Inspection on 15/04/08 for 24a Lower Hanham Road

This inspection was carried out on 15th 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

24a Lower Hanham Road 22/04/08

24a Lower Hanham Road 21/03/06

24a Lower Hanham Road 23/08/04

24a Lower Hanham Road 11/05/04

24a Lower Hanham Road 19/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOME ADULTS 18-65 24a Lower Hanham Road Hanham South Glos BS15 8HH Lead Inspector Jacqueline Sullivan Key Unannounced Inspection 15th April 2009 12:00 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 24a Lower Hanham Road Address Hanham South Glos BS15 8HH 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) 0117 960 5928 0117 9709301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Anne Elizabeth Swain Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 22nd April 2008 Brief Description of the Service: ‘24 a Lower Hanham Rd’ is managed under Aspects and Milestones Trust. The home is registered to accommodate 5 people with learning difficulties, aged 19 to 64 years, and 65 years and over. The home is approximately half a mile away from the main Hanham shopping area. There are a range of shops and community facilities, and is on a bus route to the centre of the city. The building is a detached dormer bungalow in an established residential area. There are 4 bedrooms on the ground floor with an en-suite bathroom. The other room has a shower. The home is accessible for people who use a wheelchair, and has suitable adaptations for people to be as independent as possible. The range of fees for the home is £900.00 to £1,000.00. However, fees for people considering to move into the home would be assessed individually. 24a Lower Hanham Road DS0000003378.V375327.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. This was 24a Lower Hanham Road’s Key Inspection. It was unannounced and took place over two days. Prior to the inspection, previous records and reports held at the Commission for Social Care Inspection were read, such as the home’s monthly reports carried out by the home’s Area Manager; incident reports; the previous report. We spoke with 3 people living in the home and 4 members of staff. We walked around the home with a member of care staff looking at the environment. We met with the manager who assisted us fully with the inspection. We read key documents held in the home, such as care plans; health and safety recordings; staff recruitment and training certificates; medication records, and risk assessments. What the service does well: Lower Hanham Rd provides a homely and relaxed atmosphere for people living there. One person said, “I love living here.” People are treated with respect and dignity. Mealtimes are relaxed and people are offered a varied diet. The staff team communicate well and said that their manager supports them. People have lifestyles which suit their needs and preferences. There are varied activities on offer. People feel comfortable with raising concerns; these are acted upon, and people are given a response. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? People are better protected as the monthly visit reports have been reviewed to contain more information about the visit and to fully comply with the regulation. People are better protected as the gas safety certificate is now in date. The staff team are more able to meet the peoples needs as the person centred plans and associated documents are reviewed six monthly. People are better protected as staff have refresher training in the Protection of Vulnerable Adults in line with the Trust’s policy. People are better protected as staff are trained in mandatory areas (including fire safety). People are better protected as the health and safety checks within the home are carried out according to regulations. People are better protected as advocacy service has been sought for those people with no family or supporters outside the home. The staff team have reviewed the monthly weighing of people living in the home. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 24a Lower Hanham Road DS0000003378.V375327.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 24a Lower Hanham Road DS0000003378.V375327.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have contracts reflecting their current fees or terms and conditions for living in their home. People will have their needs assessed but this may not be timely. EVIDENCE: We looked at the initial assessment for the most recent person to live at the home. This person moved into the house in November 2008. The placing authority sent their care plan/community care assessment prior to their arrival. We saw that it covered personal and family context, personal care, support networks and physical and mental health. The manager said that the staff team then use this information as a guide to see if they can meet their needs. We were told that t this person then came for a visit and that the existing people in the home were consulted about them coming to live there. Then followed a series of overnight visits. We saw a care plan from the service users previous home dated 23/09/08 and a lifestyle plan dated July 2008. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 10 The manager said that prior to this person moving in she put together a “snapshot” document of their needs e.g. personal care, communication needs and activities. We saw that a personal planning day was arranged with the facilitator from the Trust, the service users and their representatives to draw up an essential lifestyle plan on the 13/05/2008. We were concerned that this was seven months after their arrival at the home. A recommendation has been made that these plans or a care plan are in place in a more timely fashion. We looked at the license agreements for the most recent service user and saw that there are two. One is in picture format and the other contains the detail of the contract. We saw that they contain the fees (rent), information about personal allowances and the term and conditions e.g. payment for holidays and transport are written into the document. However when we looked at the activities for the service users we saw that they pay for admission fees and own snacks. This detail was not present in the document. We agreed that it would be useful for the service users to have this written into the agreement as an addendum which when signed by the service user would form part of the agreement. We saw the transport policy and the van