Inspection on 18/04/07 for 22 Abbey Drive

This inspection was carried out on 18th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

22 Abbey Drive 05/01/06

22 Abbey Drive 01/08/05

22 Abbey Drive 28/02/05

22 Abbey Drive 22/07/04

22 Abbey Drive 08/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 22 Abbey Drive 22 Abbey Drive West Grimsby North East Lincs DN32 0HH Lead Inspector Christina Bettison Unannounced Inspection 18th April 2007 10:00 DS0000002820.V336617.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 DS0000002820.V336617.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. DS0000002820.V336617.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 22 Abbey Drive Address 22 Abbey Drive West Grimsby North East Lincs DN32 0HH 01472 507311 01472 341086 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) Linkage Community Trust Mrs Jean Bristo Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000002820.V336617.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: 22, Abbey Drive West is a care home providing personal care and accommodation for up to five adults 18-65 years of age who have a learning disability. The home is situated in Grimsby and owned by Linkage Community Trust Care Services. The home is registered for 6 service users but currently one of the bedrooms is used as a staff sleep in room therefore the home only has 5 service users currently. The accommodation is provided in a large two-storey semi detached town house and is close to local transport links, a park and the town centre. All bedrooms are for single occupation. One bedroom has an en-suite and is on the ground floor. 22 Abbey Drive West shares a registered manager with another small Linkage Home situated nearby. All bedrooms are for single occupancy. Weekly fees range from £558.77 to £888.27 per person per week. Additional charges are made for the following: newspapers/magazines and sweets, hairdressing, chiropody and transport for social activities. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. DS0000002820.V336617.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key inspection and the unannounced site visit took place over 1 day on 18th April 2007. One relatives’ surveys was returned, five service user surveys were returned, and one staff survey was returned. However one member of staff the registered manager, service manager and the new deputy manager were all spoken to on the day of inspection and another member of staff was spoken to by telephone after the inspection. Three relatives were also spoken to on the telephone after the inspection and two service users were spoken to at the home on the day of inspection. The inspector looked around the home and looked at records. Information received by the CSCI since the previous inspection was also considered in forming a judgement. Prior to the visit the inspector referred to complaints received and notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire. The site visit was led by Regulation Inspector Mrs.C.Bettison and the visit lasted six and a half hours. What the service does well: Service users and their relatives are provided with information that is easy to read so that they know what to expect from the home. New service users are able to visit the home and stay overnight to help them to decide if the home will be able to meet their needs or not. Each service user had an individual service user plan to make sure they get the care and support they need. The service user plans include helping people to keep their independence and learn new skills. All service users have a single room that is nicely personalised to their own taste, providing them with an area where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. The kitchens are kept clean and service users are helped to eat a healthy diet and also some foods that they like. DS0000002820.V336617.R01.S.doc Version 5.2 Page 6 Each service user now has a health action plan which helps to make sure that their health needs are met. Service users medicines are looked after well and staff assist service users to take their medicines safely. Service users and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. The staff and managers know that they need to make sure service users are protected from harm and what to do if someone is harmed. A good recruitment policy is in place so that staff employed are safe to work with the service users and they are protected from harm. The staff are very caring and treat service users with respect and dignity. More than half of the staff have got a certificate (NVQ Level 2) which says they know how to work with the service users in the home and how to meet their needs. What has improved since the last inspection? What they could do better: Staff support needs to be more flexible so that service users can be supported to lead a lifestyle that meets their diverse needs. Now that the home has got a new deputy manager and are fully staffed the team needs time to settle down so that they all know the service users and what their needs are. Some of the paperwork needs to be tidied up so that it is clear to see that service users personal and health needs are being met. Staff need to have time with their managers so that can talk about their job, training and other things. Training needs to be provided to all staff to make sure that all staff are up to date with basic training in moving and assisting, basic first aid, basic food hygiene, infection control and fire awareness. DS0000002820.V336617.R01.S.doc Version 5.2 Page 7 Special training needs to be provided to all staff e.g. how to deal with behaviour that may harm service users or staff and to help them to meet the special needs of the service users. 