Inspection on 10/08/06 for 24 Flambard Avenue

This inspection was carried out on 10th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

24 Flambard Avenue 15/04/09

24 Flambard Avenue 28/08/07

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

CARE HOME ADULTS 18-65 Flambard Avenue (24) Fairmile Christchurch Dorset BH23 2NF Lead Inspector Veronica Crowley Unannounced Inspection 10th August 2006 10:00 Flambard Avenue (24) DS0000065314.V307741.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 Flambard Avenue (24) DS0000065314.V307741.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. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Flambard Avenue (24) Address Fairmile Christchurch Dorset BH23 2NF 01202 474848 01202 474803 Flambard@robinia.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) Robinia Care South Limited Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Newly Registered 18th October 2005 Brief Description of the Service: Flambard Avenue is a four bedded spacious detached home for young individuals with learning disabilities and associated behaviours which may challenge the service. It is registered to provide personal care for four adults with learning disabilities and there was one vacancy at the time of the inspection. The home is based in the heart of the local community in Christchurch, Bournemouth. Good public transport facilities, local shops, cinema, restaurants, churches and a library are all within walking distance or a short car journey away. Accommodation is provided on two floors. The ground floor comprises of two lounges, one for quiet, sensory activity and one for TV, a kitchen/diner, a laundry and office in addition to one service user’s en-suite bedroom. The upper floor has two en-suite bedrooms, a further bedroom with an adjacent bathroom and a staff sleeping in room. The secure back garden is mainly laid to lawn, surrounded by mature shrubs and trees. A brick built shed and a further patch of land is sectioned off at the end of the garden. There is also a patio and brick built bar-be-cue. The homes aim is to provide “a safe, homely environment for young adults with learning disabilities. Each individual accommodated in the home will be helped and encouraged to achieve as much independence as possible by the formulation pf person centred care plans with realistic goal to enable maximum potential to be reached in all areas.” Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken as part of the statutory inspection process in accordance with the Care Standards Act, 2000. All key standards were assessed according to the Care Home for Adults (18-65) National Minimum Standards. The time spent on the inspection process totalled eleven hours, nine of which were spent at the home and two hours spent in preparation. The inspector met with the Acting Manager, four members of staff and observed service users returning from activities having brief conversations with two of them. A tour of the premises took place and various records were examined, including two service user’s files and two recruitment files. Additional information received by the inspector prior to the inspection was also taken into account. This included a pre-inspection questionnaire completed by the Acting Manager, 2 service user surveys and any other information such as Regulation 37 notifications of significant events and Regulation 26 Visits in the home. The preparation and openness of the Acting Manager and staff assisted the inspection process and the inspector was grateful for their time and commitment to the inspection. It is acknowledged that this service has been troubled, staff wise, since its’ opening in October 2005 but the Acting Manager has, in the past two months, managed to maintain an order of stability and continuity to the home. The people living at Flambard Avenue prefer the term service users and this has been used throughout the report. What the service does well: Flambard Avenue offers a small family type environment providing a great deal of flexibility promoting individual choice. Observation during the inspection showed service users felt relaxed in the environment and were able to freely access all communal areas. Service users were able to fully participate in household routines such as making tea, baking cakes and helping in the garden and contribute ideas for the running of the home such as planning their meals and daily activities. Service users choices and preferences are promoted where possible. They are treated respectfully and can spend time in privacy in their own rooms or have access to all the communal areas of the home. Service users are encouraged to be involved in household activities and enjoy varying daily activities/routines. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 6 Care plans and individual risk assessments are excellent working tools, reviewed and updated monthly to ensure the staff work consistently with the service users. The home has good links with relatives and liaises regularly with them over service user care needs. Staff spoken to during the inspection demonstrated a good knowledge of service users needs and the aims of the home. Medicines storage was good and records of administration were clear. The home is decorated, furnished and maintained to a high standard providing service users with a bright, clean, homely environment. There are robust systems in place for monitoring the performance of the home against its’ Statement of Purpose and The Care Homes Regulations to ensure service users achieve good outcomes. What has improved since the last inspection? What they could do better: There has been no permanent Registered Manager in post since March 2006. An Acting Manager from another service has been managing the service since June and will continue to do so until the new Manager starts in mid September. Inconsistent leadership has affected some aspects of the running of the home, namely: recording of accidents and incidents, safeguarding both service users and staff and ensuring staff are suitable trained to NVQ level 2. Although service users have access to the community it is acknowledged by the staff team that they need to undertake more work in expanding their knowledge about services, facilities and activities held in the local community. There needs to be a system for recording medicine allergy status on the MAR chart, and for self-monitoring medication records and the audit trail to ensure that medication is given correctly. More awareness of staff is necessary in order for them to follow adult protection procedures, notify interested parties and record promptly to ensure the safety and wellbeing of all parties concerned. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 7 The Registered Person needs to identify strategies towards increasing the number of care staff qualified to NVQ level 2 and above to meet the targets set out in the National Minimum Standards. The service should ensure that all policies and procedures are readily available and accessible at all times in order for staff to be able to gain specific guidance. 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. Flambard Avenue (24) DS0000065314.V307741.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 Flambard Avenue (24) DS0000065314.V307741.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. An admission procedure is in place that ensures prospective service users are only admitted on the basis of a proper assessment and subsequent trial period ensuring the home is confident the service they provide will meet potential service users’ needs. EVIDENCE: The home has a comprehensive admission policy and from the records viewed it was clear this was being thoroughly implemented by the manager and staff at Flambard Avenue. There had been three admissions since the service opened in October 2005. The records of the last service user admitted were read. All pre-admission assessments had been collated and used to obtain a detailed picture of the service users needs and abilities and specific behaviours. The records clearly demonstrated the time and care taken to understand the service user’s needs as much as possible prior to the actual admission. This was particularly difficult as the service user has limited verbal communication and relies on non-verbal ways of communicating his needs and wishes. A very thorough transmission procedure had taken place over a period of six weeks. This included staff from the Flambard Avenue visiting the prospective service user, Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 10 the service user visiting and staying for overnight and week-ends visits and staff from the previous placement staying at Flambard Avenue for two nights to support and encourage the new service user to settle well into his new environment. There was further evidence on files to demonstrate that service users are subject to a one month, three month, six month and ultimately an annual review of the placement. Information is available to prospective new service users and there is a service user guide produced in an accessible format using clip art and simple text. Flambard Avenue (24) DS0000065314.V307741.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. The Acting Manager and staff have a detailed knowledge of all service users ensuring that their needs are well met and any changes to their care can quickly be incorporated into their plans. The small family type living environment offers service users a great deal of choice and flexibility allowing them freedom to make decisions about their lives. The home has appropriate policies and procedures in place for assessing and managing risks, which are based on enabling service users to take responsible risks rather than preventing them from doing so. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 12 EVIDENCE: Two service users’ care plans were examined. These provided comprehensive information about service users’ identified needs, expected outcomes, identified risks, support and care actions, early warning signs, recognised triggers and behaviours displayed followed by strategies to support the individual e.g. proactive, active and reactive. All areas relating to general health and mental health, finances, mobility, personal care, communication, family and friends, daily activities, routines eating and drinking and household tasks are incorporated within the plans. The plans are written in the first person and hold examples of how the service user likes to be supported e.g. “I need staff to support me in dialling a telephone number”, “ I need some supervision and gentle verbal prompts”. The manager and staff advised that the assessments and plans are developed and reviewed with input from relatives and significant others and where possible with the service user; though this is often through observations of the service user’s behaviour and reaction to situations and the environment. The plans are reviewed monthly. A recommendation is made for staff to further break down care plans into targets for each individual in order to demonstrate progress achieved. The key-worker system had recently been introduced The Acting Manager and staff spoken with in addition to records viewed demonstrated that the service is proactive in promoting the rights of service users to make decisions and control their lives. There are no limitations placed on service users in relation to their choices or human rights. Staff provide information and assistance in order to support the service users to make their own choices and decisions. Examples include menu planning, daily and weekly timetables, shopping, choosing clothes and toiletries, preparing drinks and snacks and personalising their bedrooms. The home has a comprehensive, user-focussed risk assessment policy and procedure in place. Risks are well documented and focus on enabling service users to continue to take responsible risks and maximise independence. Where, from the case files examined, risks had been identified following a needs assessment these had been duly recorded. As with care plans, risk assessments are updated monthly or on ‘an as and when basis’. Service users receive support and training, where necessary, such as Health and Safety training, road safety and personal safety when out in the local and wider community in addition to going swimming, out for lunch, walks or to the shops. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, & 17 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. Service users have good links to their local community offering them the opportunity to take part in a range of educational, social and leisure pursuits. Family visits and telephone contact are supported to ensure that personal relationships are appropriately maintained. Flambard Avenue offers a small family type environment providing a great deal of flexibility and participation in the home’s daily routines promoting individual choice and independence. Service users receive a varied and interesting menu, which provides wellbalanced and nutritional meals. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 14 EVIDENCE: A record of service users daily activities is kept on each individual’s file. All service users have regular organised daytime activities, which can be flexible according to service user’s choice. Evidence on education opportunities commencing in September for one service user was discussed with the Acting Manager in addition to other packages of timetabled activities. These are arranged with service user participation. Due to the complexities of service users’ behaviour they are always accompanied by two members of SCIP trained staff when accessing the community. Trips out into the community include swimming, snooker, going for walks, to the pub and shopping either by public transport or in the homes own transport. The Acting Manager reported that the service users maintain neighbourly relationships within the community. The Acting Manager also stated that service users would be supported to vote, should they so wish. It had been noted in staff meeting minutes and is a recommendation that some work needs to be initiated by staff to widen their knowledge about services, facilities and activities held in the local community. Relative’s details were recorded on service users’ files. Care plans seen provided detailed information about social contacts and significant people in the lives of service users, and daily care records included entries relating to contact with families, friends and acquaintances. Service users can entertain either in communal rooms or in their own bedrooms. Visits home to family are regularly facilitated and one parent was expected for lunch the day after the inspection concluded. Discussion with the Acting Manager indicated routines in the home were flexible accommodating individual’s needs. For example service users helped themselves to their own breakfasts and evening meals were generally eaten together but times could be adjusted to enable service users to attend evening activities. Housekeeping tasks are featured in the Service User guide and included in individual care plans. Service users are able to spend time in the privacy of their rooms, bath and shower when they choose and go to bed when they want to. Observation throughout the inspection showed that service users had freedom of movement around the premises and were able to help themselves to drinks and snacks when they wanted. Staff were seen to be sensitive to individual needs and promote independence. A visitor’s book is kept at the entrance of the home and was clearly used by the regular entries noted. From discussions with staff and observations made throughout the inspection it was evident that staff are very aware and respectful of the rights of the service users and the importance of encouraging and supporting service users to develop a safe level of independence based within the risk assessment framework. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 15 A sample of menus was viewed as part of the inspection. This showed service users were offered a varied and nutritious diet and supported to follow a healthy eating plan. Service users usually helped themselves to their own breakfasts and ate together in the evening. Service users can be involved in planning, preparing and cooking the meal if they choose to. Service users usually choose their meals for the week on a Sunday evening, but changes can be made at short notice. The Acting Manager reported that the service are currently purchasing laminated pictures of food, which will be colour coded to indicate nutritional value, to enable more autonomy for one specific service user. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. Personal support is offered in a way that promotes the service users’ privacy and independence. The physical and emotional health needs of service users are well met with multi disciplinary working taking place as appropriate. The home has systems in place for handling and administering service user’s medication to meet their healthcare needs but care is needed to ensure procedures are followed to protect service users from the risk of their medication not being given correctly. EVIDENCE: There was evidence that service users were receiving the personal support they needed. Support needs were clearly recorded on care plans, although all three service users were fairly independent and the majority of care needed was verbal prompts to ensure service users had washed, shaved and taken showers as appropriate. The detailed Individual Care Plans and risk assessments clearly inform staff how each person wants and needs to receive Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 17 their individual support. Daily records are kept on the individuals’ daily activities, physical and emotional health and any specific behaviour /incidents. Records of any appointments /consultations with other agencies/professionals are maintained. These records provided excellent information and help staff form a picture of the service user’s changing needs. All service users were registered with a local G.P. and any health care needs were clearly recorded. They all have access to external professional services if deemed necessary. Care plans demonstrated and service users confirmed that staff provide sensitive and flexible personal support in order to maximise their privacy, dignity and independence. Any support offered is arranged with the focus on enabling service users to be as independent as possible, therefore support ranges from prompting to actually supervising and attending with the service user. The home has a medication policy but it did not cover procedures for: ordering medicines; providing medicines required when out for the day or on holiday; when the GP changes medication and storing medicines needing refrigeration to guide staff. No service users were self-medicating. Medicines were stored securely and staff that give them were trained in house and assessed as competent. The manager said that all except two had done a medication course and they would be doing a course with the supplying pharmacy soon. From reports seen two recent medication errors were dealt with appropriately. The directions on the Medicine Administration Record (MAR) charts agreed with the labelled medicines but allergies were not recorded, or ‘none known’ where applicable, so that staff can check this before giving medication. Audit trails for medicines in the monitored dosage blister packs agreed with the records indicating that these medicines were given as prescribed and recorded but it was not possible to confirm if other medicines were given correctly as there was no system for recording a recent stock balance or the date a new pack was started. Changes to medication were clearly recorded on the MAR chart. There were individual care plans on medication, which included relevant information including an annual GP review, but it would be useful if the purpose of each medicine were identified. There were patient information leaflets for some medicines but not those in monitored dosage blister packs and the pharmacy should be asked to provide them so that they are available for the service user, advocate or staff to refer to. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. The homes’ systems and adult protection training generally ensures that service users are protected from abuse and that their welfare is being safeguarded and promoted. EVIDENCE: The home has a detailed written complaints policy and procedure. Service users spoken with were aware they could complain and were able to tell the inspector whom they could talk to if they were unhappy about something. They also felt they would be listened to and something would be done. The Acting Manager reported that no complaints had been received. Observations made during the inspection clearly demonstrated that the views of the service users are listened to and acted upon. The service has robust policies and procedures in place and staff undertake regular training in relation to the protection of vulnerable adults. However recording of incidents/accidents appeared sporadic throughout some of the year. Although this had improved since the Acting Manager had been in post a recommendation is made to ensure that staff follow procedures, notify interested parties and record promptly to ensure the safety and wellbeing of all parties concerned. A whistle-blowing policy is in place. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 19 The permanent staff team are all SCIP trained, which is physical intervention training based on de-escalation techniques, only using restraint as a last resort. Only SCIP trained staff are able to accompany service users into the community to ensure their wellbeing and safety. The Acting Manager confirmed that SCIP training is arranged for the 5th & 6th of September 2006 for all new members of staff, who will be in post by that date. This training has also been extended to agency staff working consistently with the service users. This will enable greater safety for all concerned. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 & 30 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. Flambard Avenue maintains a good standard of décor and furnishings that provides service users with an attractive, comfortable, homely environment. Each service user has a bedroom that has furniture and fittings sufficient and suitable to meet individual needs. Bathroom and toilet facilities are more than sufficient for assessed needs offering service users personal privacy. The home is clean and hygienic with satisfactory procedures in place for controlling infection. EVIDENCE: A tour of the premises was carried out as part of the inspection. All communal rooms were seen including the lounge, dining area, kitchen, laundry room and three service users bedrooms. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 21 The premises were well maintained and decorated in a comfortable, homely way that was suitable for its stated purpose, i.e. providing care and support to adults with learning disabilities. Furniture, although robust, is domestic in style. The home is fortunate to have two lounges, one that is used for quiet, sensory time and one that is used for T.V., DVD etc., The inspector was also shown the outside garden which has a brick built bar-be-cue and good size patio area with patio furniture. The garden is both secure and private and is framed by mature trees and shrubs. Service users bedrooms were observed to be personalised to each individuals taste with plenty of space for personal possessions. Three of the four service user bedrooms have en-suite facilities and the remaining bedroom has a bathroom adjacent. One service user spoke positively about his bedroom and general living environment. A further W.C. is situated on the ground floor for communal use. All bathrooms were seen to be clean and hygienic. On both days of the inspection the home was observed to be clean, tidy and hygienic. The Acting Manager was aware of procedures to control the spread of infection and an appropriate policy was seen during the inspection. The laundry room is situated off the hall ensuring any soiled articles do not need to be carried through the kitchen. Separate hand washing facilities are provided. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. The service must increase the number of care staff qualified to NVQ level 2 and above in order to fully meet the needs of the service users as per the National Minimum Standards. Good systems for vetting and recruiting staff are in place allowing the most suitable and dedicated staff team. Although the majority of the staff do not currently hold NVQ Level 2 they are able to meet the changing needs of the service users through good programmes of training and development further supported by supervision and staff meetings. EVIDENCE: Currently only two members of the permanent support staff hold the NVQ level 2 award. The Acting Manager confirmed that no dates have been scheduled for the remaining support staff to undertake this essential training and a Requirement is made for this shortfall to be addressed as a matter of priority. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 23 Two staff recruitment records were examined at random, for the purpose of ensuring all requirements under The Care Homes Regulations 2001 were being met. A robust system is in place which is working in practice. Those records seen fully meet the requirements. The Acting Manager confirmed and records demonstrated that staff are receiving regular supervision and attending monthly staff meetings. The hand over of staff was observed and considered verbally detailed, complemented with a written hand-over sheet. Each permanent member of staff had received an annual performance review where training needs had been identified. Staff spoken with felt that staff morale had improved since the Acting Manager had been in post and reported that they saw themselves as supportive to each other, committed and focussed on the service users achieving good outcomes. Training undertaken has included Health and Safety’ SCIP, Fire Safety, First Aid, Food Hygiene, Personal Care, Medication and Abuse. Future training scheduled includes SCIP physical intervention training, Abuse update, Communication/makaton specific to the direct needs of one service user, update on fire training, update on medication training from Boots Pharmacy and Autism Awareness. All new members of staff undertake a six month probation period where it is expected they will complete both their induction and foundation training in accordance with the Certificate for People Working with Learning Disabilities (CPWLD) previously LDAF. Staff also have access to and support from the Company’s Psychologist on a monthly basis. She attends a staff meeting and gives support and guidance regarding working with specific individuals and the impact this may have. The policy/procedure for dealing with physical aggression towards staff was not available for inspection. The Acting Manager informed the inspector following the inspection that the Abuse Policy was in the process of being updated and physical aggression towards staff would be included within this policy. Until this is available it remains a recommendation for a procedure to be available to all staff at all times should they wish to access it. Following some incidents of violence at the home a de-briefing package had been created. Although this was currently in a consultation process it is recommended that recorded debriefing is undertaken following any incidents of violence to ensure both staff and service user feel properly supported. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in the outcome area is good. This judgement has been made using evidence including a visit to this service. Although the home has been managed inconsistently, which has impacted on some record keeping and support of staff, service users have been helped and encouraged to achieve as much independence as possible. There are robust systems in place for monitoring the performance of the home against its’ Statement of Purpose and The Care Homes Regulations to ensure service users achieve good outcomes. Practices in the home promote and safeguard the health, safety and welfare of the people using the services. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home is currently without a permanent Registered Manager, although the post is being filled by an Acting Manager from another service until the newly appointed Manager takes up her position in September 2006. The Acting Manager is a Registered Learning Disability Nurse, holds the Diploma In Social Work (DIP/SW) the Registered Manager’s Award and is a SCIP trainer therefore meeting the criteria required under the Care Homes Regulations 2001. There are robust systems in place for monitoring the performance of the home against its’ Statement of Purpose and The Care Homes Regulations to ensure service users achieve good outcomes. These include feedback questionnaires from placing social workers and families, which are then used to inform the annual action plan, Regulation 26 visits, monitoring of all accidents/incidents/medication, concerns, health and safety issues and through day to day contact and observation of the individual service users. Health and Safety maters are given high priority. The home has an up to date fire risk assessment (November 2005) and a variety of environmental and generic risk assessments. Weekly and monthly health and safety audits are also undertaken. All permanent staff had completed emergency first aid and the majority had undertaken food hygiene training. These training courses are provided on a rolling rota system to ensure all staff are appropriately trained. Temperatures of fridge/freezer and food cooking were all recorded. COSHH substances were stored safely and had accompanying data. Water temperatures are kept at 43decrees C and are also tested weekly. The Dorset Fire and Rescue Service had visited the home prior to its opening and passed the systems and fire precautions satisfactory. All fire records were complete and show that necessary in-house and specialist checks, fire training and fire drills had been undertaken. Accident and incident records cross-referenced successfully to service user’s files. There were no outstanding recommendations from the local Environmental Health Service. Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 2 X 3 X 3 X X 3 X Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 YA20YA20 Regulation 13 Timescale for action The registered person shall make 30/09/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: 1. Having a robust audit trail and evidence of regular checks to confirm that medicines are given as prescribed and recorded. 2. Recording allergies to medicines or ‘none known’ where applicable on or with the MAR chart. 3. Updating the medicines policy with the recommended additions. The Registered Person must 31/12/06 ensure that support staff are enrolled on NVQ level 2 awards as a matter of urgency. Requirement 2 YA32 18(1) Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6YA6 YA13YA13 YA20YA20 Good Practice Recommendations Short-term targets on care plans should be devised in order to demonstrate the progress of each individual. Work needs to be initiated by staff to widen their knowledge about services, facilities and activities held in the local community. Care plans should include the purpose of each medicine. The home should have patient information leaflets on medicines used available for the service user or their advocate and for staff reference. Staff should ensure they always follow adult protection procedures; notify interested parties and record promptly to ensure the safety and wellbeing of all parties concerned. There should be records of when staff have received debriefing following incidents of violence or aggression to demonstrate that they are provided with appropriate support. The policy/procedure for dealing with physical aggression towards staff should be readily available and accessible at all times. 4 5 YA23YA23 YA36YA36 6 YA36YA36 Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Flambard Avenue (24) DS0000065314.V307741.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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