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Inspection on 04/07/07 for 204 Ashby Road

Also see our care home review for 204 Ashby Road for more information

This inspection was carried out on 4th July 2007.

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 no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a good standard of accommodation with large communal areas and single bedrooms. Individuals are able to choose which parts of their home they use and can spend time alone. People who use the service are able to continue and develop close relationships with family and friends and can receive visitors to the home or are supported to visit the family home. The home has robust recruitment procedures to ensure the protection of individuals, and all required pre-employment checks are carried out including obtaining a Criminal Records Bureau Check (CRB). For overseas workers a Police check is obtained from all countries where individuals have lived with official translations where appropriate. Staff receive a comprehensive induction for the first week of employment, covering the Health and Safety, moving and handling, abuse and disability awareness.

What has improved since the last inspection?

The registered person has reviewed the systems for storage of Controlled Drugs to meet recommended guidelines. Individuals now have protocols for administration of `as required` drugs. Staff records contain all required documentation and evidence of preemployment checks including a photograph of each member of staff.

What the care home could do better:

Plans of care are not person centred and have not been regularly reviewed, to ensure they reflect up to date needs or the support required. One plan resulted in limitations being placed upon an individual, in relation to access to community activities as appropriate documentation was not available. Without appropriate guidance staff had different interpretations of support required and expectations. There is little evidence to demonstrate that people who use the service are involved in the formation and review of plans of care, or alternative options for supporting individuals through an advocate or a representative has not been evidenced. Information and assessments regarding the support individuals require need to be used to enable the individuals. Assessments and statements have been written which disempower individuals and prevent people who use the service from playing an active role and being able to make informed choices. Plans of care need to be reviewed to reflect up to date needs and evidence appropriate consultation and agreements. Any limitations placed upon individuals` needs to be legally and ethically bound and evidence of agreement. Assessments of risk need to be person centred. A large number of assessments are generic and do not reflect an accurate representation of identified risk, or measures in place to support the individual or reduce the risk, including a generic assessment for evacuation in the case of fire. The registered service needs to review activities and educational opportunities within the local community. Individuals do participate in a limited number of social, recreational or educational activities and time within the home is spent in with passive activities. It is unclear how individuals receive appropriate support for the funded one to one hours. The staffing roster does not reflect individual work and the Service User Guide has not been reviewed to incorporate fees.The registered person needs to ensure that requirements from previous inspections are addressed. Two requirements in relation to the Service User Guide and a development Plan arising from a Quality Audit have not been met although identified within the previous two inspections. Due to the poor outcomes for individuals the home will be subject to a Management review by the Commission for Social Care Inspection. A management review is a key part of the enforcement process whereby the Commission sets out what we will do to get the care provider to improve the service. The action the Commission will take will depend upon what effect this is having on the people using the service and how the care service provider responds.

CARE HOME ADULTS 18-65 204 Ashby Road, Burton On Trent Staffordshire DE15 0LA Lead Inspector Mrs Mandy Brassington Unannounced Inspection 4th July 2007 09:00 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 204 Ashby Road, Address Burton On Trent Staffordshire DE15 0LA 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) 01283 517020 carol.walton@robinia.co.uk Robinia Care Homes (2) Limited Carol Walton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2006 Brief Description of the Service: Number 204 Ashby Rd is a large period semi-detached house located in a residential area, on the outskirts of Burton upon Trent. The other half of the semi-detached property is privately owned. The home is registered to provide accommodation to six adults with a learning disability. The home currently provides care for four adults with severe learning disabilities and complex needs and individuals who have been diagnosed as having needs on the Autistic Spectrum Disorder. The home is conveniently situated near to town centre, on a bus route and close to shops and all amenities. The house is set back from the main road and has tarmac drives and adequate parking space. The building is on four floors (including basement) and comprises six bedrooms, an office, lounge, dining/activity room, kitchen/dining room, art room, two bathrooms each with bath, shower and toilet, two separate toilets, laundry room and storage. The home is not suitable for any person with a severe physical disability. There is a very large garden at the rear and a useful patio area. Suitable outdoor furniture has been provided, including swings. A care manager and a team of support workers provide care. The home has its own multi-seat vehicle, which is available for use by people who use the service. It was reported by the senior person in charge on the day of the inspection that the care fees range from £1,509 per week to £2,435. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was an unannounced key inspection and therefore covered all of the core standards. The inspection took place over 9 hours by one inspector who used the National Minimum Standards for Younger Adults as the basis for the inspection. A tour of the home was undertaken. On the day of the inspection, the home was accommodating four people. The inspection included an examination of records, indirect observation, discussion and observation of three people who use the service, and five staff on duty. Case tracking of three care plans was undertaken. Three staff records were examined and observation of daily events took place. Inspection of the storage system and medication procedures were inspected. An Immediate requirement notice was issued on the day of the inspection in relation to limitations placed upon one individual and a further thirteen requirements and three recommendations were made as a result of this visit. What the service does well: The home provides a good standard of accommodation with large communal areas and single bedrooms. Individuals are able to choose which parts of their home they use and can spend time alone. People who use the service are able to continue and develop close relationships with family and friends and can receive visitors to the home or are supported to visit the family home. The home has robust recruitment procedures to ensure the protection of individuals, and all required pre-employment checks are carried out including obtaining a Criminal Records Bureau Check (CRB). For overseas workers a Police check is obtained from all countries where individuals have lived with official translations where appropriate. Staff receive a comprehensive induction for the first week of employment, covering the Health and Safety, moving and handling, abuse and disability awareness. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Plans of care are not person centred and have not been regularly reviewed, to ensure they reflect up to date needs or the support required. One plan resulted in limitations being placed upon an individual, in relation to access to community activities as appropriate documentation was not available. Without appropriate guidance staff had different interpretations of support required and expectations. There is little evidence to demonstrate that people who use the service are involved in the formation and review of plans of care, or alternative options for supporting individuals through an advocate or a representative has not been evidenced. Information and assessments regarding the support individuals require need to be used to enable the individuals. Assessments and statements have been written which disempower individuals and prevent people who use the service from playing an active role and being able to make informed choices. Plans of care need to be reviewed to reflect up to date needs and evidence appropriate consultation and agreements. Any limitations placed upon individuals’ needs to be legally and ethically bound and evidence of agreement. Assessments of risk need to be person centred. A large number of assessments are generic and do not reflect an accurate representation of identified risk, or measures in place to support the individual or reduce the risk, including a generic assessment for evacuation in the case of fire. The registered service needs to review activities and educational opportunities within the local community. Individuals do participate in a limited number of social, recreational or educational activities and time within the home is spent in with passive activities. It is unclear how individuals receive appropriate support for the funded one to one hours. The staffing roster does not reflect individual work and the Service User Guide has not been reviewed to incorporate fees. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 7 The registered person needs to ensure that requirements from previous inspections are addressed. Two requirements in relation to the Service User Guide and a development Plan arising from a Quality Audit have not been met although identified within the previous two inspections. Due to the poor outcomes for individuals the home will be subject to a Management review by the Commission for Social Care Inspection. A management review is a key part of the enforcement process whereby the Commission sets out what we will do to get the care provider to improve the service. The action the Commission will take will depend upon what effect this is having on the people using the service and how the care service provider responds. 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. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken and individuals and their family have opportunities to visit the home. All people who use services are given a copy of the Service User Guide, which is available in pictures but this does not include details of the care that has been funded and one to one support. EVIDENCE: The home has a Statement of Purpose that was available in the home and provided information regarding the service philosophy aims and objectives and terms and conditions. Each person had their own copy of the Service User Guide in their care files, which used pictures and symbols to support understanding. The previous inspection identified that action was required to ensure the Service User Guide for each person included the fees applicable and a break down of the cost of the service, as it is unclear as to the number of additional one to one hours and how these are delivered in the home. As this requirement has not been addressed this will form part of the Management review conducted by the Commission for Social Care Inspection. The action the 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 10 Commission will take will depend upon what effect the lack of response by the Care provider is having on the people using the service. Since the last inspection there have been no new admissions to the home. One individual has moved out of the home to a different service. There has been one new referral since the last inspection. Records demonstrated that suitable assessments were being completed. A copy of the assessment was available in the home. It is recommended that the assessment is signed and dated by the person completing the form and includes reference to other people involved. Staff reported that the individual has been able to visit the home and meet staff and other people. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Each person has a plan of care but individuals are not involved with the formation or review. Risk assessments are generic and are not person centred or reflect individual’s needs. Limitations have been placed on people living in the home without appropriate consultation or agreement. EVIDENCE: Three care plans were examined during the process of the inspection. The plans were written in the first person and covered daily activities, decisions to be made and personal preferences. The plan of care had been devised in April 2006 and there was no evidence that this had been reviewed to reflect any 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 12 changes in needs or support. Aims and objectives had been completed for domestic assistance, finances and were reviewed on a three monthly basis. Assessments of risk had been completed for activities in the community and in the home; the assessments were not person centred and inspection of records revealed that the same assessment had been used for all individuals in a significant number of areas. All persons had a risk assessment for gambling though staff reported that only one person used a slot machine. The fire risk assessment and evacuation procedure was identical and discussions with staff revealed that this was not suitable and would place individuals at risk. The registered person must ensure that plans of care are up to date and reviewed. Assessments of risk need to be suitable and person-centred. The plans of care and reviews did not contain information relating to consultation with the person who used the service or their representative or advocate, and there was no evidence of any agreement. One individual has been receiving support from the Densy Group. Due to concerns regarding fears and anxiety when in the community, a Desensitisation Programme had been devised including a two week assessment in April. This plan had been archived and was not easily available for inspection. Following the two week period, staff stated that the recorded observations were taken for assessment and no copies were available in the home on the day of the inspection. The Desensitisation Programme was to be reviewed on 27 April 2007. There was no evidence that the review had been conducted. Staff reported that the individual has limited activities in the community until a new Programme had been devised. Staff’s definition of ‘limited’ was varied and the outcome for the individual was support to access community activities was reduced. Activities had been conducted in the home including time in the sensory room, arts and crafts and visits by family members. There was no evidence available of any agreement in relation to the restriction of liberty. Any restrictions on choice or freedom, based on specialist needs and risk likely to become part of an individual Plan, are to be discussed and agreed with the person who use the service or their representative, and to include the individual’s social worker and/or advocate as appropriate. There needs to be safeguards in place, to ensure that any restriction is legally and ethically bound, this is particularly the case in relation to restriction of movement and liberty It is a serious concern to the Commission that activities in the community had been limited. Required documentation regarding the initial consultation, assessment and agreement to the Desensitisation Programme, information 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 13 relating to activities and the role of the placing authority is to be forwarded to the Commission. One plan of care contained an assessment for an individual and concluded that due to his identified needs he was not able to do a weekly menu plan. The assessment disempowered the individual. Discussion with the individual revealed the he was able to make a choice of foods if presented in a suitable format; staff confirmed this. It is a concern to the Commission that an assessment has been conducted that limits an individual ability to make decisions and have suitable choices. The registered person needs to review the plans of care and to ensure they are person-centred and the individuals are included in the formation and review. The plans are to reflect how decisions have been made and needs to consider the guidance for the Mental Capacity Act 2005, which will come in to force in October 2007. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are aware of the need to support individuals to develop their skills. People using the service, are given the opportunity to take part in a small variety of activities both within the home and in the community. Limitations have placed restrictions on accessing community facilities. EVIDENCE: The individuals do not currently attend any educational courses or work placements and staff within the home provide activities. Inspection of daily records revealed one individual chooses to spend a large part of time in the sensory room or involved with craft activities. As discussed within the outcome group for Individual needs and Choices, limitations have 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 15 been placed on social and community activities; this was agreed by a senior manager that this would cease from the day of the inspection. Suitable consultation and agreements are to be carried out to ensure the individual has access to suitable community activities. On the day of the inspection one individual went ten-pin bowling with a member of staff. In the afternoon the individual chose to sit in a quiet area of the home with a large jigsaw, upon completing the jigsaw with the individual it was noted that there were many pieces missing. One individual was listening and dancing to music and later spent time in the