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Inspection on 22/04/08 for Glyn Residential Care Home

Also see our care home review for Glyn Residential Care Home for more information

This inspection was carried out on 22nd April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

People`s needs are fully assessed prior to admission so that the individual and the home can be sure that the placement is appropriate and will meet the person`s needs. People living in the home are supported by a staff group that knows them well with a good understanding of their needs and are working in a sensitive and friendly manner. People are provided with support to meet their varying health and personal care needs in a supportive environment. They have access to a full range of healthcare support as necessary and adaptations are provided. The home`s policies and procedures ensure the safe administration of medication. The opportunities for people who live at this home to engage in activities and keep in contact with friends and family are good and are kept under review. Food is good and people are involved in menu planning. They have choices and their likes and dislikes are taken into account. Satisfactory systems are in place for people to address any concerns or complaints that they may have The home provides a homely, clean well-decorated, safe comfortable and wellmaintained environment. Good standards of hygiene are maintained. The home is managed well with people`s needs being taken into account and health and safety promoted.

What has improved since the last inspection?

In the last inspection report nine requirements were made and at this inspection all but one had been completed or progress had been made. These relate to more detailed care plans, provision of more secure storage for medication, a more robust system for medication changes and records of `as required` medication moving and handling training for staff, records of when staff start working in the home, the confidentiality of records of people living in the home and consultation with the fire officer. It was also noted that improvements had been made to the environment such as redecoration and the provision of some blinds in the conservatory.

What the care home could do better:

Three requirements have been made as a result of this inspection. There must be regular annual reviews with people living in the home and/or representatives to ensure that their care needs, wishes goals and aspirations are reviewed. A quality assurance system must be used at the home to show that people living there, their representatives, relatives and interested parties are consulted about the service and results and findings of quality monitoring are used to form a development plan. Other recommendations were advised at the time of our visit and are referred to in the body of the report such as in relation to aspects of staff supervision and training and continued development of care plans, risk assessments and recruitment.

CARE HOME ADULTS 18-65 Glyn Residential Care Home 6 Dudley Avenue Hordle Lymington Hampshire SO41 0HY Lead Inspector Sue Kinch Unannounced Inspection 22nd April 2008 10:30 Glyn Residential Care Home DS0000011739.V360997.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 Glyn Residential Care Home DS0000011739.V360997.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. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glyn Residential Care Home Address 6 Dudley Avenue Hordle Lymington Hampshire SO41 0HY 01425 614595 01425 614595 info@glyn-residential.co.uk 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) Glyn Residential Limited Mrs Suzanne Bull Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Dispensation has been given to one named service user in the MD (E) category to remain accommodated in the home. 17th May 2007 Date of last inspection Brief Description of the Service: Glyn Residential Care Home is one of three homes owned by Glyn Residential Limited and currently provides personal care and accommodation for seven people with learning and physical disabilities. An additional three service users, from one of the other homes, go daily to Glyn for day care. The home is located in a quiet rural area of the New Forest but is within reach of local shops. Glyn has a mini-bus to access wider community networks. The home is a large chalet style bungalow accommodating six people on the ground floor and one person upstairs. Six of the bedrooms have en-suite facilities. Communal space consists of a lounge/dining room, conservatory and a good size and accessible garden. The cost of living at the home ranges from £300- £1,000 per week. Additional charges are made for hairdressing, chiropody, toiletries, some activities and transport. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection consisted of a review of the file held at The Commission for Social Care Inspection (the Commission) local office and of an Annual Quality Assurance Assessment (AQAA) document completed and sent in by the manager before the inspection visit. The visit took seven hours. Conversations about the care provided were held with three people living in the home. Each discussion included a staff member for all or part of the time, depending on individual wishes and communication needs. Separate discussions were held with two staff members and the manager. Parts of the physical environment were looked at and a sample of documents and records required to be in the home, including two care plans, were viewed. Responses were received to surveys sent out before the inspection. They were received from 6 people living in the home (completion assisted by staff). Two relatives provided verbal feedback. Survey forms were sent to care and health professionals and one was returned. What the service does well: People’s needs are fully assessed prior to admission so that the individual and the home can be sure that the placement is appropriate and will meet the person’s needs. People living in the home are supported by a staff group that knows them well with a good understanding of their needs and are working in a sensitive and friendly manner. People are provided with support to meet their varying health and personal care needs in a supportive environment. They have access to a full range of healthcare support as necessary and adaptations are provided. The home’s policies and procedures ensure the safe administration of medication. The opportunities for people who live at this home to engage in activities and keep in contact with friends and family are good and are kept under review. Food is good and people are involved in menu planning. They have choices and their likes and dislikes are taken into account. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 6 Satisfactory systems are in place for people to address any concerns or complaints that they may have The home provides a homely, clean well-decorated, safe comfortable and wellmaintained environment. Good standards of hygiene are maintained. The home is managed well with people’s needs being taken into account and health and safety promoted. What has improved since the last inspection? What they could do better: Three requirements have been made as a result of this inspection. There must be regular annual reviews with people living in the home and/or representatives to ensure that their care needs, wishes goals and aspirations are reviewed. A quality assurance system must be used at the home to show that people living there, their representatives, relatives and interested parties are consulted about the service and results and findings of quality monitoring are used to form a development plan. Other recommendations were advised at the time of our visit and are referred to in the body of the report such as in relation to aspects of staff supervision and training and continued development of care plans, risk assessments and recruitment. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 7 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. Glyn Residential Care Home DS0000011739.V360997.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 Glyn Residential Care Home DS0000011739.V360997.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): 1,2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are fully assessed prior to admission so that the individual and the home can be sure that the home is right for them and will meet needs. EVIDENCE: The majority of the people who live at this home have lived there for several years and there has not been an admission since the last inspection. Five of the six people living at the home who completed a comment card said that they had received sufficient information enabling them to make a decision as to whether the home was right for them. The manager said that the service user guide has been given to the residents and is available in various communication formats including a picture form for people living in the home to understand. A member of staff confirmed this. Plans are also in place to improve information on the website. The assessment procedure was discussed and viewed at the last inspection and it was found the process was suitable including consultation and liaison with relevant parties including health professionals and care managers Preadmission visits also took place. The manager told us that the process had not changed. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 10 At the last inspection it was found that whilst everyone living at the home had been issued with a contract detailing their rights’ not all of these had been signed by either the person or their representative and none of them stated the cost of living at the home and were outdated. The manager had agreed to rectify this and has reported that she has done so. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported well by staff who have a good understanding of their needs recorded in improved care plans. However they would benefit from regular full person centred care reviews including a consideration of goals and aspirations, which are then included in, care plans. EVIDENCE: A requirement to review care plans was made in the last inspection report to be more detailed and provide specific support instructions and fully address all assessed and identified needs by 17th August 2007. Work has taken place to address this and was evidenced in the two care plans viewed when case tracking during this inspection visit. We noted these had last been reviewed in January 2008 and were increasingly including more detailed information about likes, dislikes, personal care and health needs, communication needs, routines and guidance for staff to follow. There was less detailed information about social care needs, and activities and these should be developed. It was noted that the not all health procedures were yet fully explained such as supporting Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 12 the use of a convene or aspects of catheter care and the manager agreed to follow this up. The manager said that care plans had been revised and they had gone back to the system that they were using before the last inspection and these care plans were, in her view, more detailed. A member of staff agreed. The records reviewed included some reviewed risk assessments. The manager said that staff members need risk assessment training. The risk assessments cover moving and handling identifying various pieces of equipment needed and other areas of care needs reviewed in April 2008. These are not in a lot of detail and consideration is needed to ensure that enough guidance is in place for staff such as monitoring risks when feeding one person and how often this should take place. Where appropropriate evidence of risk assessments involving other professionals is also needed and the manager agreed to follow this up. The care needs of the people living in the home were discussed with three people living in the home who were helped to varying degrees by staff to answer the questions because of communication needs. During these discussions staff involved showed a good understanding of the varying needs of the people that they were supporting and gave information about how they work with specific issues. Two people confirmed that they were involved in talking about their care and support that they need and staff agreed. All gave examples of the help received in personal care, activities and going out. In the surveys the two relatives responding were positive about care needs being met. People have not been given copies of their care plans. Running records are also recorded regularly and for one person it was noted that new health guidance had been given from the district nurse in the last two days before the inspection but it had not yet been transferred to the care plan. The manager was aware that this was needed. The staff and the manager also said that for one person more detailed monitoring was held in the person’s room. In the care plans reviewed goals and aspirations were not recorded. A member of staff agreed. However, some examples of aspirations being met were discussed when talking with one person living at the home and a staff member. They talked about various trips to attend concerts by various popular music bands. But although there was evidence of reviews of elements of peoples care such as speech and language therapy, there was little evidence of regular person centred annual reviews. Out of three people discussed with the manager, one had been reviewed in the last seven months with another planned for the same week of the inspection visit. The purpose