Inspection on 22/04/08 for 24a Lower Hanham Road

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

24a Lower Hanham Road 15/04/08

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 08/07/2008.

CARE HOME ADULTS 18-65 24a Lower Hanham Road Hanham South Glos BS15 8HH Lead Inspector Nicky Grayburn Unannounced Inspection 22nd April 2008 09:30 24a Lower Hanham Road DS0000003378.V361813.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 24a Lower Hanham Road DS0000003378.V361813.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. 24a Lower Hanham Road DS0000003378.V361813.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 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.V361813.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager to complete NVQ training at Level 4 in Care & Managerment by December 2005. 11th October 2006 Date of last inspection 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 3 bedrooms on the ground floor, 2 with an en-suite bathroom, and there is another bathroom. There is also a bedroom upstairs with an additional bedroom. 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 £987.95 to £1,016.50. However, fees for people considering to move into the home would be assessed individually. 24a Lower Hanham Road DS0000003378.V361813.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 in one day. 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 2 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 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. The Manager was due to complete the Commission’s ‘Annual Quality Assurance Assessment’ (AQAA) by 13th May, which is a self-assessment of the home, giving information regarding the service. Due to her absence, an extension has been given until 31st May. The assessment also includes details relating to each of the headings below with a description of ‘What we do well’; ‘What we could do better’; ‘How we have improved in the last 12 months’; and ‘Our plans for improvement in the next 12 months’. What the service does well: Lower Hanham Rd provides a homely and relaxed atmosphere for people living there. People’s health needs are prioritised and they are treated with respect and dignity. Mealtimes are relaxed and people are offered a varied diet. The staff team communicate well and said that they are supported by their new manager. People have lifestyles which suit their needs and preferences. There are varied activities on offer. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 6 People feel comfortable with raising concerns; these are acted upon, and people are given a response. What has improved since the last inspection? What they could do better: 8 requirements and 5 recommendations have been made as a result of this visit. One requirement is outstanding from October 2006 regarding people’s care and support plans. We should have been told that the manager is absent for a period of 28 days or more, and what management structure is in place for that time. The monthly visits by the external manager do not give sufficient information about the home and need to comply with the regulation. People need to have up-to-date contracts about living in the home with current fees and terms and conditions. The contract also needs to include details about the purchasing of the van and financial arrangements regarding holidays. The ramp leading to the garden needs to be repaired so that people who use a wheelchair can access the garden safely. Staff need to have refresher training in the Protection of Vulnerable Adults and be aware of who to contact when an allegation is made. Senior members of staff should have further training for managers if they are expected to act up when the manager is absent. Other training is also needed for staff (infection control; first aid; food hygiene; fire safety, and health and safety) and it is recommended that staff have training specific to people’s health needs. The gas safety certificate was out-of-date and needs to be done. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 7 Fire drills have been sporadic. Staff and people living in the home need to practice what to do in the event of a fire. Some people do not have close family members and it is recommended that an advocacy service is contacted. The manager needs to maintain staff recruitment files according to the regulations and ensure that all the relevant documentation is kept on site. Following Criminal Records Bureau guidance, it is good practice for these checks to be carried out every 3 years. It is recommended that the monthly weighing of people living in the home is reviewed as it could be deemed institutional practice. The bathroom upstairs has a carpet and cannot be regularly cleaned properly. It is recommended that this is replaced with a more appropriate floor covering. 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. 24a Lower Hanham Road DS0000003378.V361813.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.V361813.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): 2, 5 Quality in this outcome area is adequate. People’s needs are being met. People do not have contracts reflecting their current fees or terms and conditions for living in their home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the home has gone through a period of change as there is a new manager working at the home. There is currently a vacancy in the home. The room is on the ground floor and has a bathroom next door. Standard 1 was not fully inspected. The Statement of Purpose and Service User Guide was up-to-date at the last inspection and we were told that it has been updated since the new manager started working. The new copy must be sent to the Commission. From people’s care files, it was clear that people had assessments from their placing authorities. 2 people have recently had a postal review, which were completed by staff working in the home. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 10 People living in the home have individual licence agreements. The 2 seen were dated December 2006 and August 2006. They were signed by the individual. These must be reviewed and updated to reflect current fees; allowances, and terms and conditions within the home (for example payment of holidays and the payment of transport). The transport situation must be clearly explained within the terms and conditions, or in a separate document, to ensure that people are not being financially abused and are clear as to what they receive if they move house or if the transport is sold. 24a Lower Hanham Road DS0000003378.V361813.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 adequate. People’s needs and goals are not reflected in their personal plans. People can, and do, make decisions about their lives. Risk assessments do not reflect current lifestyles and therefore not protecting people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement from the last visit (timescale given was by January 2007) was for people’s person centred plans and associated documents to be kept under review every 6 months. The external manager also highlighted this in the monthly visit in March 2008. We were told that this has not yet been completed. One person’s care plan has been reviewed. Staff spoke about some of the changes in people’s choices; likes and dislikes, and morning and evening routines. This needs to be recorded to ensure that people’s needs are 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 12 being met. The previous inspection report stated that staff have had training in person centred planning. 