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. DS0000002820.V336617.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 DS0000002820.V336617.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 and 4 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed in full by a range of professionals and service users and their families are given sufficient information about the home so that they can be assured that the home can meet their needs. EVIDENCE: The home has a statement of purpose and this details all of the information required by this standard and Schedule 1 of the Care Homes Regulations 2001 for adults 18-65 years. A number of appendices have been attached covering key policies such as Adult Protection, Whistle Blowing and Confidentiality. This had also been produced in an audio format. A service user guide is available and this contains all the information required by National Minimum Standard 1.2. The service user guide had been expanded to also meet the requirements of a statement of terms and conditions for service users. The care files of two service users were examined, one of these being a new admission to the home. This contained a range of assessments carried out by a variety of professionals who hade been involved in the care of the service user DS0000002820.V336617.R01.S.doc Version 5.2 Page 10 in previous care settings. In addition to this the manager undertakes a linkage assessment and Linkage employs a professional support team made up of qualified social workers, psychiatrist, clinical psychologist, speech and language therapist, visual impairment specialist and a registered nurse who can support the ongoing assessment process and provision of professional support. The staff team had more than enough information on the assessed needs of the service user and this enabled them to provide an individually tailored service to meet the service users complex needs and ensure their emotional stability. There was evidence that the service users had been offered and had taken up the opportunity of visits and overnight stays prior to making a choice about living at the home. Despite an unsettled start the staff have managed this placement admirably and the service user has now settled in well. Another service user has expressed a wish to move away from the home to live nearer to their relative, this is being progressed with the Local Authority and an independent advocate and the staff are supporting the service user to make an informed choice. DS0000002820.V336617.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 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are met and service users and their representatives have been consulted, however the quality and consistency of the service user plans and risk assessment needs to be improved. EVIDENCE: Two care Files were examined as part of the inspection process. Each file contained a focus page which gave staff a quick overview of a service users needs, dietary requirements, information on advocacy services and a personal history. Linkage have made some changes to the way they present their care planning for service users. Although all of the information was available to ensure that DS0000002820.V336617.R01.S.doc Version 5.2 Page 12 all of the service users assessed needs were identified and met, the planning process and paperwork was a little disjointed and contained far too may risk assessments. A number of the risk assessments were actually plans of care and the home would benefit for re organising the plans and risk assessments. The manager and staff commented that this was not the easiest of formats to follow and would welcome some reorganisation. It is also recommended that the plans be produced in a format that is accessible to the service users living at the home. However this did not in any way detract from ensuring that service users needs were met, observations of care practice evidenced that service users needs were met and independence promoted in many ways. Service users physical and emotional well being was recognised and met by very attentive staff. In addition to this some of the service users had benefited from a person centred planning review, actions from these reviews need to be incorporated into the care planning process making it more comprehensive and cohesive. A number of risks had been identified, assessed and were being minimised by the production of risk assessments that staff were familiar with and followed and a number of these related to measured risk taking allowing service users to develop and maintain their independence i.e. for one service users who regularly goes out alone and often travels and for another developing their road safety skills and for another cooking. Any limitations placed on service users are only undertaken with their agreement, in their best interests and had been agreed in a multi agency meeting and are reviewed regularly. For example one service user has recognized that they need assistance to manage their money and budget for holidays and clothes and has agreed that the staff can hold their bank card and assist them with budgeting. All records were available to evidence this. Care plans were kept under review and they were reviewed every 3 months. There was evidence of excellent daily recordings and in the care files examined they had been reviewed by the placing authority. All service users had a key worker and were able to tell the inspector who this was and explain what their specific role was. The inspector observed service users being offered opportunities to participate in the day to day running of their own home; they have house meetings once a week and all service users have a house day when they change their bed, clean their room and do their laundry, with as much or as little support as is required by the individual. DS0000002820.V336617.R01.S.doc Version 5.2 Page 13 Staff and service users confidential information was observed to be securely kept and handled in accordance with the Data Protection Act. Lockable facilities were used and service users are consulted about when and where there information can be shared. Staff were observed to knock on doors and to ask permissions to enter bedrooms. Linkage has a policy on sharing information with partner agencies and a policy/procedure for missing service users. DS0000002820.V336617.