and reason for reviews was discussed with the manager who Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 13 was advised to obtain guidance, and consult the Commission’s Key Lines of Regulatory Assessment (KLORA) and the National Minimum standards. During the inspection people in the home were supported to make decisions about what they wished to do. Staff said that if there were three staff on duty it was possible to take people out on request. In the survey all six residents said that they can do what they want to do in the daytime, evenings and weekends but only three said that they could make decisions about what to do each day. The manager thought that this could be due to needing a driver for some activities and some people recently loosing their day services. In the last inspection report a requirement was made to ensure that care plans are held securely. The manager said that this had been dealt with and that care plans are held in a locked cupboard. However, although the plans were in the cupboard, the key was in the lock during the inspection visit and a member of staff thought that it could not be locked. The need to ensure that the care plans are securely held was discussed with the manager who was advised to ensure that the staff were clear about the policy and how it would be implemented in the home on a day to day basis. The requirement has not been repeated. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The opportunities for people who live at this home to engage in activities and keep in contact with friends and family are good. They are able to choose how they live their lives and to engage in activities of their own choosing except for use of the kitchen. They would benefit from goals and aspirations and levels of stimulation being included in annual reviews. The food in the home is good offering both choice and variety. EVIDENCE: Daily activities and stimulation are provided at the home for the people living there and three people from another care home and this has been an established practice for some time. Altogether up to ten people are supported each day and this has just increased due to loss of day services for two of these people, one of whom lives at the home. Some other people have daytime commitments out of the home on some days at day services but mostly Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 15 during the day two or three staff on duty meet all social and recreational needs as well as the personal care needs. Some of these needs are identified in the care plans but not in a lot of detail and these needs have not been included in an annual review for all people. The manager said that opportunities available for people are being reviewed. On some days two people have additional one–one support. The manager said that they have arranged access to more individual courses for people but plans to find more employment opportunities and opportunities to mix with people other than from the Glyn Residential homes. This has proved to be difficult in the area. Meetings are also being held following the lost day services to try and find alternatives. One person said that there was not enough to do at the home. One relative said that they were not sure if enough activities were provided. During the inspection one person was at a day service. Others not having one to one support were using computers in the conservatory and art and craft is also offered. Some people were individually taken out for a walk and confirmed that they were taken out in the local community for activities and shopping. They are also helped with their personal interests and hobbies and in their own rooms. People spoke about regular shopping trips on Fridays and trips out on Sundays and a minibus is provided for his. They also spoke of trips to concerts and shows at the theatre. Regular arrangements are in place for support and contact with families including by telephone and the internet. The manager said all people living in the home have had contact with family or friends in last 12 months. One relative said that staff members are friendly, communicative and flexible when visiting unannounced. Another always feels welcomed and is offered refreshments. They also said that they felt adequately informed and one gave an example of a recent health issue that staff had followed up. In discussion with one person and a staff member they described the support given to contact family and friends as regular. The manager has identified a training need for some of the staff on sexuality and brain- injured people to assist staff to review how they support people and to consider appropriate strategies. We saw a sample of menus and these demonstrated that people are provided with a nutritious, healthy and varied diet. The cook said that she has good knowledge of the likes and dislikes of people and that influenced what is cooked. In discussion with people at lunchtime, three people sitting together said that they liked the food, another agreed and a fifth agreed that they were given food that they like. Choices are available, people are involved in menu planning and lot of food is home made. Individual needs are taken into account Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 16 at mealtimes and equipment such as plate guards were seen to be in use. Some of the food was pureed but attractively presented. Specialists have been involved in food issues. Speech therapists were reported by the manager to be involved with two people over eating issues and the district nurse in peg feeding. The option of involvement in food preparation, cooking and kitchen tasks are limited. One staff member said that one person helps with sandwich making sometimes, if staff take the ingredients to the dining room. Access to the kitchen for people in wheelchairs is limited as cupboards prevent movement beyond the entrance and facilities are not adapted for this purpose. Therefore people living in the home cannot be involved in some of the domestic routines such as food preparation, cooking and clearing away. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with support to meet their varying health and personal care needs in a supportive environment. The home’s policies and procedures ensure the safe administration of peoples’ medication and promote their independence. EVIDENCE: Care-plans and records include health and personal information and this is documented in the individual needs and choices section although more work is needed to ensure that every aspect of care is in sufficient detail for staff to follow. During the visit in most instances information sought by us in the care plans viewed, was available. Examples of information missing are in the section on individual needs and choices. Staff, have mostly worked within the service for some time and those spoken with have a good working knowledge of the health and personal care needs of the people living at the home. In discussion staff referred to the involvement of professionals such as doctors, consultants, a dietician, the district nurse and speech and language therapists. They also spoke of regular wheelchair Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 18 assessments. Records of visits were also noted in the running records and a list of appointments attended is recorded. There is also information in the care plans relating to these visits and guidance for staff. There are some procedures for which staff have been trained by the district nurse and there is a record in the files signed by the nurse to state who is trained to carry out the tasks. Assistance with health matters was discussed with two people living in the home. One person had not needed a doctor but thought the staff would get one if needed. Another was aware of a forthcoming hospital appointment and confirmed with a member of staff that staff members assist with attending appointments. One relative said that there was ‘Nothing lacking in health care’ and another was confident that the home is meeting needs including health needs. Positive comments were also received from a health professional regular to the home who said that the home is excellent and ‘provides a high quality of care based on individual needs’. They continued that the home was reported to seek advice and act on it to manage and improve the individual’s health needs that health needs are always met by the service and care is provided with dignity and privacy. In respect of improvements the manager reported to have plans to improve health plans for people living it the home. Since the last inspection a new medication cabinet has been purchased and used for secure storage and a monitored dosage system introduced so that medication is pre-dispensed by the chemist. A member of staff showed the system in operation when we visited and was individually administering mediation before signing each record. The sample of records viewed was of a pre printed and supplied by the chemist and were completed in line with the medication given. Therefore the requirement made in the last report to store medication safely has been met. However, we noted that the medication records were not held securely during our visit and this was brought to the attention of the manager who agreed to take action. In the report of 17th May 2007 it was also required that guidance for ‘as required medication is also held with the care plans’. Where sampled these were have been provided but held with the medication records. There is also detail of homely remedies for each person. A third requirement was made about changes to medication doses to be authorised by the person prescribing the medication and the manager said that this has been addressed by prescriptions going to the chemist for changes to the monitored dosage system and changes are recorded in personal files. Since the our last visit the manager said that self-medication has been discussed with one person who does not wish to manage their own medication Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 19 and that lockable storage has been provided for one person. The need to keep this under review was discussed. A staff member said that only staff trained in medication carry out medication procedures in the home. There is evidence in the files of staff training in medication. Some certificates were viewed in a sample of files. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems are in place for people to address any concerns or complaints that they may have. Procedures are in place to offer them protection from harm but staff need training in procedures. EVIDENCE: Since the last inspection we have not received any complaints about the home. and neither has the manager. The complaints log in the home was available during our visit and no entries had been made since our last visit. This was supported by feed back from relatives before the inspection. One person said that there were ‘No niggling doubts’ about the service, they had no complaints, and said any concerns were addressed and responded to. Another said they had no complaints and if they had issues they can raise them with staff and they are dealt with straight away without waiting for the manager. In the survey of six people living in the home, which was completed with staff, all six knew what to do if they were unhappy and five knew how to make a complaint. Five said staff always treat them well and listen and act on what they say and one said sometimes but at the inspection said that staff do listen. The manager said that in the residents meeting specific issues could be discussed and showed some minutes of a meeting in November 2007 in which food was discussed. She said that people living in the home have all been given copies of the complaints procedures using various communication tools. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 21 The home has an adult protection policy. Safeguarding was discussed with a member of staff who was aware that there is an adult policy although did not recall having received any training in adult protection and was not aware that it was included in induction of new staff. Staff are required to read the policy. The staff member was aware of the need to act if an allegation is made but not aware of procedures other than reporting it to the manager straight away. The person agreed need to read procedures and be clear about what should happen. We have noted that this matter was raised at the last inspection and the manager agreed then to revisit issues with the staff. In the two files viewed for staff there was no evidence of adult protection training. This was discussed with the manager who said that training was being planned with a local college. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and well-maintained environment. The home is well furnished, homely and comfortable and adapted to accommodate people with physical disabilities with improvements planned but limited access to the kitchen reduces options for involvement in daily routines and independence. Good standards of hygiene are maintained. EVIDENCE: A number of areas of the home were viewed when we visited and this included three bedrooms on the ground floor, an open plan dining room, lounge and conservatory, ground floor bathrooms, toilets and the kitchen. The home was decorated and furnished to a good standard. The manager referred to decorative improvements in the AQAA and some relatives and staff supported this. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 23 It was clean and people living in the home relatives and a health professional say that it is a clean home. Separate cleaning staff are employed regularly and are on the rota. The home is maintained well and the manager agreed that this was a large task considering the number of adaptations and amount of equipment used at the home. A maintenance book is available for staff to report things that need fixing although no entry had been made since the middle of 2007. However, staff and relatives said that things were maintained and the manager was aware of items for repair noticed by us. The three bedrooms viewed included personal effects and adaptations, hoists and other equipment needed by each person. Staff confirmed that items of equipment were working. It was noted that one person does not have a suitable en suite facility or a shared bathroom that is suitable to meet their needs and the current arrangement is for that person to use the en-suite facility in another person’s accommodation. The manager said that this had been agreed several years ago but had not subsequently been reviewed and agreed to do so. Other people use the bathroom facilities that were previously an ensuite facility and they still go through the outer bedroom door, marked with the resident’s name, to access this. The manager said that it was changed to a shared bathroom some years ago and agreed to move the nameplate. The manager noted in the AQAA that the kitchen is not accessible to all due to its fittings. We viewed the kitchen and noted that is not accessible to most people as the door way is not wide enough and cupboards at the entrance make it inaccessible for independent use by people in wheelchairs. Also the kitchen has not been adapted to meet the diverse needs of the people living in the home such as lower level worktops. The matter was not raised in any of the surveys. There is evidence of other improvement to the home since the last inspection and this includes the provision of blinds in the conservatory and magnetic fire door closures. The manager said that they had also replaced the washing machines several times as the domestic sized ones struggled with the amount of washing in the home. She also said that there were plans for a new central heating system and to provide a new driveway and a ramp to the front door. People returning questionnaires said that the home is fresh and clean. We noted this when we visited and that bathrooms and toilets are equipped with paper towels and dispensable soap. Staff said they are issued with gloves and aprons and yellow sacks as necessary. In the AQAA the manager that the home had an infection control policy and had not specific action plan outstanding, however, she is planning to increase the frequency of collections of clinical waste. She said that currently four staff have received training in infection control. One spoken with had not had training and another said that it was not part of formal induction. Infection control staff training was discussed Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 24 at the inspection with the manager who agreed to approach a local college about it and started the process during the inspection. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 25 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): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff receiving supervision and training supports people living in the home but this could be documented more fully and planned in more detail. Work is needed to ensure that people living in the home are protected by rigorous recruitment checks. EVIDENCE: A sample of the staff rota was viewed and staffing level discussed with the manager who said that the rota was indicative and that variations are recorded in the diary. On the morning of the inspection two carers were on duty with the manager and an additional person was providing one to one support for two hours. The manager and staff said that for most daytime shifts there were two to three carers. This is to provide care for the seven people living in the home and the three people from the other care home during the day care period. At times, fewer people are receiving care when others attend courses or day services but with recent reductions the manager said that this has made meeting needs more difficult on Fridays. The manager agreed that annual reviews would include consideration of staff levels needed. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 26 The home also employs domestic staff for cleaning and cooking on some days but at times carers also have to carry out these tasks. The rotas also indicated that the staff level at night as one staff member awake and one asleep for the seven people living in the home. Staff confirmed this. A number of staff have worked in the service for several years providing continuity of care but some recruitment has taken place and a sample of records were requested to be viewed. One set of records was initially available and checks were in place but the manager was advised that one reference gave little information and in such circumstances when recruiting it was advised to obtain another. The file of the second person was not initially in the home but obtained on request as the person had transferred from another home within the group. The manager had not seen the contents. Advice was given to ensure that the manager has assessed all information for anyone working in the home. The requirements made in the last report about start dates for staff was met. Although staff working in the home often cover for each others’ absences, recently the home has started to use an agency and information about one person was requested by us and obtained by the manager during the inspection. The manager was advised to make sure this information is checked before anyone works at the home to make sure proper checks have been made and that they have received the right training. She was also advised to obtain a letter from the agency about recruitment checks and to view guidance on our website. In records and conversations about training it was noted that there is an induction system in the home although the manager has obtained a new format to use for future staff based on the common induction standards. There is an induction process for staff to follow and this involves shadowing during initial weeks and talking with the senior. This was not in place for the person who had worked in another home and is was advised that an induction should be followed. New staff had not yet had supervision but records were not clear about how they are being supported. The manager said that staff were generally provided with one to one supervision twice a year and was reminded that this was less than advised in the national minimum standards. She said that more informal guidance and support took place on a day-to-day basis and was advised to consider how adequate supervision could be evidenced. She said that she was currently planning the next supervision sessions. A requirement was made in the last report to ensure that staff had received moving and handling training appropriate to the work that that they are to perform. Where sampled in four files for staff at this visit we found that this training had been provided and the requirement has not been repeated. The manager was also advised to ensure that they use agency staff with up to date moving and handling training. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 27 In discussion and observations of paperwork with the manager there was evidence that moving and handling training was to be continued and another session was being planned to update other staff. In the records viewed there was also evidence of other short courses that had been provided for staff in 2008 including first aid, food safety, and heath and safety. This was confirmed in conversation with a member of staff who also referred to fire training. Each training record is held individually for staff with no clear list of training completed. This was advised to aid monitoring the overall training needs. Further training is planned and was partly discussed by the manager with a representative from a local college during our visit to the home. A clear training plan however is not documented. There are fewer people than noted at the last inspection with National Vocational Qualifications (NVQ) level 2 or above. Two people have achieved this with one other interested. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 28 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): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed with people’s needs being taken into account and health and safety promoted. However a more effective quality assurance system is still needed to ensure that consistency is maintained and all standards met. EVIDENCE: The registered manager has completed a registered manager’s award and has had several years experience of managing the home. She has a good knowledge of the needs of people living at the home and it was clear that they and the staff had confidence in her. She feels that she has an open positive management approach and bases this in feedback from staff and professionals. This is supported in all of the feedback that we have received for this inspection. Staff are consulted and feel able to raise issues and people living in the home are able to raise issues in meetings. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 29 A requirement was made in the last inspection report about establishing a quality assurance system at appropriate intervals for monitoring the services and care delivered in the home to be done in consultation with people living at the home and their relatives/ representatives to gain their views and opinions. In the AQAA the manager indicated that views and opinions are being sought from people living in the home, relatives, families, staff and professionals and some changes were referred to such as to menus and activities. This was not illustrated with detailed supporting evidence in the AQAA. Resident meetings are held regularly. The manager spoke of plans for improvement but said that more frequent quality monitoring systems were needed, as were more detailed development plans. A clear development plan was not available for observation. There was no paper evidence to support that there is a clear action plan based on issues raised or on fully effective quality assurance monitoring in the home. The manager was advised to obtain some guidance about quality assurance. Monitoring systems are not in place to ensure that for example, reviews, and recruitment, training and supervision procedures are fully in line with standards. Action has been taken to promote the confidentiality of records for people living in the home and the requirement had been met but checks need to be made to ensure that all staff lock them away when not in use. Health and safety is promoted. A requirement was made in the last report about consulting the fire officer and this has been met as the fire officer was consulted before the timescale given and the report provided was dated 26/6/07. Areas for improvement were identified in the report. The manager had taken detailed notes and had acted on the requirements made. The two main issues were about efficiency of the system and improving the environment to improve evacuation. The manager had a certificate from specialists to demonstrate that a specialist had completed the fire alarm check in September 2007 and this included emergency lights. She said she had also taken advice and now one call point is checked each week. She said magnetic door holders were installed and these were seen in use around the home during the inspection. She said that she had planned for fire training from an outside agency on 24/4/08 for ten people and more to be trained on 1/5/08. A member of staff spoken with confirmed that she had received fire training twice in the last year. There is a fire risk assessment, which was reviewed on 13/2/08 and the manager is arranging an external service to complete a professional risk assessment and this was to be planned on 24/4/08. In staff training records there is evidence of staff doing training in health and safety related areas (see staffing section). Certificates arrived for some people who had completed a course in March 2008 on Health and Safety. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 30 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 3 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 31 Yes 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 YA6 Regulation 14(2)(a) Requirement The full assessment of people living I the home should be regularly reviewed to ensure that they have the opportunity to have all their needs, wishes, goals and aspirations revised. A quality assurance system at appropriate intervals must be established for monitoring the services and care delivered in the home. This must be done in consultation with people living at the home and their relatives/ representatives to gain their views and opinions. Results of quality assurance monitoring must be made available at any time to the Commission for Social Care Inspection. This is a repeat requirement from 17/5/07. Timescale for action 22/07/08 2. YA39 24 (1)(2)(3) 22/07/08 Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 32 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 YA26 Good Practice Recommendations Service users should be supplied with secure lockable storage in their rooms. This needs to be appropriate to their needs. Glyn Residential Care Home DS0000011739.V360997.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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