contribution agreement. The first part of the transport policy is that of this home and the latter part is that of the Trust. The van contribution agreement was seen to be signed by a staff member and not the service user. We were told that this person would be able to sign their documents. It is recommended that there is a system in place to ensure that all service users sign any agreement to ensure that they have read and agreed to its conditions. Discussion with the manager and the information in the above documents confirmed that once the van is purchased with service users disability allowance it is then the property of the Trust but service users pay for the repairs. It is unclear as to why, if the van belongs to the trust are the service users paying for its continued repair. If the van is sold then it is unclear who receives the money. Therefore, so that both the Trust, staff at the home, service users and the Commission is clear about .We recommend that the registered person write to the Commission explaining the detail and the rationale for this arrangement. We also recommend that service users and their representatives are given a forum for input into any decision made so that we can be assured that their wishes and feelings are taken into account. We noted that these issues were subject to a requirement in the last inspection. We were shown the policies have been introduced by the manager in order to meet these requirements. Whilst we acknowledge the work that has taken place there is further work to be done therefore this requirement will remain. We noted how positive the manager viewed the inspection process. She said “I find inspection useful as they highlight areas of development”. 24a Lower Hanham Road DS0000003378.V375327.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs and goals are not reflected in their personal plans. People can make decisions about their lives but these are not always accurately recorded. Risk assessments do not reflect current lifestyles and therefore not protecting people. EVIDENCE: We looked at the care files for three service users and saw that care plans from placing authorities and essential lifestyle plans are reviewed every six months. We looked at a care plan completed by the placing authority. The manager said that she reviews these six monthly. We noted that there were handwritten entries on these reviews and that comments from a service user written on the 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 12 plan for one year were again used for the following year. This feedback was relevant at that time and may or may not be relevant now. We saw that this care plan stated that X needs a mobility car and that the action is for the provider (the home) to explore getting one for him as soon as possible. The review did not detail what the staff team had done to get one for him or if it had been achieved. There were many examples of this type of issue. It is required that the staff team use the yearly review from the placing authority as a template for their own reviews which includes the detail of the care provided and the name of the staff member who will complete each task. These should be completed with the service user and include their wishes, feelings and aspirations. We saw that decisions that service users made about aspects of their lives were not included in these plans. For example we were told that X wishes to live independently and that the staff team have completed extensive work to ascertain wishes and feelings about the move. We noted that a staff member is allocated several hours to meet with him to ensure they fully understand what he wants. However these views were then not recorded in his care plan. We asked to see the Essential Lifestyle Plan for this service user was not available. The manager said, “It’s a shame as it is really good”. We looked at another persons Essential Lifestyle Plan and we saw that this contained more of the detail we referred to above as being needed in the care plan e.g. communication needs and sexuality. However, we noted that the information is not current, as it has not been updated. The activities in this plan were not the activities that this person was actually doing. These activities were recorded on the activity plan. The activities described in the Essential Lifestyle Plan had ceased therefore this persons routine described in the plan “I return home at 3.30 pm” are not happening now. We noted that there are no key worker meetings are taking place therefore a recommendation has been made that these start as this is a forum to ensure that peoples plans are upto date. We noted some similar discrepancies in the health section of the Essential Lifestyle Plans and this is discussed in a later section of the report. The requirement has been extended and the manager must ensure that people’s care plans meet the regulations and national minimum standards. At the last inspection it was noted there were some risk assessments in place to ensure that people are supported to take risks in their lives. However, the information is basic and did not address all the risks posed. A requirement was therefore made. Whilst some work has taken place to meet this requirement, it was seen that more work is required. For example we read that X had a risk assessment about migraines but concerns about vomiting noted elsewhere were not in the 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 13 plan. The information in the risk assessment was limited and required more information about consequences and frequency of the occurrence. We saw that risk assessments are reviewed but this is mostly just a signature on the existing assessment and does not indicate a new assessment of present risk. We were told that the keypad for the front door is rarely used. Therefore we suggested that a risk assessment is undertaken with a view to its removal. We also saw that the door to the office was extremely heavy and that service users often had to open the door to talk to the staff. A risk assessment should be in place about the risk this door poses. We looked at the recording in the care files and noted that this is signed by staff members but not service users. The concerns raised in the recording were not consistently followed up. For example we read that X often seems to be choking a lot. But there was no follow up action to resolve this. A recommendation has been made that the recording in the care files is reviewed. At the last inspection it was recommended that the manager seek external advocacy advice for people who would like it to ensure that there is someone they can talk with about any issues they may have. At this inspection it was noted that this has been completed. 