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): 11,12,13,14, 15,16 and 17 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are assisted to continue their personal development and have access to the community for a range of leisure/educational pursuits. This could be further enhanced by the maintaining and flexibility of the staff rotas and attention to individual’s personal aspirations. Family contact and personal relationships are maintained and all service users enjoy a healthy diet. EVIDENCE: The inspector was informed that none of the service users currently access any work placements, however they do engage in a range of activities to continue their opportunities for personal development. DS0000002820.V336617.R01.S.doc Version 5.2 Page 15 Emphasis is placed on service users taking an active role in household chores and they all have at least one day at home to change their beds, clean their rooms and do their laundry with staff support as required. Some service users attend the Linkage occupational recreational services during the day and take part in activities such as drama, IT, art, communication skills and horticulture. The sessions are tailored to individual need, which is assessed by the instructors. Some service users attend the day services provided by the local authority at Queen St day centre and some attend the Grimsby Institution and the Nunsthorpe/Bradley Adult education centre for literacy skills. Some staff and relatives indicated that due to the inflexibility of the staff rota the staff are not always able to ensure that service users have access to all of the leisure activities they would like. One service user and their relative indicated that the service user likes and is good at bowling, he has his own bowling ball and would like to join a league, however there is not adequate staff available to ensure that this can happen on a regular basis. This must be addressed. 22 Abbey drive west is situated in a residential area of Grimsby, close to Peoples Park. The inspector was informed that the staff and service users continue to get on well with their neighbours who always say hello. Service users told the inspector that they enjoy going to the cinema, bowling, shopping, disco’s, walks and out for meals at burger king and pizza hut and visiting the pub but are not able to go as regularly as they would like. They all either visit their parents/relatives homes or are visited by them at Abbey drive and contact is welcomed. One of the service users has special female friend who he visits or she visits him, this is welcomed and supported by the staff. Service users personal responsibility is promoted and measures in place to ensure both service users are safeguarded. The manager and staff promote a healthy eating menu but try to balance this with service users likes/dislikes and special treats on occasions. Breakfast consists of a variety of cereals, crumpets, toast, tea, coffee and juice. Lunch is a choice of sandwiches, soup, toasted sandwiches, beans or egg on toast or omelette. Options on the menu for dinner included chicken, mince, pizza, pasta, fish, all served with fresh vegetables and the manager confirmed that there is always plenty of fresh fruit and yogurts available. Any restrictions are clearly documented in the care plan and agreed to by the service user. One of the staff in a questionnaire had commented that service users “are not allowed any cake, biscuits or pop except on birthdays”, however from discussion with staff, the manager, examination of records and from observation it was apparent that this was well balanced. Due to health needs, DS0000002820.V336617.R01.S.doc Version 5.2 Page 16 weight issues and general well being the home promotes a healthy eating menu however on their house days service users usually go out shopping and can buy whatever they want to, (on the day of inspection one of the service users came back from the shop with two cans of coke) in addition to this when they are out alone, at day services or visiting family they can buy and eat whatever they choose and on special occasions I.e. birthdays, Christmas etc special treats and buffets are provided. On the day of inspection one of the service user was observed making a choice of lunch, he chose beans on toast and told the inspector that this was his favourite. It was felt that the balance was right for the service users and ensures their physical well being and ongoing good health. DS0000002820.V336617.