sensory room and completed some craft activities. Positive interaction was observed between the individual and staff and the person was laughing, smiling and dancing with staff. Discussion with staff and inspection of records revealed that individuals have been involved in arts and crafts, shopping, listening to music and singing, having a meal out and going for a walk. A large number of entries in daily records reported individuals stayed at home looking out of the window, or watching traffic, and the current weather conditions of heavy rain were recorded as causing some distress to two individuals. The home has a vehicle to use but staff reported there is a limited number of drivers able to use the car. The plans of care contained details of individual’s preferences for activities but there was little evidence to demonstrate how individuals were enabled to participate in activities of their choice or involved in structured activities or for opportunities to develop skills. It was recorded in daily notes that individuals have chosen to stay inside or listen to music and refused other activities. There is no evidence to demonstrate how the home is being proactive in the planning of activities and utilising all local resources, to engage individuals in meaningful activities in the home or in the community. The poor levels of engagement were addressed within the last Key Inspection in October and this has not been addressed. Some of the people who use the service have additional one to one hours funded through the placing authority. As addressed in the Outcome for Choice of Home, the service user Guide has not been reviewed to reflect the funding arrangements and it is unclear how many hours each person receives, and how the registered person uses these hours to support the individual. Individuals are able to maintain close relationships with family members and friends. Individuals are supported to visit the family home or are able to receive visitors to their home. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 16 In the kitchen a menu of the days meals to be served was displayed using pictures and photographs. The home has a menu plan and staff reported that generally only one choice of meal is served daily. On the day of the inspection, the evening meal consisted of pork chops, potatoes and vegetables. Discussion took place with staff regarding enabling individuals with opportunities to choose their meal. This was discussed with the person in charge on the day of inspection, in conjunction with the assessment regarding menu planning as discussed within the outcome group for Individual need and Choices. The registered person needs to explore methods to provide individuals with opportunities to choose or plan each meal. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use services have access to health care services both within the home and in the local community. Health needs are monitored and appropriate action and intervention taken. Evidence of decisions regarding personal care and any intervention are not always available to ensure consistent person centred care is delivered. The home has robust systems in place to ensure suitable medication systems and practices are in place. EVIDENCE: Plans of care recorded personal health care needs, a record of visits to health care professionals and any outcomes was maintained. The previous inspection identified the introduction of Health Action Plans, these continue to be developed though staff reported the completion has been affected by further new systems of recording being implemented. The individual’s medical file had no evidence of service user involvement. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 18 There was evidence of health care professionals involvement to meet identified needs and the registered service contracts with a Psychology Service to provide assessment and support to individuals in the home. As addressed within the outcome group for Individual Needs and Choices, required documentation regarding consultation, assessment, and agreements were not available in the home for one individual and as a result staff had developed different practices for working alongside individuals. To ensure consistency, good practice and to meet identified needs, the registered manager must ensure that copies of all work and assessment carried out by the organisation are maintained in the home. People who use the service have complex needs and have high dependency needs and all individuals require personal care. Observation of daily activities revealed personal support is responsive to the varied and individual needs and preferences of the people who use services. Staff demonstrated a good knowledge of the support individuals require and used appropriate methods of communication to which individuals responded positively. Medication is stored in a locked cabinet in the home and the Monitored Dosage system (MDS) is used. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Individual protocols for ‘as required medication’ (p.r.n.) were on file. Medication records contained required entries, and were signed by a staff. A monthly audit of the medication system and records is carried out in the home. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand and is displayed in within the home. The policies and procedures for Safeguarding Adults are available and staff know when incidents need external input and who to refer the incident to. EVIDENCE: The home has a complaints procedure that is clearly written and easy to understand using a suitable system of pictures. The complaints procedure is supplied to everyone living at the home and is displayed in the home. Inspection of records and discussion with staff revealed there has been one complaint from a neighbour regarding summer games equipment being found in the their garden. The service provider has fitted netting to the top of the fence to prevent balls and equipment from straying in to the garden. Staff have received training for safeguarding adults and this is included as part of the induction of new staff. Through discussion staff demonstrated an understanding about when incidents should be reported and how to respond to an alert. Where a referral has been made staff have always attended meetings and provided appropriate information. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use services are encouraged to personalise their bedrooms to reflect their interests and domestic furniture has been used throughout the home to provide a homely atmosphere. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, though the temperature of the bath was too low. EVIDENCE: The home is a large semi detached property in a residential area of Burton on Trent, located on a busy main road. The home has a main front entrance and a side entrance leads into a small fenced area and provides some security for people who use the service once they leave the home. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 21 The accommodation consists of a large entrance hall, with a large lounge, lounge/dining room, kitchen/dining room, toilet and an office on the first floor. There is a large basement, which accommodates a sensory room, an activities room, a laundry and a medical room. The first floor is on two levels and provides five bedrooms, all of which were large single rooms, and none had an en-suite. The home’s main bathroom and separate toilet are located on this floor. The main bathroom was locked during the day to prevent a service user flooding it. The water temperatures are measured monthly and a number of the temperatures were low including the main bathroom on the first floor, which recorded 38 degrees. The recommended temperature is around 43 degrees. The water temperature was checked on the day of the inspection and it was agreed that this was not a suitable temperature for bathing. The temperature needs to be raised so individuals do not bathe in cool water. Individuals were able to personalise their rooms to reflect their interests. Staff had explored methods of finding suitable equipment and furniture, which was domestic in design but suitable for potential complex behaviour exhibited by individuals. On the day of the inspection one individual had the night stars painted professionally on his ceiling to represent star constellations. An Ultra Violet light was installed and two florescent football pictures to reflect his interests were painted on the wall. The individual visited his room upon completion and began to manipulate his favourite possessions in the specially lighted room, which staff reported was a positive reaction. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a good recruitment procedure for the protection of individuals and staff are supported through a comprehensive induction programme. The Staffing rotas does not take into account additional one to one support for individuals in addition to the core care hours provided. EVIDENCE: On the day of the inspection the staff on duty consisted of:1 Team leader working 7.30am – 3.00pm 1 Care Assistant working 7.30am – 3.00pm 1 Care Assistant working 9.00am - 9.00pm For the afternoon 1 Team Leader working 2.30pm – 10.00pm 1 Care Assistant working 2.30pm – 10.00pm There were two waking night staff working 9.45pm – 7.45am. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 23 Staff reported that the shifts were flexible to meet the needs of individuals and any planned activities. The Area manager reported the registered manager is able to organise the shifts flexibly. Concerns were raised by staff regarding the length of some shifts; the registered manager should ensure that all hours worked by staff meet the requirements of The Working Times Directives. Inspection of the home’s roster, contracts for individuals and from discussion with staff, revealed it was unclear to the total number of hours contracted by the placing authority, to provide one to one hours. The Service User Guide had not been reviewed and individual’s contracts were not available. The Staff roster does not record how and when these hours are used. It is required that a review of staffing is completed to demonstrate the core care hours provided and one to one funding individuals receive. The review is to demonstrate how this support is provided to meet individual’s assessed needs. This was identified within the previous inspection and has not been addressed and therefore, will form part of the Management review conducted by the Commission for Social Care Inspection. On the day of the inspection a planned staff meeting was conducted. The meeting was well attended and staff reported the meetings are generally conducted monthly and the agenda is flexible. Inspection of three staff records demonstrated all required pre-employment documentation, including a copy of identity, appropriate work permits, two references and a satisfactory Criminal Records Bureau Check (CRB) was in place to ensure the safety and welfare of individuals in the home. Staff receive a weeks training when commencing employment and the induction includes Fire Safety, Values, Moving and Handling, Health and Safety, Infection Control, Disability Awareness, Abuse and Care Planning. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service provision is not user focused and management of care planning systems have resulted in individuals being disempowered. Responsibility for the management of the home is the responsibility of the registered person and clear boundaries are to be in place for external agencies. Generic assessments of risk for fire evacuation places individuals at risk. EVIDENCE: The registered manager had ensured that all maintenance work, repairs, annual checks, testing of equipment and regular fire drills were undertaken. Fire risk assessments for individuals were generic and discussion with staff 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 25 revealed these would be unsuitable to ensure safe evacuation of individuals. It is required that the risk assessments be reviewed. Hot water temperatures are checked monthly, some temperatures were unsuitable as recorded as 38 degrees. Fridge and freezer temperatures are recorded daily. Portable appliances were tested in June2006 and now due. Gas Safety test was