Inspection on 07/11/07 for 21 Lime Street

This inspection was carried out on 7th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 21 Lime Street Evesham Worcestershire WR11 3AW Lead Inspector Sue Davies Draft - Unannounced Inspection 7th November 2007 11:00 21 Lime Street DS0000069582.V342936.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 21 Lime Street DS0000069582.V342936.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. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 21 Lime Street Address Evesham Worcestershire WR11 3AW 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) 01386 422 017 Noble Care Ltd Mr Martin William Crookston Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes between the age of 18 and 65 whose primary care needs on admission to the home are within the following category: Learning Disability (LD) 8 The maximum number of service users to be accommodated is 8 2. Date of last inspection 17th January 2007 Brief Description of the Service: 21 Lime Street is a residential care home in Evesham, which provides specialist support for up to eight people with a learning disability and associated behaviour, which challenge the service. Service users have complex and diverse needs. The home is a spacious home, which offers single bedroom accommodation and is close to Evesham town centre. The registered provider is Noble Care Limited. The registered manager is Mr Martyn Crookstone. Current fees for this service range from £975 to £1400 per week 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was made to carry out a statutory key inspection. The focus of this first inspection since the new registration was to monitor the management and service provision at the home. Preparation for the inspection included information about the home’s recent history, the Annual Quality Assessment Audit, contact information and monthly visit reports completed by the provider. The inspection was undertaken over the late morning to early afternoon and later in the evening on the day of inspection. Time was spent talking with the manager, staff and all service users, who all indicated they were generally happy to be living and working at 21 Lime Street although some matters of concern were raised for attention. Some service users provided a tour of the building and their own rooms. The care records of 2 service users were seen, and delivery of care and support was discussed with the manager and staff members. Records kept in respect of complaints, staffing, medication and food provision, and a sample of the home’s written policies and procedures were also checked. The time and assistance everyone made available for the inspection were much appreciated. What the service does well: Service users with various difficulties have good help from staff to live together in a small family style home and to have more responsibility and control over their own lives. They receive individual support from staff who understand them well, make the most of training and are very keen to help them make the best use of opportunities to build their life skills and confidence. The communal areas are generally well looked after and staff are supporting service users to make the home their own but much more work needs to be done upstairs to make sure it is a comfortable place to live. Staff and service users treat each other with friendly consideration and respect, and daily routines reflect the service users chosen lifestyles. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 6 The new owners have spent a lot of time getting to know the service and the people who live and work here, and this has helped people feel better about the changes that have happened. What has improved since the last inspection? Staff have had more training to improve service users’ safety and well being, although better staff training records need to be kept to show this. Service users can be confident staff know and understand better the special support they need and can do this skilfully, as staff are all encouraged to undertake care practice training at National Vocational Qualification levels 2, 3 and 4. Recent training in the last year has included how to take care of risk and being able to deal safely with behaviour that is challenging, and the new providers have brought this up to date with training in recognising and responding to abuse, and understanding better how to support people’s sexual health needs. Service users can be sure staff understand better how to work safely as staff report most of them are now trained in fire safety, health and safety, food hygiene and moving people. Service users and their key workers continue to work together on making sure their care plans are written clearly from their own point of view. Their care records show staff listen to what they say about how they want to live their lives, and are helping them develop this information in their Essential Lifestyle Plans within their care plans. These are very individual and detailed, and show very clearly the many ways staff give service users the individual and personal support that suits them best. All care records are well written, showing staff have a professional approach. Although one staff has left, the staff group has not otherwise changed since the last inspection. This means staff are developing their knowledge and skills to a good standard. They and service users are getting to know and understand each other very well, and this gives everyone more confidence about getting the right support. Service users have a copy of the complaints procedure they can easily understand, including an excellent audio guide, so they know how to complain if they need to. They feel they can talk to staff if they have a problem, and that staff put things right for them quickly. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 7 The service is committed to taking complaints seriously. One service user has used the formal procedure and has had a written reply with an undertaking to respond within the stated timescale (action has been initiated, although the Commission has drawn attention to the need for use of safeguarding procedures – see ‘what they could do better’ below). What they could do better: Service users must be able to feel confident their well being is safeguarded by a soundly managed service. The staffing and management arrangements need attention to make sure the manager has the time to do his job properly. This is a complex service that needs to have its own full time manager, but this manager is responsible for more than one service and is also included on the staff rota. This means there is unlikely to be enough time available for service management. The building has been neglected so it is not a comfortable or safe place to live. It needs a lot of improvement and this needs to be done quickly to a good standard. The providers have supplied some information showing how they are already attending to some matters with proposals for overall improvement, and this will be followed up at future inspections. Service users need to be confident staff training keeps up with their needs. Although good staff training is valued, training management needs improvement. There needs to be a proper training budget and plan. Individual staff training records must be complete, clear and up to date. The right procedures must be used to safeguard people from unfair treatment. When a lot of people with different needs live together relationships can sometimes be difficult. Some people are unhappy with some things that have not been working well at 21 Lime Street and have told the manager so. Complaints made have been responded to but more needs to be done. The providers and manager have been reminded of the need to use local safeguarding procedures too. Better management arrangements should make sure there is enough time for management duties. The providers must make sure they have done enough to make real improvements, for example by making thorough checks at monthly visits. A full quality assurance system needs to be set up so service users have a real voice in how their service develops in future. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 8 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. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 9 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 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. While there is no current vacancy the service is well prepared should one arise, to help future service users make the right decision about whether the home would be right for them. EVIDENCE: The current service users are settled and any change in the resident group is unlikely for now. However should this happen, there is a good approach to admitting new people with a chance for the new service user and staff to meet first and get to understand each other well. There are opportunities for a visit, meeting other service users and staff, and staying overnight in the home, to help prospective service users, their carers and supporters in reaching decisions about moving in to the home. 21 Lime Street DS0000069582.V342936.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have care plans that are beginning to help them explain their needs and hopes in their own words, so that staff understand and respond to them in a more person centred way. Service users are being helped towards playing a bigger part in the decisions about their own lives. Staff all need training in working in a really person centred way to make this work properly for all service users. It will help this process to review the way all personal records are structured, to integrate information about all aspects of a service user’s needs, well being, interests and goals so that it is well coordinated. EVIDENCE: Service each have a service user plan. Each service users needs and personal preferences in the way they are supported and enabled, are recorded with 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 12 them in their Essential Lifestyle Plan within their service user plan. This says in their own words what is important to them about their life and the help they have. One service user showed and talked about his plan but explained that he could not read it himself. The service user demonstrated the audio service users guide enthusiastically and said how helpful he found this. This shows the service has understood the need for alternative communication but needs to address this more broadly. There is therefore a need for staff training in total communication, and a more comprehensive communication strategy within the home. This service user felt staff were supporting him well so that he was able to play a bigger part in decisions about his life, but wanted a complaint resolved so that he could get on with his life confidently without fear. He explained his concerns in detail with the help of a staff member and it was evident he trusted staff to give him the support he needs. (see also Complaints and Protection) Service users take part in reviewing their service user plans monthly with the provider, manager and their key worker. Placing authorities also hold regular, although less frequent, reviews. Service users decide who they wish to invite to their in house reviews. They are supported to take a key role in all their regular reviews, agreeing action plans to work on with staff support. This process helps each service user to look at their own needs and goals, and work towards making more decisions about themselves and how they live their lives. Full training in using a person centred approach and the use of alternative communication methods will help staff make sure this works well for all service users. All service users here face challenges in managing their daily lives and areas of risk. Staff support them to identify and manage risks, in a way that helps them gain more control over their own lives. Service user plans show how they deal with risky situations and any support and guidance they may need, together with any agreements that may be reached with them about limitations on their behaviour. Care should be taken to make sure the plans are reviewed and updated. For example one service user is now able to go to local shops unaccompanied, but although care records show the steps towards achieving this and the procedure to be followed, the risk assessment has not been updated. Observation showed staff are careful to respect service users’ privacy and confidentiality in practice, but more care needs to be taken over the display of personal information in the office. Risk management details on the notice board need to be kept in service user plans. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users generally have good contact with their families, and enjoy a variety of individual and group activities both within and outside the home, which are appropriate to their age and interests and offer the chance to try new experiences. EVIDENCE: Each service user has good staff support to develop a fulfilling lifestyle. As they get to know each other better, staff understand the things that are most important to service users and what suits them best, they are continuing to move forward in their lives. Service users are well supported to look after their home together and take part in their community. Staff help them plan the things they would like to do, to build on their skills and confidence, and to widen their circle of friends and acquaintances in a planned way that suits their particular needs. As well as household chores and planning and cooking meals, activities at home include 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 14 using the computer, gardening, arts and crafts, puzzles and games. A system of therapeutic wages is used to motivate and encourage service users who need specific help, who receive ‘wages’ for undertaking some extra household chores such as cleaning the car. A new computer and satellite television have been purchased, with other developments planned for the future to further extend lifestyle opportunities. Service users lead varied, active and fulfilling lives. They go out daily to college, day centres and voluntary jobs. Some of the many things they enjoy outside the home in leisure time include going to the cinema, bingo, out to the pub and for meals, shopping including car boot sales and markets, photography and sports such as snooker and pool, bowling, bike rides, swimming fishing, and walking. Most have good contacts with family and friends, go to church if this is important to them, and all have the chance to enjoy trips out and holidays of their own choosing, in Britain and abroad. Photographs around the home, on computer and in the ‘house newsletter’ show how much these are valued and enjoyed. Everyone takes turn to plan and cook meals with a member of staff after all discuss what they want to eat for the week ahead, and the menus are recorded in writing and pictures so everyone knows what to expect. A sample menu seen gives limited information but service users and staff explained the aim is for balanced and healthy meals. The written record needs to include more detail so that this is clear. People can choose something different if they want to, so this must be written down too. An observed mealtime was a casual, friendly social occasion, which some service users and staff joined in as they arrived in the home while other staff and service users went for meals out. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is some good practice and as staff training has been extended they are improving their knowledge and understanding of service users personal and health care support needs. This support is being developed to help service users build on their personal awareness and skills in a planned way, to help them develop more control over their lives. Medication arrangements require some improvement. EVIDENCE: Service users know their records contain up to date information about the help they need so that staff can understand and support them properly, as they prefer, so that they keep well and active as far as they are able to and enjoy life. Staff spoken to were able to describe service users needs in depth and clearly understood them well. One service user showed and talked about his service user plan and with staff help explained how this worked for him. It identifies and clearly explains his personal and healthcare needs, and the help he gets from staff. The service 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 16 user is unable to read so had to rely on staff to explain his records. While it was clear the service user has full confidence in the staff to do this, he would like to be able to understand and contribute to his own records more effectively and total communication techniques could be used to support this by providing his plan in a more suitable format for him. Service users have also been working with key workers to develop health action plans, and staff confirmed these are now up to date. Each service user is supported to take responsibility for their own personal and healthcare, and where help is needed this is given in a way which has been discussed and agreed with them. Any agreements about how they are to be supported are carefully written into their plans, for example where it is important to follow a special diet. The structure of service user plans needs to make sure personal and healthcare information is fully integrated and coordinated to inform forward planning from the service users point of view., although service user plans could be better integrated and coordinated to help staff understand and support the service user as a whole person. For example if information about progress and the effects of change are clear, staff can help service users understand and take a full part in planning their own future. Service users involvement in their care planning is clear from their records and in discussion with them, and they are supported to take a key role in their regular reviews, held monthly. Each service user has a daily diary where dayto-day care, events and activities are recorded. The keyworker uses this as the basis of a monthly summary, which is used to monitor progress and contribute to regular care reviews. Reviews are attended by the service user and recorded. If the review shows care plans need updating this is done as needed, signed and dated. Care plans seen confirmed this process. Although service users here are generally quite independent in looking after their personal care each has particular physical and/or emotional needs they rely on staff to support them with. Where needs and behaviour may challenge the service, such incidents are recorded to help staff and the service user follow up what is happening and why, and to check the right help is given. For this to work well staff need a clear policy and procedure to guide them, for consistency. Incident records need to be kept in a way that can contribute to the overall picture, and be regularly reviewed with the rest of the service users plan. It is important this record is written in a person centred way too, to help the service user explain how they are feeling and why, and what they need to help them manage better. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 17 Evidence from records seen and discussion with staff indicates all but one staff now have suitable medication training. The remaining member of staff needs to complete this training before administering medication. Medication administration practice was observed. No service users take responsibility for their own medication, and this is appropriately recorded although service users’ capacity for this must be kept under review. Administration is carried out with due care, and respect for service users’ dignity and privacy. Two staff do this together, the staff were reminded of the need to make sure the administration record is signed by the person who gives the medication to the service user. There is limited need for medication and no controlled drugs are currently used. The medication storage arrangements were checked. Most medication is in a monitored dosage system that is stored in a proprietary medication cabinet containing dedicated storage for controlled drugs if needed. However this needs attention as the cabinet is in poor condition with chipped paintwork allowing some rust, and the lock although working has been damaged. This must be attended to. A quantity of medication was being stored in the controlled drugs compartment awaiting return to the pharmacy and staff were advised this needs to be done promptly as the cabinet did not have enough space for some creams, these were being stored on adjacent open shelves that also contained cleaning materials and empty alcohol bottles. All medication must be stored in a secure locked cabinet suitable for the purpose. A reminder was also given to make sure creams and liquid medication are dated on opening. Medication records sampled were seen to be in order. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Procedures for protecting service users interests are in place. The complaints procedure has been provided to all service users in suitable formats. Staff have received safeguarding training including in the provisions of ‘No Secrets’ and local procedures for responding to abuse. However, safeguarding procedures had not been considered in response to a recent complaint. EVIDENCE: There is a sound approach taken towards encouraging service users to air their views and voice any concerns. Care is taken both in every day communication and support and as part of the review procedure to encourage them to do so. The complaints procedure has been provided to all service users in written and an audio format. Service users are familiar with the procedures, feel able to raise any concerns they may have, and generally believe these will be responded to appropriately. However, some significant concerns were raised during this inspection that were still awaiting an effective response. Some concerns were about the unsatisfactory progress in improvement works. The Commission was concerned at the effect on service users and has pursued this with the providers, who have subsequently given details of extenuating circumstances but acknowledged that unforeseen delays could have been better handled. The failure to respond to service users’ concerns until the Commission’s intervention has drawn their attention to the need for 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 19 improvements in procedure, and they have expressed an undertaking to attend to this so that in future service users can have confidence all their concerns will be heard and responded to promptly and effectively. Additionally, one formal complaint had been made to the service and was recorded. This concerned treatment of one service user by another that was making him fearful for his safety. The manager explained that other service users had also expressed concern about the same matter in their reviews, but these had not been treated as formal complaints. In view of the serious nature of these concerns, there is a need to review how all concerns raised in this way are viewed and responded to, to make sure that complaints and safeguarding matters, however reported, are recorded as such and are not overlooked. The service user concerned had received a written undertaking to respond to his complaint, made about a series of incidents that had resulted in a request for police intervention. However despite evident staff concern for him consideration had not been given to the need for a safeguarding alert, so the manager was asked to refer the matter to the adults at risk co-ordinator without further delay and the Commission has itself made a referral. The outcome is awaited. All staff including the manager are said to have received recent safeguarding training including the provisions of ‘No Secrets’ and local procedures for responding to abuse. It is strongly recommended that further training is arranged to provide an opportunity to review practice in relation to the current situation, and ensure sound future practice. There have been no new staff, records previously seen show robust procedures used in staff recruitment. 21 Lime Street DS0000069582.V342936.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The location and layout of the premises are suitable for their purpose, but at the time of inspection are not providing a safe and secure home. The ground floor communal living areas are in good order, but redecoration and further refurbishment is still needed in the ground floor shower room and throughout upstairs. Information has been provided to show this is acknowledged and planned for the coming year, but a regular programme of ongoing maintenance and refurbishment has not been fully established to ensure service users’ comfort and wellbeing as work progresses. EVIDENCE: 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 21 Service users provided a guided tour of their home. All communal areas of the home and some bedrooms were seen. The service users live in a home with layout and accommodation that is suited to their needs, enough space for them to enjoy a variety of activities, and room to entertain visitors in private. A garden area provides for a range of outdoor activities although some attention to features such as redundant walls could improve layout and usability. Communal areas consist of a kitchen, lounge, conservatory (used