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 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users physical and emotional needs are met, by the provision of a wide range of healthcare professionals and outside agencies and a caring and professional team of staff promotes their privacy, dignity and respect. EVIDENCE: Discussion with Service users, families and staff and observations confirmed that the staff promoted service users dignity, privacy and respect. Staff were observed to behave in an appropriate manner towards service users. Individual likes and dislikes were recorded on the care plan and service users told the inspector that they had a key worker. Records examined confirmed that service users health needs were met by GP, dentist, chiropody and that they had access to a wide range of other health professionals e.g. psychiatrist and psychologist, speech and language therapist and visual impairment specialist if and when required. DS0000002820.V336617.R01.S.doc Version 5.2 Page 18 One of the service users have recently been diagnosed with diabetes which is currently diet controlled and under review with the diabetic clinic. The staff spoken to were knowledgeable about their condition and what their diet now consisted of and are checking blood sugar levels as instructed and this had been recorded in the care file and an optician appointment made to check for Glaucoma. However there needs to be some improvement in the screening, identification and planning to meet health needs. Health action plans had been produced but these were basic and had not been regularly updated. In addition to this the recording of outcomes to health appointments were in the general daily recordings and did not sit alongside the health action plan, this could made it difficult to track if health needs had been met or not. Linkage has robust medication policies and procedures that include receipt, storage, administration and disposal of medication. Service users who wish to self medicate are encouraged to work toward this with a graduating selfmedication programme. The manager and staff will assess the service user prior to commencement and a risk assessment is undertaken. Facilities are made available for service users to lock their medication away in their room. The medication systems were examined by the inspector as part of the inspection process and found to be well managed and robust. All staff are given medication administration induction training which includes an exam to ascertain competence. DS0000002820.V336617.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 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are protected from harm by a robust complaints procedure that is provided in an accessible format and all service users are aware of and a Protection of Vulnerable Adults policy and procedure that the staff and manager are aware of their responsibilities within this. EVIDENCE: The home had a well-developed complaints procedure. This contained contact details for the CSCI and the ombudsman and gave an assurance that service users and their families would not be victimised for making a complaint. The timescale given for responding to complaints was 21 days. The complaints procedure was also available in Makaton symbols and on audiocassette. In addition to the above the home also had a service user specific complaints policy. Each service user had been given a copy of the complaints policies in written and Makaton format, and Social Services “Right to Complain” leaflet. These were kept in service users individual files. DS0000002820.V336617.R01.S.doc Version 5.2 Page 20 All minor issues were dealt with through the house meetings. More serious issues were taken to the manager and a mechanism is in place for responding to these areas of concern and/or complaint. There had been 24 complaints since the previous inspection, the majority of these were from one service user who was a new admission and was going through the settling in period; these were all taken seriously, investigated and resolved appropriately, some of the other complaints were from service users being grabbed or feeling intimidated by another service user. The manager checked the complaints log on a regular basis. The home had a copy of the “Multi agency Guidelines for the Protection of Vulnerable Adults” and an in house abuse policy and procedure that links in with the “Multi agency Guidelines for the Protection of Vulnerable Adults” in respect of alerting, referral and investigation. All service users had been given a copy of the leaflet from the local authority on abuse and this was kept on their individual file. The home has a separate whistle blowing procedure. There was evidence from the home’s recruitment and selection processes, staff training records, complaints log and the use of risk assessments that the manager ensured that service users were protected and safeguarded from abuse. However staff, service users and relatives all commented on the impact that one of the service users behaviour was having on the rest of the service users in the home. There is a behaviour management in place for this service user and input from Linkage,s psychologist however relatives suggested that the behaviours are escalating, this has resulted in one of the service users requesting to move way from the home and find alternative accommodation. (He also wants to move to be nearer his relative). The manager must monitor this more closely and take action to safeguard other service users in the home if necessary. Training records evidenced that staff had received training on the protection of vulnerable adults and the staff spoken to were clear about their responsibilities within the POVA procedures. The home had a policy for dealing with physical and verbal aggression by a service user. DS0000002820.V336617.