on their behalf by staff. The manager was met with during the site visit along with the deputy manager. The line manager for the home was met with on the second site visits to gain further information about the running of the home. In addition, two staff were interviewed individually and two others together. What the service does well: The inspection process has identified the home as operating adequately in some areas and good in others. The relatives and staff spoken to collectively acknowledged the home had been going through some difficult times in the last year with continuing to settle a person to the home and manage some changing behaviours in another person. However those spoken to had said that the moral in the home had improved and the staff felt they had made some progress in supporting the people with activities and getting on better with each other. One staff member had said that the home was “the best place I’ve worked and the team really pull together” Evidence was seen through observation and feedback from the relatives that the staff were concerned with providing good outcomes for the people who lived at the home. This was observed during the visits to the home and improvements were noticed with some 1:1 working with people. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 6 It was noted during the visits to the home that less restriction were in place around the home than on previous occasions. The manager had removed the double handled doors to the kitchen, which stopped some people moving freely in and out of the kitchen. One person attends a day centre and a representative from there was spoken to. She said they worked closely with the homes staff and described the homes staff as “one of the best we work with”. A relative spoken to described the staff as kind and caring. She felt her relative was happy living at the home and that he was currently enjoying an active life do more than he had ever done. Another relative particularly praised the keyworker of his relative who he thought had provided good quality of care. He was happy with the staffs support of his relative and felt they had done well in helping the person to get out and about more. Staff observed administering the medication were knowledgeable and competent and used appropriate reporting process when an error was found. What has improved since the last inspection? What they could do better: Further work was needed to ensure the staff team work from up to date community care assessments for all the people. The individual plans are in the process of being updated and will be a good formate when completed. The manager needs to ensure they are in use for staff to work from as soon as possible. The manager needs to ensure that staff only use approved handling techniques and that these are recorded. It was also required that the manager records and reports all restraint that is used, incidents and accidents and medication errors. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 7 The environment was generally nice and the home presented in a homely way. Some furniture needed replacing and some areas of the home were in need of decoration. Staff were praised by relatives and other professionals for their care of the individuals. The regular use of agency staff was raised as a concern from relatives and the Brighton and Hove monthly monitoring report. This will need to be monitored as the lack of permanent staff affects the continuity of care. Clearer evidence of the training for each staff was required as although staff had been attending some training the records did not reflect this. The manager needs to produce a fire risk assessment for the home. 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. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 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 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people needs and aspiration are not fully assessed. EVIDENCE: Since the previous inspection no new person has been admitted to the home. At October 2005 inspection concern was raised about the compatibility of the people living together. A requirement was made for one person to have a full re assessment of needs to look at whether the placement was suitable. The manager confirmed during this inspection that a social worker had undertaken a re assessment of needs and was waiting on the assessment to be sent. A discussion was held with the manager and deputy manager about the possibility of conflict between the people living at the home being resolved. Both stated that they felt they were able to meet the needs of all the current people with additional support from community learning disability professionals. Both the manager and deputy manager better understood the importance of having the people needs and aspirations regularly reviewed to ensure the home could meet the people’s needs. It was noted during time spent with the people at the visits that the atmosphere appeared calmer and the interaction between the people seemed less stressful. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 10 The manager and the keyworking staff arrange for in house annual reviews. Each person, their relatives and in one case representatives from their day services are present at the reviews. Minutes of the reviews were not noted in the information available. The issues concerning the compatibility of the people were raised under Adult Protection protocols in November 2005. It was noted that at the time of this inspection the assessment for the person was not in place at the home and the Adult Protection the placing authority had conducted had not concluded investigation. It is required that the home works from up to date community care assessments to ensure they can support each persons needs. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 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 adequate. This judgement has been made using available evidence including a visit to this service. The individual plans were not complete, in transition in format. The people at the home are supported to make daily choices. The individuals risks were identified although it was not clear if they were supported to take risks. EVIDENCE: The home’s operational management is being transferred from South Downs NHS Trust to Brighton and Hove City Council. This meant that the individual plans for people were being changed into the Councils format. The manager explained that she and her line manager were in the process of changing over the individual plans. At the time of the visits to the home the individual plans were not fully usable by the staff as parts of them were in different files. The information available form the plans were viewed for all four people. The new formats look good and would be easy tool to use once complete. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 12 A staff member was asked about the change of format in the individual plans. He knew that the format was changing and said he expected it to be discussed further in the staff meetings. He was asked about particular routines of the people and their preferred ways of being supported. He was able to talk about information that would be recorded in the individual plans that ensured staff were consistent in their approach to people. It was required the manager provide evidence of the plans being completed and implemented. It was noted during the visits to the home that less restriction were in place around the home than on previous occasions. The manager had removed the double handled doors to the kitchen, which stopped some people moving freely in and out of the kitchen. Two staff spoken to and the manager and deputy said that the atmosphere in the home had improved along with the conflict between the people. They said this had enabled them to remove the door handles. The monthly monitoring visits to the home conducted by a representative of the provider (Brighton and Hove City Council) look at issues of restrictive practice. In addition the line manager to the home provided evidence of a restrictive practice audit tool they will be using at the home soon. The staff continues to improve the opportunity for each person to make choices in their lives. The staff were seen to offer the individuals choices during the visits mainly based around meal choices and activities. The home does not conduct formal meetings for the people to air their views. The manager stated this would not be beneficial way of gathering peoples views as the group would be dominated by particular individuals. The home has a keyworking system were each person has a named staff member who oversees the support needs. A staff member along with the keyworkers had developed individual communication books. People had a small book that contained photographs of places of interest to them. The staff member said that this was to help the individuals make choices and also help the staff to explain to a person were they would be going for the day, for example going to the doctors. It was not evident if the long term goal setting for each person was based around their choices this was mainly due to the absence of the reviews notes. Risk assessments were seen for all four people at the home. They were detailed and included risk of falls, challenging behaviour and environmental risks. It was not clear form the information if the risk assessment process was designed to help the individuals gain more independence by taking measured risks. It is recommended that the manager continued to develop the risk assessment procedure linking in with the reviews of restricted practices within 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 13 the home. This would show the risk assessment process was enabling people to achieve more independence and choice in their lives. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected 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 adequate. This judgement has been made using available evidence including a visit to this service. The activities and engagement of people in the home was improved. The home supported good family relationships and the meals provided met the required standard. Peoples rights were not protected as the should be with gaps in recording of restraint and the use of unauthorised manually handling methods. EVIDENCE: The staff team supported each person to engage in activities within and out side of the home. It was difficult to look at information in the individuals plans for information of planned activities. An activity planner was in the kitchen identifying college sessions, day centre attendance and community outings. On the days of the visit the staff spoken to were clear about which person was attending what activity. It was noted that in the monthly monitoring visit report for May 06 the officer had observed on 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 15 her visit some confusion about what one person was due to do for the day. This may be due to agency staff working the morning of the officer’s visit. On the first visit to the home one person was on a day out to London with two staff. Another person was at his day centre and another went to an East Sussex college to meet with a walking group. A staff member accompanied him to the college. The staff were seen to work hard at ensuring the people had opportunities to go out and it was noted that the trip to London had been a special outing for the person who had two staff to support him. Previously the staff team had difficulty in engaging one person with activities either inside or out side of the home. The deputy manager reported some significant improvements in this area and describes the person as appearing more confident and settled. She listed that the person had been out to the pub, shopping and to a Disco. It was observed during the visits that staff were involving the person more around the house. They engaged her in doing the laundry and hanging out the washing. This was an improvement since the last visit were the person was mainly shadowed by staff around the house. On this visit staff were involved in showing her ways in which she could participate in the activity and were responsive to her when she did not want to continue. One person attend a day centre and a representative from there was spoken to. She said they worked closely with the homes staff and described the homes staff as “one of the best we work with”. She said the homes staff were good at updating the day centres staff with information and someone was always available to talk with if they had concerns about the person. They run the persons annual review jointly with the home, where the person, their relatives and the staff attend. It was noted that since previous inspections the organisation have developed a better awareness of protection the peoples rights and attempting to raise the issues of restrictive practices