Inspection on 10/09/07 for 26 Ladyfield Road

This inspection was carried out on 10th September 2007.

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

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

Other inspections for this house

26 Ladyfield Road 19/07/06

26 Ladyfield Road 12/10/05

26 Ladyfield Road 21/04/05

26 Ladyfield Road 15/11/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Ladyfield Road (26) 26 Ladyfield Road Chippenham Wiltshire SN14 0AL Lead Inspector Malcolm Kippax Unannounced Inspection 10th September 2007 1:50 Ladyfield Road (26) DS0000053430.V345048.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 Ladyfield Road (26) DS0000053430.V345048.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. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladyfield Road (26) Address 26 Ladyfield Road Chippenham Wiltshire SN14 0AL 01249 654451 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) Tranquillity Care Ltd Mrs Sharon Wright-Palmer Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager, Mrs S Wright-Palmer, must commence the Registered Managers Award within one month of the date on which the first service user is admitted to 26 Ladyfield Road and must achieve the award within one year of this date. 19th July 2006 Date of last inspection Brief Description of the Service: 26 Ladyfield Road is a semi-detached property in a residential area of Chippenham. The home is owned by Tranquillity Care and has places for three people with learning disabilities. The directors of Tranquillity Care, Mrs S. Wright-Palmer and Mr E. Palmer, are both involved in the day to day running of the home. Mrs Wright-Palmer is the home’s manager. Mrs Wright-Palmer and Mr Palmer work in conjunction with staff members, so that there is always one person available to support the people who live in the home. Each person in the home has their own bedroom. There is a living room with a dining area, which leads on to a kitchen. Tranquillity Care has applied to vary the registration of the home in order to increase the number of places from three to six. This would involve using the adjacent property at 28 Ladyfield Road. Work was being undertaken in connection with this at the time of this inspection. The range of fees at the time of the inspection was between £675.00 and £1,105.00 per week. Information about the service provided is available in the home’s ‘Statement of Purpose’. Copies of inspection reports are available from Tranquillity Care. They are also available through the Commission’s website at: www.csci.org.uk Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included an unannounced visit to the home. This took place on 10th September 2007 between 1.50 pm and 6.10 pm. A second visit was arranged in order to complete the inspection and to discuss the outcome. This took place on 18th September 2007 between 10.00 am and 2.00 pm. Evidence was obtained during the visits through: • • • • • Time spent with the three people who live at the home. A meeting with a staff member who was working during the visit on 10th September 2007. Discussions with Mrs Wright-Palmer and with Mr Palmer. Observation and a tour of the home. An examination of records, including the three people’s care files. Other information has been taken into account as part of this inspection: • • An Annual Quality Assurance Assessment (referred to as the AQAA) that was completed by the manager. Comments received from a relative who completed one of the surveys that were sent out by the Commission. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: Each person in the home has an individual plan which they have agreed and signed. The plans include information about people’s day to day needs and how they are to be supported. This helps to ensure that people’s needs are clearly identified and that their views are reflected in the plans. People in the home are supported with doing things that they find interesting and enjoyable. Meetings are held when people’s needs are reviewed and they can talk about new things that they would like to do. Risks are being assessed, which helps people to be safe in their activities and when using certain items of equipment in the home. People’s lifestyles include involvement in the local community and in the home’s daily routines. During the visits, people helped out in the kitchen and talked about places they went to outside the home. One person has family living nearby who they visit frequently. People in the home are supported with going on holiday, both in this country and abroad. The mealtime arrangements are flexible to fit in with people’s different activities and routines. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 6 People’s individual plans describe the support that they need throughout the day and on different days of the week. This helps ensure that people receive a consistent approach from staff. There is written guidance for staff, which highlights the personal support that people require in order to be safe. Procedures have been produced so that staff have information about how to protect people in the home. Checks are undertaken on new staff, which helps to ensure that they are suitable to work with the people they support. People receive support with personalising their own rooms. Regular checks are being made, so that the accommodation is kept clean and tidy. What has improved since the last inspection? What they could do better: Action must be taken to ensure that people are not at risk because their medication is not being properly administered. The home must ensure that medication is appropriately recorded. There should also be a system in place for checking the records and for following up any errors that arise. Information needs to be provided about the services and goods that people receive in the home, but are not covered by the weekly fee. This is to ensure that people in the home know when they are expected to contribute to the costs from their own money. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 7 Guidance is available to staff that helps to protect people in the home. There will be further safeguards for people following developments in the home’s practices and procedures. As discussed at the last inspection, a policy and procedure for the safe handling of finances in the home should be produced. This should reflect the systems in use and show that robust methods are in place to protect people from financial abuse. People’s needs and goals for the year ahead are being discussed at annual review meetings. Some information is recorded following the meetings, but people’s personal goals could be better reflected in their individual plans. This will help to ensure that people make the progress that they are capable of between review meetings and that the goals continue to be relevant. A policy on gender and personal care could be produced. This would help ensure that staff have a consistent approach when providing personal support, in accordance with the company’s intentions. Developments are being made in the provision of training, although a consistent programme of staff training has not yet been established. Initially, a training needs assessment should be undertaken to ensure that the training provided is matched to people’s individual needs and statutory requirements. The fire precaution arrangements need to be formally considered using a risk assessment process. This is so that a decision can be made about whether there are sufficient control measures in place to ensure people’s safety. A policy and procedure on quality assurance should be produced, reflecting the systems that will be in use and how people’s views are sought and taken into account. 