as an additional lounge), dining area and a smoking room. Much upgrading had been done in these areas within the last 18 months prior to the new providers taking over the service. These areas of the house are clean, simply but adequately furnished and in good decorative order. The home is fresh and free from odours throughout. Since the new providers have assumed responsibility the hall and front stairway have been redecorated and recarpeted, and work has started on the ground floor shower room and upstairs bathroom. All areas upstairs remain in poor condition, worn and in significant need of attention. A matter of particular concern to service users is that the ground floor shower room had been out of action for three months. Staff said plumbers out of the local area, who do not always return, were carrying out the work. The providers have since advised exceptional circumstances were partly responsible with delays due to freak local weather conditions causing extensive damage to property locally so that construction firms have been fully occupied elsewhere in emergency repair works. Difficulty obtaining parts had compounded the delays. The providers do acknowledged the matter could have been better handled, and that procedures will be improved as a result of this experience. At the time of writing this report the providers state that the work has been completed, with a quality purpose built shower installed. The first floor bathroom although much improved awaits completion of finishing work, while redundant panelling is being stored on the upstairs landing and broken sanitary ware has been left in the garden. A temporary repair enables the office door to be secured but has left unsightly damage, and the office space and equipment including medication storage requires full upgrading. It is highly desirable for consideration to be given to the manager having space separate from the general administrative office in order to carry out his own duties and to provide for private meetings without interruption. Bedrooms seen appeared ‘lived in’ and individual with service users’ own personal touches. However décor in these and the upstairs landing areas all show signs of general wear, while bedroom furniture is in need of upgrading, 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 22 some items being quite worn or damaged and in need of repair. There are inadequate storage facilities for both service users own possessions and those of the household, with items stacked on landings and stairways. Carpets in the hall, stairs, landing and bedrooms are showing signs of wear and in need of replacement. Work had begun on upgrading service users bedrooms one at a time. Information provided during the inspection indicated staff are doing the redecoration in their spare time so this is being done in a random way. The opportunity to redecorate while one service user was away on holiday had not been used (it was subsequently explained this was at his request) so he had been sleeping on a sofa in the ground floor rear sitting room with a bag of essential possessions and clothes, and sharing staff washing facilities. The service user who had just moved back to his own bed was very grateful to do so and said he had backache when sleeping on the sofa. Information has subsequently been provided indicating that each service user is consulted individually and that therefore more planning and care was given to this than first appeared, but nonetheless this was not a satisfactory arrangement and the approach needs improvement. A planned redecoration and refurbishment programme should address all these matters in a satisfactory way that is acceptable to service users. A full and continuing programme of maintenance and upgrading needs to be established as a matter of priority, to bring the accommodation up to an acceptable standard of safety and comfort and ensure it will in future always be maintained to an acceptable standard throughout. The people who live here are involved in the timetabling of work in their own home but the process needs to be better thought through and clearer. For example they need to have a copy of the schedule of work showing when it is to be carried out, so that they know when to expect things to be put right, what will be done to ensure their safety and comfort and to minimise inconvenience, and have every chance to comment and contribute to this throughout the process. A risk assessment should be carried out for every aspect of the work to be done, and its impact on service users. It would be good practice to update all risk assessments, making sure all areas of potential risk have been assessed. The risk assessments review also needs to include the fire safety risk assessment which was updated during 2006, to make sure it is fully up to date and includes subsequent upgrades and changes to the accommodation. The registered provider is reminded of the responsibility to consult the fire safety officer to ensure all fire safety measures in the home are satisfactory, and it would be timely and advisable to do so before upgrading plans are finalised. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staffing numbers and deployment provide for consistent support to service users, by staff who are well supported and becoming well trained. However the manager is currently included in the care rota, which means he has less time for management duties, and this shows more staff hours are needed. Good progress is being made in developing an effective programme for addressing staff training needs. This must be supported by an improvement in staff training records ensuring information is complete and up to date, to make sure training can be effectively planned and managed. EVIDENCE: Service users are well supported by the staffing arrangements for this service, with a stable staff group who are benefiting from an improving approach to supervision and training to ensure they do their job well. There are 11 members of staff plus the manager. There is one relief staff but no agency staff are used. This provides for a minimum of 3 staff on duty throughout the day and two staff on duty at night, one waking and one sleeping in. Staffing stability means service users and staff know each other 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 24 well and service users benefit from the continuity and consistent support this