within the organisation. However a restraint method continues to be used each week with one person during a medical procedure. This is not being recorded in accordance with The Care Homes Regulations 2001. It is required that the home records all incidents of restraint used in the home and provides the evidence of the recording to the Commission. It was observed during the first visit that one person was politely asked to by staff to get up from the sofa and go to another room. The person did not respond to the request and was then approached by the staff that tried to verbally encourage the person up. When the person did not respond the two members of staff used and manually handling technique to raise the person from the sofa. The persons individual plan was checked to see if the technique 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 16 was an approved method of moving the person, no evidence was found of the method. The situation was reported to the line manager of the service to look into. It is required that the manager ensure that people are protected from being handled in an unapproved ways that maybe against their will. The manager in the pre inspection questionaire provided the menus for the home. They appeared nutritious and varied. During the visit the staff prepared the meals for the one person at home. The individual’s records did not highlight any issues with the meals provided at the home. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal care support is offered appropriately. Each person’s physical and emotional needs are not fully met. The staff do not always ensure the people are protected by the homes medication administration procedures. EVIDENCE: Each person’s preferences about their daily routines were recorded in their plans. Daily morning and evening routines were recorded for each person with indication on how to support the person with personal care. A staff member was asked about one persons routine was able to talk about the individual’s preferences. During the visits to the home staff were seen to react sensitively to the personal support needs of the people and were discreet when supporting them. The health care checks for individuals are arranged by the home. The manager gave an example of a recent medication review one person had with his G.P. Each person is registered with a G.P and attends community-based appointments for dentists and opticians. Health care monitoring for each 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 18 person is recorded in the daily records. Staff were proactive in responding to changing health needs of the individuals. The manager said the staff had good links with community healthcare professionals who provided support with managing, medication and behavioural and mental health needs. Evidence was seen of some appointments in the individual plans. A discussion took place with the line manager of the home during the second visit about the ongoing difficulties with a regular medical intervention that one person has. This situation will be continued to be monitored by the Commission with particular attention to restraint, consent and pain control. The line manager confirmed that she, with the manager would review the procedures ensuring that attention was paid to the person’s pain management and use of restraint. A check of the medication was carried out on the first visit to the home. Two staff members were observed to administer the medication. One was a permanent member of staff the other was a relief member of staff. They were asked to go through the medication procedure and discuss any change in medication for any of the people. They demonstrated good knowledge of the current medication regime for each person and was able to describe why people were taking certain medications. During the observation of the medication procedure the permanent staff member identified that medication was missing form one second of the measured dose system. No information was recorded on the medication sheet to account for the medication missing. The staff member acted appropriately and contacted the on-call manager to ask if the error had been noted. The error was known by the manager but had not been recorded appropriately. Another medication error picked up by the officer and reported in the May monthly monitoring visit by the organisation It is required that medication errors are recorded and reported appropriately. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at the home relied on others to raise complaints on their behalf, the complaints system is suitable to support their complaints and concerns. The people are protected from abuse in part. Staff have not been suitable trained in detecting and reporting abuse. EVIDENCE: The organisation has a complaints leaflet that has been designed to be more accessible to some people by using pictorial information. The current group of people living at the home would need support to make a complaint. The manager said that the home would rely on relative’s staff or other people to raise a complaint on behalf of the people who live at the home. The monthly monitoring visits check on complaints during their visits. The commission has not received any complaints about the home since the previous inspection. The manager reported one complaint from a neighbour that had been appropriately addressed. The manager provided information about adult protection training Brighton and Hove City Council provide. It is a mandatory course and all staff need to do a refresher course every three years. Three staff were asked if they had attended the course. One person had in the last year another person had but 2-3yrs ago and the third was supplied to the home by an employment agency. He had not received adult protection training by either the agency or the home. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 20 They were asked about reporting abuse, they stated they would report any suspected abuse to the deputy or manager of the home. It is required they manager provides information about which staff members have completed adult protection training. In order to protect the people from abuse staff must be suitable trained in detecting suspected abuse and the appropriate reporting procedures. Evidence was seen that the staff work to procedures that protect people from some aspects of abuse. For example each shift change over check the peoples money and record the balance. Any discrepancies are noted and reported to the managers. If bruising or marks are noted on a person they are recorded and reported to the managers. The home has an ongoing adult protection issue that has not been completed by the investigating authority. The home has investigated previous issues of the use of in appropriate physical intervention by some agency staff. Some reporting of this information to the Commission was slow. The manager and line managers of the home needs to ensure the recording and reporting of adult protection alerts are conducted swiftly. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 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 was presented in a homely way and was safe. The home was clean and the staff competent to keep it hygienic. EVIDENCE: The home is a large building that is still domestic in appearance. The people share a lounge, dining room, bathrooms and a laundry. Each person has their own bedroom and one person has an ensuite shower room. At the previous inspection the layout of the home was contributing to the conflict amongst the people. The manager and staff had tried to address this situation by creating another smaller lounge on the first floor. This provides an addition space for people to be if they wish to be in a quieter space. It was noted on this visit to the home that the staff engaged with one person in a more positive way and encouraged her to be involved in activities around the house rather than spending a lot of time standing in the busiest part of the 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 22 home. Staff had worked out trying to make the layout of the building work better for the people who lived there and themselves. The home has had some improvements made since the previous inspection. New flooring has been laid in the lounge and hallway making the rooms feel brighter. A staff member said that the wood laminate flooring had made the lounge bigger and easier to clean. Each persons bedroom was organised and decorated to their individual needs and likes. Personal items such as family photos, and items of interest were in their rooms. The people were seen to move freely around the home including using the garden. The kitchen and dining room would be in need of decoration in the near future although generally the home was presented well. The lounge suite was in a poor condition and it is required that the furniture be replaced. The deputy said that the furniture was not very old and the staff had been disappointed about how the suite had deteriorated. Between the firsts and second visit to the home they had a major leak from a pipe in the loft of the home. Water damage was caused to the office and sleeping in room ceilings and furniture. The staff reported that the leak was reported to the maintenance department who took several days to send out someone. The damage to the ceilings was significant and needs repairing and redecoration. The manager said that they had now had an agreement for redecoration. It was required the organisation make good the damage from the leak. The deputy was supporting one person to do some washing and hanging out the laundry in the garden. The deputy was asked about how the staff reduced the risk of spreading infection in the home. She was able to describe the procedures for handling foul laundry and clinical waste. All the staff were trained in Food Hygiene who were involved in preparing food. The home was found to be clean and hygienic. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedures does not fully protect the people who live at the home as gaps were found in documents. Training on offer from the home and organisation should support the needs of the people however a clear audit trail of which staff had received training was not evident. EVIDENCE: A relative spoken to said that the staff had worked very hard to ensure her relative received some medical treatment. She particularly praised two keyworkers who had ensured the treatment took place. She described the staff as kind and caring. She felt her relative was happy living at the home and that he was currently enjoying an active life do more than he had ever done. She acknowledged the recent difficult times at the home and had noted that sometimes the home was short staffed. However she felt the staff had “worked very hard” to ensure that her relative continued to do the things he liked to do. Another relative particularly praised the keyworker of his relative who he thought had provided good quality of care. He was happy with the staffs support of his relative and felt they had done well in helping the person to get out and about more. The relative was also concerned about the staffing situation with the use of agency staff, although the staff were good he was concerned about continuity which he said was important for his relative. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 24 The amount of shifts covered by agency staff was highlighted in the May monthly monitoring report and will be monitored by the Commission. The recruitment records where viewed for four members of staff. Each person had a folder that did not have sections for the required documents received during the recruitment process. Hand written notes on the outside of the folders referred to outstanding documents. Most of the information was complete in the folders however some gaps were noted. One staff file did not have any references. The line manager was present on the second visit to the home when the recruitment records were checked. The issue of having a clearer filling system for the records was raised with her. It was required that all the documents be in place prior to staff working at the home. On the first visit to the home manager was asked to talk about the homes and organisation recruitment procedures. She was able to describe the application and interview process and the documents required to ensure the home was appointing suitable and competent staff. She said she was involved in selection of the staff that would work at the home. Information about staffs attendance of training was not available. It was not clear from their personal files what courses they had attended and when. The manager forwarded the pre inspection questionnaire with a list of courses the Brighton and Hove City Council run for the staff. These were divided into groupings including statutory and mandatory. The manager had written that four of the staff team had undertaken