2 people’s care plans were read and there was some good information. However, parts of it were evidently out-of-date. For example, prescribed medication did not match with what people are prescribed now; staff told us that how some people have changed their mind about how they like to be supported with their morning routine; some people’s care plan stated that go out on their own, whereas they don’t anymore; someone’s care plan states that they use someone else’s shower whereas they have their own en-suite now. As there are ‘bank’ staff who People living in the home have allocated key workers who they can approach with certain issues. The senior member of staff told us that they were going to be doing all the updating of the care plans with the manager. People need to be involved, with their key worker, and where appropriate their supporters, in the review and updating of their care plans. This is to ensure that the person and their key worker are fully aware of what is written in their care plan. The requirement has been extended and the manager must ensure that people’s care plans meet the regulations and national minimum standards. There were some risk assessments in place to ensure that people are supported to take risks in their lives. However, the information is basic, for example, does not address all the risks posed; the hazards, or include who is involved in reducing the risk. Some were dated from 2004 and there was no evidence that they have been reviewed. For example, one person can be verbally abusive towards other people and this is documented but there is little information about the triggers of this behaviour or what diffusion techniques are used to support the person. When we asked staff about it, they knew what made the person angry and upset and how they can be helped. This needs to be documented to ensure that all staff who work in the home know what to do. We were told that the Trust has introduced a new risk assessment form and therefore the assessments will all be re-done. A requirement for this been made. House meetings are held monthly and the minutes of the last one was on display in the kitchen. People living in the home attend these and issues such as holidays, activities, and the environment are discussed. The minutes showed that one person was asked about a specific health problem during the meeting. We were told that the person had brought the subject up. Personal health issues should be discussed in a more private domain. Some people living in the home do not have any family relations, but do have friends outside the home. 1 person does not have an official advocate whom they could talk with or who could speak on behalf of them. 3 people do have someone who would represent them if necessary. It is recommended that the 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 13 manager seeks 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. 24a Lower Hanham Road DS0000003378.V361813.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, 14, 15, 16, 17 Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 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.V361813.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. 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. Two people need the van to go where they want to. The manager must ensure that they both want to go to the same place rather than going to one place because they both need the van. The financing of this was discussed and according to National Minimum Standard 14, as good practice, “Service users in long-term placements have as part of their basic contract price the option of a minimum seven-day annual holiday outside the home, which they help choose and plan.” We were told that some people finance this themselves depending on where they want to go. People’s contracts do not specify the financial arrangements. These must be clearly stated in the person’s contract, stating what they are expected to pay and what the Trust will pay for (see requirement 1, under Standard 5). 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. The monthly visit in March by the external manager stated that the ‘staff are working with residents more around menu planning and cooking’. The menus viewed showed which person had chosen the meal. Daily entries showed that people are given an alternative meal when they don’t like the initial choice. 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. Staff commented that they felt that they did not have enough money within the budget to buy sufficient amounts of fresh foods, i.e. fruit and vegetables. We were told that there has been a recent increase in the budget, being one pound per person per month. Lunch was observed. 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.V361813.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the visit, a further health need was identified following on from a health appointment. Staff discussed this and took action straight away. Within people’s care notes, staff record 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). Within people’s care files, there is a personal care statement explaining what they can do independently and what they need support with, for example, oral 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 17 hygiene; hair care; dressing; and washing. It also states whether the person has a preference of gender of who supports them. 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. Another example is that staff record when people have had a bath and/or shower. Some people bathe every day. It is noted that 1 person had not had a shower/bath for 6 days, but staff confirmed that they have basin washes, and this is their choice. The person’s care plan must reflect this choice. One person has a new en-suite shower room. Their preference on how they wish to be supported must also be recorded. 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 is recommended that this practice is reviewed and people are asked if they want to be weighed as it may seem institutional. The administration of medication in the home was inspected with the senior member of staff. 