offers. While these staffing arrangements provide time for one to one support for service users, this depends on input from the manager and there is evidence this is at the expense of meeting management responsibilities. In order to allow for support time in house, and flexibility for service users to plan activities outside the home with their key worker and other staff, more support staff time is needed to avoid relying on the manager. Service users can be confident staff have important skills to understand and meet their needs well, as this staff group have worked here for some time and the previous provider made a commendable commitment to care skills training and staff development. The current providers need to continue this commitment with a planned programme of staff training and development. It is their stated intention all staff undertake foundation training linked to the Learning Disability Award Framework, and National Vocational Qualification programmes. Currently five staff hold an NVQ (National Vocational Qualification) level 2 or 3, all staff are supported to progress to at least NVQ3 and four more staff are currently enrolled on this programme. Staff explained that they receive continuing support and encouragement to progress their learning beyond this, one staff has completed NVQ4 and two more staff have enrolled on the programme to this level. Good progress is being made with this training programme, but some aspects of training still need attention to make sure they are fully covered and kept up to date for all staff. Training in safeguarding vulnerable people has been provided for all staff. However recent concerns were not brought to the attention of the adult protection coordinator showing staff still need to be fully familiar with the ‘No Secrets’ policies available in the home, and with local procedures for responding to allegations of abuse. Further training is strongly recommended. Information provided showed staff have been trained in breakaway techniques and managing challenging behaviour, and the manager and one staff have attended a course in risk management. It would be good practice for this to be provided for the full staff team. Because of the needs this service seeks to meet, the new providers state all staff have now received training in understanding and responding to behaviour that challenges. Safe working practice training is mandatory. Training by suitably qualified trainers must be provided to all staff in fire safety, health and safety, food hygiene, moving and handling, and first aid to at least the one-day first aid at work standard. The manager should be trained in these areas to a managerial level in keeping with his responsibilities. Evidence from training records in the 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 25 home was incomplete and it was therefore not possible to confirm this training is being done. Accurate and up to date staff training records must be kept showing all training provided, with dates, and identifying when refresher training is needed, booked, and completed. Training records overall would benefit from a more coordinated approach to support effective training management. This needs to include a staff training needs assessment linked to the stated aims of the service and the identified needs of service users, accurate and up to date individual staff training profiles, and a completed staff training matrix. The training matrix should provide accurate and up to date information about all training planned, booked, undertaken and when this needs updating, so that this can be effectively monitored and all gaps addressed promptly as needed. This would contribute effectively to the annual review and forward planning to make sure the training programme continues to be tailored to the needs of the service, and provide a link to the quality assurance process. During the previous inspection, available staffing information did not show all necessary checks were being made on recruitment. This matter had been outstanding for some time but records sampled on that occasion were in order showing robust recruitment practices had been followed when new staff were appointed. No new staff have joined the team since that time. Supervision records were not seen however staff confirmed they are receiving regular supervision approximately monthly, that this is thorough and supportive and that they receive a copy of their supervision notes. Staff who supervise other staff should be properly trained to do so. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is managed with an open and inclusive approach, and staff are well supported to provide a responsive and effective service. However this needs to be supported by sound records and administration. There are ongoing improvements but work is still needed and improvements must be sustained. The manager must take responsibility for making sure all aspects of service users wellbeing are properly safeguarded. Although some progress has been made the home does not yet have a full quality assurance procedure. Better recording and systems for managing training are needed to make sure safe working practice training is provided for all and kept up to date in a timely way. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 27 Monthly visit reports need to be copied to the Commission, to show the provider is effectively meeting responsibilities for oversight of the home and the way it is operating. EVIDENCE: Staff and service users think highly of the manager and generally feel well supported by him. He uses regular service user and staff meetings, individual staff supervision and service users one to one time with key workers and himself to keep everyone up to date with what is happening in the service. It is also evident from observations that all find him approachable and are readily able to speak to him more informally as needs arise. Service users did however note three areas of particular concern during this inspection, that need closer management attention (see Concerns and Protection, and Premises.). The manager is responsible for making sure procedures designed to look after service users wellbeing are followed properly, and that service users are consulted and listened to about matters that affect them. Therefore he needs to take responsibility for making sure complaints and safeguarding procedures are used