24a Lower Hanham Road DS0000003378.V375327.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): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home enjoy a lifestyle, which suits their needs and preferences. People’s daily routines are respected. People have supported to maintain relationships outside of their home. People enjoy a healthy diet with relaxed meal times. EVIDENCE: As noted at the last inspection, people living in the home have personalised routines and enjoy many activities. These include going to church; discos; sewing; ladies group; football matches; going shopping; going bowling; visiting the zoo and going for drives. Some people go to local drop in centres, and some people have voluntary jobs in the community. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 15 People living in the home have been paying for a van over the past few years, and pay for the maintenance and petrol costs. This gives people access to the local community and further a field. As written under Standard 5, the ownership and financial details need to be clearly written and agreed to by the owners of the van, and clear financial terms if someone leaves the home. As noted at the last inspection annual holidays are being planned according to where people would like to go. One person goes to the same place every year, which they enjoy. As noted at the last inspection, some people living in the home have family supporters and have regular contact with them. This is recorded in people’s care plans and the staff told us about the different relationships. One person does not have any family but has lots of friends and supporters at their local church. People’s personal daily routines were observed during the visit and were respected. People could access all areas of the home and garden and choose whether to spend time on their own or with other people. We saw one person doing embroidery. She said, “I like doing embroidery. We look after each other here. I was in here (The lounge) and X went funny so I told the staff straight away.” “ I like watching the television. I like Coronation Street and X factor.” We spoke with three service users about whether they can choose the food they eat and they confirmed that they did. One person said, ”The food is lovely like to eat fish…I made a Christmas cake and it was all nice on top”. Another said “I buy bacon and eggs with the staff and I mash the potatoes when we have mash” There was a good range of meals, such as Sunday roast; Sheppard’s Pie; Fish pie; spaghetti bolognaise, and scrambled eggs. There was a good selection of fruit and vegetables in the kitchen. People were asked what they would like, assistance was given with dignity, and the mealtime was relaxed. Food temperatures had been recorded, along with fridge and freezer temperatures to make sure that food is served and stored safely for people living in the home. 24a Lower Hanham Road DS0000003378.V375327.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their personal and health care needs. The home’s medication procedure needs to be adhered to, to ensure that people are safeguarded at all times. Information about the medication people take needs to be recorded accurately to ensure peoples safety. EVIDENCE: As noted at the last inspection people’s care notes contain staff records of when people visited external health professionals (optician, dentist, Podiatrist and GP). When people refuse to attend appointments, this is recorded. Some people have more complex health needs than others and reviews are held with the relevant persons (Community Learning Difficulties Team). 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 17 At the last inspection it was noted that the when the care plans are reviewed, there needs to be more information for staff as to how to support people with their personal care needs, for example, what temperature they like their bath, what time they would like to be supported etc. At this inspection we looked at the Essential Lifestyle Plan’s which have a health section and noted that the medication that people are actually taking is not consistently accurately recorded in these plans. For example the information about one persons’ migraine is different in the Essential Lifestyle Plan and the health action plan. This health action plan was seen not to contain information about the person’s chiropody or dental needs. We looked at another persons Essential Lifestyle Plan and health action plan and saw that there were similar discrepancies. It is required that the health action plans for all service users is reviewed so that it contains upto date information. At the last inspection it was noted that people living in the home are weighed on a monthly basis. We asked staff why this happened, and we were not told any reason other than habit. No one in the home has a specific weight problem or needs their weight to be monitored for a health needs. It was recommended that this practice be reviewed and people are asked if they want to be weighed as it may seem institutional. At this inspection it was noted that this practise no longer continues. The administration of medication in the home was inspected with the manager. The cupboard is kept secure at all times. Each person living in the home has their own folder for the recording of their medication, with a photo of the person. There is a signatory list to identify staff’s signatures. In the individual’s file, there is a description of how they like to take their medication. At the last inspection it was noted that some risk assessments in people’s care notes regarding their self-medication. It was noted that these need to be reviewed to accurately describe what medication is self-administered and what staff need to do to reduce the risk of error. At this inspection it was seen that the risk assessment is the same one seen at that inspection with some handwritten alterations. It was seen that this assessment requires more review as it identifies a risk if this person takes too much medication but doesn’t state what staff should do. As previously stated we saw in a care file that a staff member had noticed a service user seemed to be choking but it was not clearly plan 24a Lower Hanham Road DS0000003378.V375327.