conducted in February 2007. Public Liability Certificate was displayed and valid until September 2007. The registered provider conducts an annual quality review of the service and includes information on the catering and food, personal care, the premises, daily living and management. An annual quality assurance had been carried out in June and July 2006 and it was identified during this inspection and within the previous visit that a number of comments were negative. Staff stated they were not aware of any action to review the service and an annual report had not been compiled. The requirement to complete an action and development plan has not been addressed, and will therefore the lack of response from the registered person will be considered within the management review. The registered person completed the Annual Quality Assurance Audit for the prior to inspection of the home. Due to the complex needs of individuals, Service users Questionnaires were completed by staff. It is recommended that the registered person explore other methods of supporting individuals to participate in any quality audit. The current service provision is not user focused and there is no evidence of consultation or agreement with individuals. As addressed within the report, the plans of care and assessments have disempowered and limited individual’s rights. It is also a concern to the Commission that an External Agency has assumed responsibility for some of the care and practices in the home. It is the registered person’s responsibility to ensure that the Care Standards Act and Care Homes Regulations 2001 are upheld within the home and required evidence is available. Due to the poor outcomes for individuals in relation to individual needs and choices and conduct and management of the home, and unmet requirements from the previous report, the home will be subject to a Management review by the Commission for Social Care Inspection. A management review is a key part of the enforcement process whereby the Commission sets out what we will do to get the care provider to improve their service. The action the Commission will take will depend upon what effect this is having on the people using the service and how the care service provider responds. 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 2 15 3 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 2 2 X X 1 X 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation Requirement Timescale for action 24/08/07 (5)(1)(bb)(bc)(c) The Service User Guide does not include the current rate of fees charged, including any additional fees and a breakdown of how those costs are calculated. The registered person must ensure that people accessing the service are aware of all costs. Previous timescale not met 05/10/06, 09/12/06 15(1) The plans of care need to be reviewed to ensure they are person centred, reflect up to date needs of individuals and enable individuals to develop necessary skills, to ensure peoples needs are met appropriately. The plans of care are to include evidence of consultation and agreements with individuals or their representative to ensure agreement is DS0000004912.V344970.R01.S.doc 2 YA6 20/08/07 3 YA6 15(1)(2) 20/08/07 204 Ashby Road, Version 5.2 Page 28 obtained and plans need to be kept under review 4 YA6 17 (1)(a) Limitations placed upon 04/07/07 individuals in relation to community activities are to be cease with immediate effect. Any limitation is to be agreed and appropriately recorded. As Schedule 3 (q) Documentation regarding the initial consultation, assessment and agreement to the Desensitisation Programme, information relating to the continued loss of liberty for the individual and the role of the placing authority is to be forwarded to the Commission, and a copy available in the home. Assessments of risk are to be reviewed to ensure they are person centred, appropriate and reflect the identified risk and support for people who use the service. 11/07/07 5 YA6 17(1)(a) 6 YA9 13(4)(b)(c) 14/07/08 7 YA12 12(1)(b) To explore options for 30/08/08 development of skills and educational activities in consultation with people who use the service or their representative, in order that suitable activities are provided. In consultation with people who use the service or their representative, make arrangements to enable individuals to engage in local, social and DS0000004912.V344970.R01.S.doc 8 YA14 16(2)(m) 30/08/07 204 Ashby Road, Version 5.2 Page 29 community activities. 9 YA18 17 (1)(a) To keep any records in 11/08/07 relation to assessment, care planning and agreements, to ensure a consistent and appropriate plan of care is available, as Schedule 3 (1)(b)(m)(q) The water temperature in the first floor bath needs to be around 43 degrees to enable individuals to have a warm bath. Staffing provided in the home is to demonstrate how additional support hours are provided to meet individuals needs. 24/07/07 10 YA27 23(2)(j) 11 YA33 18(1)(a) 24/08/07 12 YA39 24(1)(2)(3)(4) The registered person 30/08/07 should produce an action and development plan based upon the outcomes of the quality survey undertaken earlier this year to demonstrate how individual’s views are reflected in the review of the service. Previous timescale not met 09/12/06, 05/10/06 Fire Risk assessments are to be reviewed to ensure they reflect the dependency levels of individuals and suitable methods for safe evacuation. 24/08/07 13 YA42 23(4) 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA6 YA39 Good Practice Recommendations Assessments of new referrals should include details of persons involved and be signed and dated. The service should make further efforts to fully implement a person centred approach to care. To explore options to assist individuals to participate in quality audits and complete questionnaires 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Stafford Local Office Unit D, Dyson Court Staffordshire Technology Park Beaconside STAFFORD ST18 0ES 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 204 Ashby Road, DS0000004912.V344970.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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