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. Staff told us that the pharmacy they use is very helpful and they can ring for advice any time. The training for the administration of medication was explained to us, however, there were no certificates on file to evidence that staff are competent in this area. Staff have to complete a medication course, and then are assessed internally on an annual basis. There have been a few medication errors, which were reported to the Commission, and the member of staff’s competency test have been brought forward. There are no controlled drugs kept in the home. There are some homely remedies used by staff which are kept separate in the medication cupboard. The Medication Administration Record sheets were all complete and the actual medication tallied with the records. There were a few opened bottles and creams which did not have a date on which they were opened, and there was some medication dating from 2005, which was no longer being used, so should have been returned. We were told that this should have been picked up during the checks. There were some risk assessments in people’s care notes regarding their self-medication. Only some people look after some of their medication but the document does not make that clear. These need to be reviewed to accurately 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 18 describe what medication is self administered and what staff need to do to reduce the risk of error (see Standard 9). Some people are on a lot of medication due to their health needs. Letters in people’s files evidence that this is kept under review by external health professionals. This is important due to the types of medication. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. People feel comfortable with raising their concerns and complaints, are listened to and action is taken. People are not wholly protected from abuse due to the need for staff training, but are looked after properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the notice board, the complaints procedure is on display with pictures to make it easier to read. The complaints book was read. As highlighted in the previous report, the record of the complaint must include the action taken and the outcome including the date. This has been taken on board and the book contained the relevant information with 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. It was clear that people living in the home feel comfortable with raising their concerns to staff. Actions are recorded with the date, and people receive a response. 4 of the 6 staff’s training files were looked at, and all 4 staff had received training in the Protection of Vulnerable Adults (POVA). However, this was in 2004 or 2006. Staff told us that the Trust’s policy is have their main training on POVA every 3 years, and refresher training every year. We asked staff about their awareness of the subject and they were aware that they had to 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 20 report it to the Commission and their external manager, but they were not aware of the involvement of Care Direct or the Police. It is required that staff have a refresher course on POVA in line with the Trust’s policy. Further, it is recommended for good practice that senior members of staff who step up whilst the manager is away have the training for managers. 2 people’s personal finances were checked and the amounts held by the home tallied with the records. These were also checked in the monthly visit by the external manager in February and were correct. Staff explained to us the checks that are in place for safeguarding people’s monies. It was suggested that higher interest accounts are sought for those people with large amounts of money in a current account. A requirement was made at the last visit to develop a plan for one individual in relation to the checking and support of personal finances, including the reason. This was partly met and we were sent the renewed plan 2 days after the inspection. The finance situation for the home’s van was discussed and how people are charged. The van will be paid for completely this year. One person had a document in their file stating that they understood the agreement. It is a complicated arrangement and must be kept under review, and staff must ensure that the people, and/or their supporters, paying for it are fully aware of the agreement and are not at risk of being financially abused. A requirement regarding this has been made under Standard 5 to include details within the person’s contract. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30 Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. 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 4 bedrooms on the ground floor, along with a large lounge; a kitchen; a toilet; laundry area, and a bathroom. Upstairs has the fifth bedroom; a bathroom, and the staff sleep-in room and office. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 22 A requirement at the last inspection was for the hallway to be decorated. Staff told us that it had been painted. 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. It needs to be fixed to ensure that the ramp is safe. A requirement has been made regarding this. There are protective surfaces along the corridor to protect the walls for people who use a wheelchair independently. 4 bedrooms were viewed (1 was the spare room). Two bedrooms have an ensuite shower room. One of them is extremely damp and therefore smells of damp. There is some ventilation but it is not adequate. The member of staff told us that the ventilation system is too noisy for the person whose bathroom it is and they always close the door. This was recognised in the monthly visit in February 2008 and staff told us that the order to refurbish the bathroom has gone through head office and it should be done in the next few weeks. Therefore, a requirement has not been made regarding this. 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. The 2 shower rooms are ‘walk-in’ shower areas, and the bathroom on the ground floor can be used with a hoist. A recommendation was made at the last visit for the bathrooms to be considered for refurbishment. This has not happened, and could appear dated. The upstairs bathroom has a carpet. This is not hygienic and cannot be regularly cleaned properly. Staff told us that the person who most uses the bathroom would prefer a more suitable covering, and this should be considered in the near future. 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. However, some cupboards in the kitchen need a deep clean. The senior staff member confirmed that this will be done. 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.V361813.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home are supported by a permanent stable staff group of 5 people and a permanent manager. Some of the staff members have worked for the Trust for a number of years either in other homes or in the day service. There is currently one care staff vacancy within the team. ‘Bank’ staff cover these shifts. The rota showed and staff told us that there are 4 core members of staff who work these shifts to maintain continuity for people living at the home. We were told that there are no plans to employ a fifth permanent member of staff due to the budget restrictions caused by the vacancy within the home. This will be followed up at the next inspection. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 24 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. 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. A recommendation was made at the last visit for staff training and personal details to be recorded in line with the Trust’s procedure. 4 staff member’s recruitment records were checked. 