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot always be assured as their safety as there is no plan in place to address challenging behaviour or risk assessments. People feel comfortable with raising their concerns and complaints. People said that they feel safe and the majority of staff members are trained in how best to protect them. EVIDENCE: On the notice board, the complaints procedure is on display with pictures to make it easier to read. The complaints book was read. At the last inspection it was noted that a clear description of the situation and that it had been read back to the person. The person making the complaint also signs the entry if they are able to do so. At this inspection it was clear that people feel able to complain and two people told us they feel confident the staff will sort out their complaints for them. One person said, ”I feel safe here”. However many of the complaints were about the challenging behaviour of a service user which impacted on others. There were no risk assessments nor action plan to address this. Neither was staff training in place. We looked at the staff’s training files were looked at, and all staff had received training in the Protection of Vulnerable Adults (POVA). At the last inspection it 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 19 was required that the It is required that staff have a refresher course on POVA in line with the Trust’s policy. At this inspection it was seen that this had been completed At the last inspection it was recommended for good practice that senior members of staff who step up whilst the manager is away have the training for managers. This had not been completed. 24a Lower Hanham Road DS0000003378.V375327.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and safe home. People have personalised bedrooms with good access to bathrooms and toilets. The home has adaptations for people to be as independent as possible EVIDENCE: A tour of the property was taken with a member of staff. The home is in a residential area and the building is in similar design to the neighbourhood. The home is accessible for people using a wheelchair. It is essentially a 2-floor bungalow. There are 5 bedrooms. 4 have an ensuite bathroom and the fifth a shower. There is a large, comfortable lounge; a 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 21 kitchen; a toilet; laundry area, and a bathroom. Upstairs has the fifth bedroom; a bathroom, and the staff sleep-in room and office. The home has a front garden area, and a patio-ed garden with pots, a pond, a shed and a barbeque at the back. The garden can be accessed via the kitchen or the lounge. It was observed and read in notes that people living in the home use the garden and enjoy it. There is a ramp from the lounge to the patio, which is broken. At the last inspection it was required that the it was fixed to ensure that the ramp is safe. The manager explained they had tried to do this but had experienced problems. There are protective surfaces along the corridor to protect the walls for people who use a wheelchair independently. However the person who uses the wheelchair cannot easily move around the house, as the doorways are not wide enough. The frames are badly scratched by their chair. A requirement has been made that these are resolved. All of the lived-in rooms were personalised and reflected the person’s choice in décor. Those who need adaptations in the their room and around the home have been provided for to increase their independence and comfort. One person said, “I like my room” and confirmed they could choose their furnishings. The manager has plans to refurbish the kitchen and lounge. One person said “She does a lot for us, she keeps the place nice.” Laundry facilities are satisfactory and we were told how the home follows guidance from the Environmental Health Officer. The home was clean and tidy on the day of inspection. The kitchen cupboards in the kitchen have had a deep clean. Staff keep a maintenance book to ensure that repairs and jobs needing to be done are reported, and then done. 24a Lower Hanham Road DS0000003378.V375327.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by an effective stable staff group. People living in the home would benefit from having a staff group who are fully trained. Staff are well supported in their role in the home. People are protected by the home’s recruitment procedure. EVIDENCE: We asked to see the staff file of the newest staff member. We were told that she is seconded for six months to the home and that her file is with her substantive home. The manager supervises this member of staff. We asked if the Trust has a protocol about where seconded staff members files are kept 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 23 and found that they did not. Consideration should be given to putting one in place. We saw the staff file for another person and we saw only one reference on file as their former employee was the Trust. We were told that the trust has main files and the home receives copies. We saw the training files and saw that training included epilepsy. We saw a quick reference guide completed by the manager which is good practise. We saw that all staff had training in food hygiene and fire and manual handling. We looked at the supervision notes for staff members and saw that they were well organised and timely. There are 2 members of staff on duty at all times, except at night, when one staff member sleeps in. During the week, there are 3 members of staff on duty in the morning to ensure that people are effectively supported in their morning routines and during the day’s activities. It was clear from observations and spending time with staff, that they understand their role within the home. It was observed how staff ask others for assistance and advice when necessary and discuss issues within the home openly. Staff interactions with people living in the home were observed, and people were treated with respect, and care was given in a person centred approach. Staff were able to communicate with those people who do not verbally communicate. One person said, “I like the staff they are really kind.” The staff team have meetings on a monthly basis and the last meeting’s minutes are available in the kitchen, and issues such as COSHH; shopping; the future allotment, and people’s holidays were discussed. These were well recorded and showed that the staff team communicate well. At the last inspection it was required that a recommendation was made, as stipulated by CRB guidance, it is recommended that subsequent checks be done every 3 years. We were told that this has not been completed, as it is not the policy of the Trust. 