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users live in a well maintained home that is safe, homely and comfortable and is in the heart of the local community and meets their assessed needs. EVIDENCE: 22 Abbey drive west is a large house in the heart of the local community in Grimsby. It is close to Peoples Park and all local amenities. All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Service users have access to a secure, private and pleasant back garden area. DS0000002820.V336617.R01.S.doc Version 5.2 Page 22 Furnishings and fitting were of good quality. The home was well maintained, clean, tidy and free from offensive odours throughout. The accommodation was comfortable and homely with service user’s personal items on display. The home has a Maintenance book that recorded day-to-day work and a plan for the ongoing redecoration of the home and the manager informed the inspector that they are about to purchase a new sofa and chairs for the lounge and a leak in an upstairs bedroom was in the process of being attended to. Policies and procedures were in place to support infection control and all staff have received training in infection control. The laundry was situated in an outbuilding sited away from food preparation or eating areas and accessed through the back door. COSHH sheets had been obtained for laundry products used. The laundry was kept locked when not in use. DS0000002820.V336617.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): 32,33,34,35 and 36 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing is provided in sufficient numbers and with the competence and qualities to meet service users needs, however a degree of flexibility within the staff rota will further enhance the opportunities for service users to access activities of their choice when they want to attend them. A robust recruitment and selection process protects service users from the risk of harm. EVIDENCE: There have been no changes to the rota pattern and there are usually two staff on duty when all service users are at home, however comments from staff and relatives indicated that the numbers of staff are often reduced to one when service users are out or on home leave. This was confirmed by the manager however this is when two of the service users go home on a weekend, one of the other service users is independent therefore this leaves one staff to two service users which is acceptable. DS0000002820.V336617.R01.S.doc Version 5.2 Page 24 The current staff rota provides waking staff up to 11.00pm and after that they sleep in, this does create some difficulties if service users wish to access activities that finish after 11.00pm therefore Linkage need to review the staffing rotas and ensure that staff can be provided in a flexible manner to support service users diverse needs and expressed wishes. The home has had a period of instability with regard to staffing. The deputy manager has been on long term sick and has now left the employment of Linkage trust. A member of staff was temporarily upgraded to a deputy and her post partly filled by a part time houseparent and partly by bank staff. This did lead to some staff feeling unsupported however this should now have been resolved with the appointment of a new deputy manager. One of the service users was involved in the interview process for the new deputy manager. The new deputy manager has considerable management experience and maturity and is keen to fulfil her role and ensure the staff team and service users are well supported, however most of her experience has been working with the elderly or disabled children and she will need to undertake some training specific to the needs of adults with a learning disability. Since the previous inspection a member of staff has transferred from another Linkage service and another staff member has transferred to another Linkage service. The home is now fully staffed with a permanent and consistent staff team, however this will need time to settle down into a cohesive team. Staffing is provided in sufficient numbers and staff have the competence and qualities to meet service users needs. From examination of staff files and discussion with staff it was evident that all staff have clearly defined job descriptions and are clear about their role and how this fits in with the linkage aims and meeting service users needs. Observation of staff practices confirmed that they have developed appropriate relationships with service users and treat them in an age appropriate way and with the utmost of dignity and respect whilst offering guidance and support in a firm but sensitive manner. The staff team are supported by a wide range of health professionals e.g. psychiatrist and psychologist, speech and language therapist and visual impairment specialist for advice and support. The inspector was satisfied from previous inspections that Linkage recruitment policies and procedures are robust and that all staff have CRB disclosures, all identity as required by regulation and references obtained prior to commencement in employment at Linkage. DS0000002820.V336617.R01.S.doc Version 5.2 Page 25 Staff are subject to a 6 month probationary period following appointment and a detailed induction programme which includes LDAF standards is undertaken. Due to the instability of the staff team the provision and quality of supervision has slipped, 4 staff files were examined in the course of the inspection and for one of the staff they had 6 one to one sessions with their manager however 3 of these had been return to work discussions following sickness absence, for another they had only had five sessions, with the appointment of a new deputy manager this now needs to improve. In addition to this the training records were untidy and not up to date and the updating of mandatory training appears to have slipped (this may be due to the records not being updated). In one of the staff files the member of staff had not had any updated fire training since January 2006 and did not appear to have had any first aid training. In another file the member of