3 files did not contain evidence that a Criminal Records Bureau (CRB) check was carried out prior to them starting work in the home. The fourth person’s check was carried out in March 2004. This was discussed with the senior member of staff and scanned evidence was sent to the Commission within 2 days, therefore an immediate requirement was not issued. As stipulated by CRB guidance, it is recommended that subsequent checks are done every 3 years. Only 1 staff file was complete with the necessary documentation. For example, 1 staff member did not have an application form or 2 satisfactory references on file. 2 members of staff only had 1 reference. 2 people had confirmation that they were fit for work. This was discussed with the senior member of staff, who acquired the documents and sent them to the Commission 2 days after the visit. The manager must ensure that staff have the correct recruitment documentation within the home at all times. Of the 5 staff members, certificates and a discussion, confirmed that 2 staff members have their National Vocational Qualification in health and social care. 1 person is currently doing it, and 2 people will be doing it in the near future. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 25 4 staff’s training files were read with the senior staff member. It was clear that some people need to have refresher training in certain subjects. 2 people need training in food hygiene; 1 person needs training in First Aid; 1 person needs training in Moving and handling, and all staff need training in infection control. Due to some people’s health needs, staff need to know about epilepsy, and what to do for specific people. From the training files looked at, only one person has done this training. A requirement has been made regarding staff training. Staff’s supervision records were read and evidenced that these are now regular and are recorded well. The senior member of staff is soon to do their training in being a supervisor. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is adequate. 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. The quality assurance system does not entirely ensure that people’s, and their supporters, views underpin the development of the home. People are generally protected by the home’s health and safety procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, a new manager has started and the home has gone through a period of change. Ms Swain started in September 2007. Her Criminal Records Bureau check has just been returned to us, and she is now ready to apply to be the Registered Manager. 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 27 Staff spoke positively about the manager and she seems to have settled in well. There is one outstanding requirement from October 2006. The senior member of staff agreed with the concerns and compliments raised from this visit, and acted promptly to requests during the visit and sent in the needed information which was missing on the day. The manager was not working on the day of the inspection. She is currently absent from the home. Under Regulation 38, The Commission for Social Care Inspection should have been told that the manager was going to be absent from the home for a continuous period of 28 days or more. We told the senior member of staff this who was going to inform the Area Manager. The quality assurance systems within the home were discussed with staff and corresponding documents were read. The manager needs to ensure that people’s supporters need to be asked their opinion of the home to gain another perspective. As written within this report, 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. The Area Manager also visits the home on a monthly basis. The reports are sent to us regularly. Some of these have been very basic in information and it is recommended that these are reviewed to contain more information about the findings from the visit. As written earlier in this report, care plans and risk assessments need to be reviewed and updated. However, the other records kept are up-to-date and entries are well written. People’s personal information and staff personnel records are kept in locked cabinets. Some of the paperwork held in people’s files dates from previous placements and could be archived. The fire safety folder was read. Appropriate checks and tests are carried out on the home to make sure that it is as safe as possible. The fire procedure was discussed with staff. Fire Drills are recorded but have been sporadic. Since the last inspection, in October 2006, there have been 4 drills. Not all the staff or people living in the home have been part of them. Some staff told us about recent training they had. Records showed that 3 people watched a fire video in November 2007. However, according to the certificates and records, some staff are also in need of fire training. 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. The fire risk assessment has been reviewed within the past year but needs to be checked by the manager. The external 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 28 contractor has visited the home recently and checked the fire safety equipment. Health and safety checks (such as the Portable Appliance Testing; Electrical Installations and on the hoist) are carried out appropriately. However, the last Gas Safety certificate is dated 15/3/7 and is due. 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.V361813.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 2 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 2 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 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 2 X 3 3 X 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 30 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 People living in the home must have up-to-date contracts in place. To keep person centred plans and associated documents under review a minimum of six monthly. (Outstanding requirement, previous timescale 12/01/07) Timescale for action 30/07/08 2. YA6 15(2b) 30/06/08 3. YA9 13(4) Risk assessments to be current and to reflect current risk for people living in the home. Staff to have refresher training in the Protection of Vulnerable Adults in line with the Trust’s policy. 30/06/08 4. YA23 13(6) 30/07/08 5. 6. YA24 YA35 23(2)(b)(o) The ramp to access the garden must be repaired. 18(1a) Staff must be trained in mandatory areas (including fire safety). The monthly visit reports must be reviewed to contain more DS0000003378.V361813.R01.S.doc 23/05/08 30/08/08 7. YA39 26 30/06/08 24a Lower Hanham Road Version 5.2 Page 31 information about the visit and to fully comply with the regulation. 8. YA42 13(4) The health and safety checks within the home need to be carried out according to regulations. 30/06/08 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 YA8 YA19 YA23 Good Practice Recommendations Advocacy service to be sought for those people with no family or supporters outside the home. To review the monthly weighing of people living in the home. For senior members of staff who are expected to step up as managers to have training for managers in the Protection of Vulnerable Adults. Criminal Record Bureau (CRB) checks are carried out every 3 years, in accordance with CRB guidance. Staff to be trained in subjects relevant to the people’s health needs. 4. 5. YA23 YA35 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 24a Lower Hanham Road DS0000003378.V361813.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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