N.V.Q training including herself, three staff had attended risk management and two staff attended adult protection training in the last twelve months. A clear training plan was not evident in the home, although access to training was happening and the manager facilitated applications for training. Three staff were asked about the training they had received. A permanent member of staff had received training in most areas including medication, food hygiene, and fire safety. The other two staff one a relief member of staff and one an agency had not received much training. All said they had received some induction when they came to work at the home. The permanent member of staff said he would ask for training in supervision if he felt he had a gap in knowledge. It was required that the manager provided a copy of a training plan for the staff with information about the induction programme. The member of staff spoken to said the home was “the best place I’ve worked and the team really pull together” Other staff spoken to both from the agency 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 25 and permanent staff team said they liked working at the home. Moral was described as good by the staff spoken to in the May monthly monitoring report. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 26 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well run with improvements needed in record keeping and reporting of incidences. The home does not have a quality assurance system that meets the standard currently in place. The home generally promotes the health safety and welfare of the people. EVIDENCE: The manager has been running the service for some years and is supported by a deputy manager. The staff spoken to said they found the manager and deputy approachable. It was noted that the line manager had also spent more time at the home to assist with the transfer of the service from South Downs NHS Trust to Brighton and Hove City Council. The relatives spoken to said they found the manager and deputy helpful and approachable. One describe when she needed to raise a concern with the 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 27 manager she fully understood her concern and acted on it. The relative went on to described the management and staff as very caring and kind. The manager has made changes in dealing with the conflict between the people who live at the home. She had made changes to the environment so that it could be used to provide people with space away from each other. The ethos of the home has remained strong even when times had been difficult, this is to try and focus on the individual needs. The staff were seen to work hard in engaging with the people and several staff described that the atmosphere and moral in the home had improved. Further work is needed to improve the reporting of incidents and accidents, when restraint is used and medication errors. Staff and the people’s files need improving and the information about staff training and recruitment needs to be clearer. At the previous inspection a requirement was made for the home to develop a quality assurance monitoring tool. The organisation conduct’s monthly monitoring visits to the home and produce a report after each visit. A discussion was had with the line manager to the home who confirmed that Brighton and Hove City Council are developing a quality assurance tool for all the services. The work has currently focused around health and safety monitoring. It is recommended the tool be expanded to include people who live in the service views, their relatives and staff. The inclusion of these views should ensure the quality monitoring meets the standard. The health and safety checks where mainly carried out by contractors from the NHS trust. One the first visit to the home a contractors was present checking the fire detection system. Records were seen of the weekly test the contractors carry out. Fire safety training is undertaken by the Trust and staff attend at the Brighton General Hospital. It was not evident if the home had a fire risks assessment, the manager and staff were unaware if the home had one. It is required the home produce a fire risk assessment. The home is due to transfer to the operational management of the council shortly. It is important for the managers to identify who will be undertaking the health and safety checks in the future and ensures that staff receive the appropriate training. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 2 x 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? YES No. 1 Standard YA2 Regulation 14(1)(ad) Requirement It is required that the home works from up to date community care assessments to ensure they can support each persons needs. (outstanding from October ’05) It was required the manager provide evidence of the plans being completed and implemented. It is required that the home records all incidents of restraint used in the home and provides the evidence of the recording to the Commission. It is required that the manager ensure that people are protected from being handled in an unapproved ways that maybe against their will. It is required that medication errors are recorded and reported appropriately. It is required they manager provides information about which staff members have completed adult protection training. It is required that the lounge furniture be replaced and the organisation make good the damage from the water leak. Timescale for action 30/07/06 2 YA6 15(1) 30/07/06 3 YA16 13(7) 01/06/06 4 YA16 13(5) 13(6) 01/06/06 5 6 YA20 YA23 37(1)(e) 13(6) 01/06/06 30/07/06 7 YA24 23(d) 30/12/06 8 YA35 18(c)(i) It was required that the manager 30/07/06 provided a copy of a training plan for the staff with information about the induction. It is required the home produce a fire risk assessment. DS0000060477.V289417.R01.S.doc 9 YA42 23(4)(a) 30/07/06 Page 30 20 Windlesham Road Version 5.1 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 YA9 YA39 Good Practice Recommendations It is recommended that the manager continued to develop the risk assessment procedure linking in with the reviews of restricted practices within the home. It is recommended the quality assurance tool be expanded to include people who live in the service views, their relatives and staff. 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 20 Windlesham Road DS0000060477.V289417.R01.S.doc Version 5.1 Page 32 - 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!