staff had not had updated fire training since November 2005. One of the staff told the inspector that she still needed to receive training in how to mange difficult behaviour. The new deputy manager although she has been put forward for a number of training courses appears to have had very little training in the needs of adults with a learning disability and this must be addressed. However she does hold qualifications equivalent to NVQ level 3 and 2 of the staff team have NVQ level 2 and the other has nearly completed it. The registered manager had a training and development plan for the staff team that clearly identified staff training needs and all staff had an individual training and development action plan that was completed annually. A wide range of training is provided by linkage and included mandatory training, DDA, HIV/Aids, Protection of vulnerable Adults, diabetes, makaton, competence to drive the mini bus, administration of medication, epilepsy, religion and culture, confidentiality, whistle blowing, principles of care, Non Violent crisis intervention and human rights. DS0000002820.V336617.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a home that is part of a creditable organisation that is well run and managed from the top down and the service at Abbey drive is managed by a very competent manager. Service users are at the heart of the organisation and their views are taken into account by the quality monitoring scheme, house meetings and reviews that promote their involvement. EVIDENCE: DS0000002820.V336617.R01.S.doc Version 5.2 Page 27 Mrs Jean Bristo is the registered manager at 22 Abbey Drive West and its’ sister home Bellamy’s Cottage. She has been the manager there since February 2002. Prior to this Mrs Bristo had been the deputy manager at Bellamy’s Cottage. Mrs Bristo has her NVQ 4 in care and management and many years experience of working with adults who have a learning disability. Regular house meetings that include staff and service users, staff supervision and the key worker system ensure that staff and service users have the opportunity to influence the way the service is delivered. Mrs Bristo is a very effective manager, however the service at Abbey drive has suffered a little from the long term sick leave of the deputy manager, this has now been addressed with the appointment of a new experienced deputy manager who it is hoped will lead the staff team and ensure consistency and stability for the staff and service user group. Linkage have a Corporate Quality Monitoring system (EFQM) and a Quality Manager who co ordinates and leads on quality issues. A year long calendar is produced that provides the framework for QA activity including surveys, audits and appraisals. Service user comment cards had been translated into makaton symbols to aid students understanding and enable them to participate in the process. Linkage produces an Annual Review document and regular newsletters. All of which were seen by the inspector. Areas for improvement in the forthcoming year are to increase the numbers of staff across the organisation that have NVQ level 2, to roll out person centred planning, to further promote self advocacy, to purchase a holiday home for linkage and to ensure all staff have basic IT skills. As part of the inspection all maintenance records were seen and were up to date and in order ensuring that the service users live in safe environment. DS0000002820.V336617.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 4 3 x 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 4 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 x 3 4 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 x 3 x 4 x x 4 x DS0000002820.V336617.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 The registered person should review and amend to the care planning process/paperwork to ensure its effectiveness and care plans should be produced in a format that is accessible to the service users. The registered person should review the quantity of risk assessments and ensure that they relate to identified risk areas and not areas where service users require support to live an independent lifestyle. The registered person should ensure that service users are able to access leisure activities of their choice and that staff is provided to support this. The registered person should ensure that staff support is provided flexibly to enable service users to maximise their right to independence and control over their lives. The registered person should review and amend the health action plans and recording methods to ensure that they are kept up to date and are effective. The registered person should ensure that where service DS0000002820.V336617.R01.S.doc Version 5.2 Page 30 2 YA9 3 4 5 6 YA14 YA18 YA19 YA23 7 8 9 10 YA33 YA35 YA36 YA37 users present behaviours that are difficult to manage and affect other service users well being that this is reviewed regularly with the placing authority and action taken to ensure compatibility within the home. The registered person should review the staffing rota and numbers of staff to ensure that service users diverse needs can be met. The registered person should ensure that all staff are up to date with their mandatory training and are provided with training specific to the needs of the service user group. The registered person should ensure that staff are provided with support and supervision that meets the requirements. The registered person should ensure that the new deputy manager is competent in managing a service for adults with a learning disability. DS0000002820.V336617.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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