effectively, and that work on the service users’ home is done to a good standard in a satisfactory and timely way. Service users need to be sure there are good record systems so the service is managed properly for their benefit. There has been necessary progress in the management of records. This is being ably supported with the recent appointment of a deputy. The manager does need to ensure this progress continues, to make sure systems and information underpinning the running of the service are serving their purpose and up to date. For example, training records in particular need further attention, as identified in the Staffing section of this report. The service has not yet complied with the regulation to have a full quality assurance system in place by July 2006, and a full system must now be implemented without further delay. A quality assurance system comprising consultation exercises, report and action plan must be designed and put in place for the overall service. This needs to seek views on the quality and effectiveness of the service from service users and interested parties, including professional agencies with links to the service. The results should be analysed and incorporated into an annual report, which identifies each aspect of service provision, aims for the year, and evidence (from consultation and other measures) as to how these have been achieved and how well they have been met. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 28 Health and safety practices were not checked in detail but sample checks on action and records showed these are generally satisfactory. A sample of risk assessments showed these are being kept under review. There are good policy and practice guidance notes for staff on legionella checks, which are being made and recorded regularly. COSHH (Control Of Substances Harmful to Health) guidance and data sheets are in place, and sound practice is followed. Staff were aware of this and knew some rationalising of products was due soon. The staffing section shows in detail that the approach to training in safe working practices is now improving, although better records are needed to ensure this training is well managed so that refresher training is kept up to date. It would be good practice for staff to sign and date a ‘read and understood’ checklist after policy and procedure guidance has been given to them, to monitor and ensure they know what is expected of them and take responsibility for following guidance provided. The fire log was examined and practice was found to be generally satisfactory although some regular weekly and monthly checks were overdue. Staff now receive distance learning–based annual fire safety training. However records were unclear as to whether all staff were receiving quarterly fire safety instruction as stipulated by the fire safety officer, and this must be attended to. Care needs to be taken to record the names of staff attending when fire drills are held, to make sure every staff attends one drill every 12 months. The fire safety risk assessment was checked. This had been reviewed in 2006. A copy of the monthly visit report needs to be kept in the home and a copy forwarded to the Commission. These should show the provider is effectively meeting responsibilities for oversight of the home and the way it is operating. The providers responded promptly to the matters identified before this report was finalised, with constructive action proposed to begin addressing all matters, and progress will continue to be monitored in future inspections. 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 29 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 3 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 2 23 1 ENVIRONMENT Standard No Score 24 1 25 2 26 x 27 1 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 1 x x 1 x 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 30 N/A 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 YA23 Regulation 13(6) Requirement Arrangements must be made to prevent service users being harmed or suffering abuse, or being placed at risk of harm or abuse. Specifically, the home’s policies and procedures must include details of the local Adult at Risk Coordinator’s role and procedures for responding to abuse, and these procedures must be followed when responding to suspicion of abuse A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 39, which include the provision of a report to the Commission. Timescale for action 13/12/07 2. YA39 24 08/03/08 3. YA24 23(2)(b), The premises must be (d),(j),(i),(m) maintained to a good standard of decoration and repair throughout, having regard to service users safety, needs and wishes, with upgrading work carried out in a manner that restores all facilities to use with minimum possible DS0000069582.V342936.R01.S.doc 31/01/08 21 Lime Street Version 5.2 Page 31 3. YA37 10 4. YA42 13; 18 disruption. A planned schedule of work must first be established taking into account the views of service users, showing how current and ongoing needs are to be met. The service must have 31/01/08 sufficient management time provided and protected so that all management and administrative responsibilities can be met. Training must be provided and 12/03/08 kept up to date for all staff in all safe working practice topics, specifically health and safety, fire safety, first aid, food hygiene, moving and handling and infection control. Complete and up to date training records must be maintained showing training completed, needed and planned for each staff member RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It would be good practice to provide all staff with full training and support in person centred planning to ensure this approach is fully and consistently implemented in practice and in records Effective up to date training records should be maintained, specifically, to support sound management of staff training. They should provide sufficient information in a clear format to facilitate monitoring and to plan for all required updating and new training to be provided in a timely way 2. YA41 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road Worcester, WR3 7NW 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 21 Lime Street DS0000069582.V342936.R01.S.doc Version 5.2 Page 33 - 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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