24a Lower Hanham Road DS0000003378.V375327.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People using the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory for people living in the home. Most of the records are well kept and secure in the home. People are protected by the home’s health and safety procedures. EVIDENCE: Ms Swain is the registered manager of the home. She started in September 2007 She told us that she worked with adults with learning disabilities nurse and holds the registered managers award and has a wide experience of working with adults with learning disabilities. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 25 She said that when she first came to the home she was undergoing many changes to the staff team and now there is a stable staff team who work well together. She is well liked by both staff and service users. She was seen to be very willing to learn new ideas and was very committed to She has worked hard to try and meet the requirements and recommendations of the last report and we acknowledge the work that has taken place. The rating of this group is a reflection of the requirements that have been made and the outstanding work that needs to be in place in order to meet some requirements of the last inspection. At the inspection she said ”I have been working with all staff members to ensure their development whilst recognising individual skills…We are a small team and the commitment is reflected in the good attendance record…I am enlisting the assistance of facilitators and others (service users choice) to update the Essential Lifestyle Plan’s and ensure that they reflect the wishes and needs of the service users. As a manager I feel at times I wear to many hats, taking responsibility for reviewing most of their paperwork. I am working towards letting go of the reins and delegating responsibility to key workers and my deputy. We welcome visitors to the home. They know they are welcome at any time. I have built up relationships with X’s family which had previously broken down. We send out questionnaires and conduct service users satisfaction surveys. As noted at the last inspection people living in the home have monthly house meetings; the staff team have regularly meetings, and it was observed how people living in the home freely express their thoughts and tell staff if they are upset or if something needs doing. At the last inspection it was noted that the Area Manager visits the home on a monthly basis. However some of these were seen to be very basic in information and it was recommended that these be reviewed to contain more information about the findings from the visit. At this inspection it was noted that there is a new area manager and the reports were seen to meet the standard. At the last inspection it was noted that Fire Drills are recorded but were sporadic and according to the certificates and records, some staff are also in need of fire training. It was stated that the manager must ensure that fire training corresponds to the regularity stipulated by the fire authority and that people living in the home practice what to do when the alarm sounds. At this inspection these were seen to meet the standard. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 26 At the last inspection it was noted that health and safety checks (such as the Portable Appliance Testing; Electrical Installations and on the hoist) are carried out appropriately. But the last Gas Safety certificate was overdue. At this inspection these were seen to meet the standard. The home’s certificate was on display in the hallway, along with the home’s current Employers Liability Insurance certificate. 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 27 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 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 3 X Version 5.2 Page 28 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc 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 YA5 Regulation 5 Requirement The registered person should ensure that People living in the home must have up-to-date contracts in place. (Outstanding requirement although there is work in place to try and meet it) Timescale for action 30/11/09 2. YA6 15 The registered person should ensure that peoples care plan accurately reflect their needs are fully reviewed The registered person should ensure that Risk assessments to be current and to reflect current risk for people living in the home. (Outstanding requirement although there is work in place to try and meet it) 30/11/09 3. YA9 13(4) 30/11/09 4 YA19 12 5 YA20 12 The registered person should ensure that people’s health action plans and information in their care plans are accurate. The registered person full risk assessments are in place about people’s health needs, including self-medication. (Outstanding requirement DS0000003378.V375327.R01.S.doc 30/11/09 30/11/09 24a Lower Hanham Road Version 5.2 Page 29 although there is work in place to try and meet it) 6 YA22 22 7. YA24 The registered person should ensure that there is a clear record about complaints which involve challenging behaviour which includes the action taken to resolve it. 23(2)(b)(o) The registered person should ensure that The registered person should ensure that The ramp to access the garden must be repaired. The registered person should ensure that the Commission is sent information about the purchase and repair of the communal van. 30/11/09 30/11/09 8 YA5 5 30/11/09 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 Refer to Standard YA2 YA23 Good Practice Recommendations The registered person should ensure that people have a timely full assessment of need. The registered person should ensure that senior members of staff who are expected to step up as managers to have training for managers in the Protection of Vulnerable Adults. The registered person should ensure that peoples wishes, feelings and decisions are recorded in their care plans 3 YA7 24a Lower Hanham Road DS0000003378.V375327.R01.S.doc Version 5.2 Page 30 Care Quality Commission South West Region PO Box 1251 Newcastle upon Tyne NE99 5AN National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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