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. Ladyfield Road (26) DS0000053430.V345048.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 Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visits to the home. Further information will ensure that current and prospective service users know the arrangements being made for additional charges and the payment for services that are not covered by the weekly fee. Standard 2 did not apply at the time of this inspection. No new service users had moved into the home during the last year. EVIDENCE: There is a Statement of Purpose for the home. Mrs Wright-Palmer said that this had been amended and that the new version was included in the application to increase the number of places in the home. A service user’s guide to the home has been produced. The guide did not include information about the arrangements in place for charging and payment for additional services. Mrs Wright-Palmer said that the most recent admission to the home took place in May 2005. Standard 2 was looked at during the inspection in October 2005 and was met at that time. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 10 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. People’s primary care needs and goals are discussed and reflected in their individual care records. People are assisted to make decisions about what they want to do and receive support to reduce the risk of being harmed. EVIDENCE: Each person had a personal file which contained an individual care plan. People had signed their own plan. The plans included information about people’s day to day needs and how they are to be supported. The information described the support that people needed throughout the day and on different days of the week. The content of the individual plans was focussed on people’s care and personal needs, rather than on their goals and aspirations. This meant that the plans did not appear to be ‘person centred’. However, there was evidence that people’s goals were being discussed at annual review meetings. Information about the meetings and agreed goals had been recorded in separate care Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 11 plans. One person had attended a review meeting earlier in the year when goals had been agreed concerning their independence when outside the home. It was recorded that these goals would be achieved by the time of the next scheduled review meeting. The meetings were also a time to talk about people’s individual routines and how they participated in the home. There was no system of cross-referencing used between the two types of plan and the records did not show how progress with achieving the goals would be monitored and recorded; or how new goals would be introduced if appropriate. Dates had been recorded on people’s main care plans to show that they had been reviewed, although there was no clear review section identified. People’s files included records of risk assessments. These showed that hazards relating to certain activities and use of equipment were being discussed and decisions made about people’s personal safety. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. People’s lifestyles include involvement in the local community and in the home’s daily routines. Plans are being made to develop the opportunities that people have to participate in appropriate activities. Mealtime arrangements are flexible and people are offered a varied menu. EVIDENCE: People had attended review meetings during the last year and talked about their daily activities and routines. Decisions had been made at the meetings and information recorded about people’s future needs and objectives. Changes in the local authority’s day care provision during the last year were having some impact on people in the home. This had meant that their attendance at a local resource centre had reduced from five to two days a week. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 13 Copies of weekly activity plans were displayed in people’s rooms and kept in their personal files. These were not up to date, as they did not reflect the changes in resource centre attendance. It was recorded at one person’s review meeting that opportunities for in-house activities were to be explored. Another person had objectives agreed which would promote their independence outside the home. This included travelling independently to some regular activities. The home was well placed for people to access a range of town shops and local facilities. One person had family living nearby, who they visited frequently. Mrs Wright-Palmer said that they were looking at new ways of supporting people with their activities and occupation. The AQAA that Mrs Wright-Palmer completed also reflected the need for people to be more actively involved and to maximise their potential in the coming year. Additional facilities, such as a recreation room, were expected to be available as part of the plan to enlarge the home. The garden was being developed and had increased in size following the acquisition of the adjacent property. During the visits people were helping out in the kitchen and involved in other domestic routines, such as hanging out washing. The garden was being well used and people sat at patio tables playing board games and doing puzzles. They said that this was something they did a lot of. At other times, people spent time in their rooms and in the communal areas. One person talked about a holiday in Spain that they had enjoyed recently. They showed the photos that had been taken and the holiday was reported to have gone well. This person had completed a college course in June 2007 and had a certificate about this displayed in their room. The relative who completed a survey stated that the home is always cooperative and helps them to keep in touch with their relative in the home. They also commented positively about the holidays that have been arranged for people in the home. People had some regular social activities outside the home, which included going to a Gateway Club. There was a church nearby which people attended. The mealtime arrangements were flexible to fit in with people’s different activities and routines. People living in the home helped to choose and prepare the meals. There was no forward menu planning. The staff member met with said that they looked back at the record of meals to ensure that there was a variety of meals. One person had a diabetic diet, which was reported to be well managed. Guidance about diabetes was available to staff. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area varies and is adequate overall. This judgement has been made using available evidence including the visits to the home. Arrangements are in place for meetings people’s needs in most areas, although they are not sufficiently protected by the medication procedures. EVIDENCE: The way that people’s personal care needs were to be met were described in their individual care plans. There was also written guidance for staff, which was separate to the care plans. This highlighted the personal support that people required in areas such as managing behaviour, shaving and diet. There was guidance on bathing which provided information about how staff would need to be involved and present in the bathroom at particular times to ensure a person’s safety. The staff member met with said that they generally worked alone and therefore would provide the support that was needed at a particular time. The staff team included male and female support workers. There was no written policy on gender and the provision of personal care. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 15 There were sections in people’s individual care plans which described how their healthcare needs were to be met. Staff recorded details of appointments with healthcare professionals and the actions that need to be taken following these. There were separate entries for chiropody, dentist and optician. Staff did not provide support with toenail cutting and the home used a private chiropody service. The arrangements were discussed with Mrs Wright-Palmer, which included people paying for the service from their own personal allowance money. There was information on people’s moving and handling needs. One person had received advice from a physiotherapist. Diaries were also being used to record day to day events concerning people’s care and support. The small number of staff meant that information could also be communicated directly at handovers. At a recent meeting, staff had been reminded to inform Mrs Wright-Palmer or Mr Palmer if any changes were observed concerning the people living in the home. People were up and about at the time of the visits. Support from staff was by way of encouragement, with suggestions being made about what people might like to do. Relationships between people appeared to be informal and easy going. There was a written policy and procedure for dealing with medication. As with some of the other polices, staff members had signed to confirm that they had read the information. The arrangements being made for medication were initially discussed with the staff member present on 10th September 2007. There was a suitable storage facility for the medication. The staff member confirmed that very little medication was being administered in the home, although one person was prescribed medication to be taken each day. It was reported at the last inspection that Mrs Wright-Palmer, who is a registered nurse, had devised her own medication administration sheet and also a checklist for assessing the competency of staff. This was done after a period of supervision and in house training. The medication records were looked at on 10th September 2007 with the staff member. The medication administration sheet devised by Mrs Wright-Palmer was currently been used. It had a column in which to record the time that the medication had been administered. However this information was not being recorded on the current sheet. A different type of sheet had been used during August 2007 for the recording of medication. This did not have a line or row for 8th August and there was no entry on the sheet to show whether medication had been administered on that day. There were spaces on the sheet for the recording of medication on 6th and 21st August, although these were blank. It was confirmed with the staff Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 16 member present that there was no record of medication having been administered on these days. There was no explanation as to why the record had not been completed at these times and the Commission had not been notified of errors in administration during August 2007. The administration of medication was discussed with Mrs Wright-Palmer on 18th September 2007. There was no evidence of checks being undertaken which would ensure that errors in administration are quickly identified and followed up, so as to prevent a further error. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is varied and adequate overall. This judgement has been made using available evidence including the visits to the home. People have the opportunity to express their views. Formal complaints are not being made. Guidance is available to staff that helps to protect people in the home. There will be further safeguards for people following developments in the home’s practices and procedures. EVIDENCE: Tranquillity Care had produced a complaints procedure and a version of this was included in the service user’s guide. The relative who completed a survey confirmed that they knew how to make a complaint. Mrs Wright-Palmer reported that no complaints had been received since the last inspection. The Commission has not received any complaints about the home during that period. It was reported at the last inspection that the home had received many compliments in the two years that it had been open. Mrs Wright-Palmer had been recommended to keep a record of these and this has since been set up. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 18 Mrs Wright-Palmer had attended a course in adult protection and used the notes from this to devise a pack in the policy and procedure file. This included an enlarged copy of the flowchart to make an alert. A recommendation was made at the last inspection about concerning the need to amend the home’s adult protection policy and procedure. This was in order to signpost staff to the Swindon and Wiltshire ‘No Secrets’ guidance. The policy had been amended, although it was confirmed with Mrs Wright-Palmer that a new version of Swindon and Wiltshire’s procedures and ‘No Secrets’ guidance had been produced since the last inspection. It was recommended at the last inspection that a policy and procedure on the safe handling of people’s finances in the home should be devised. This would reflect the systems in use and show that there are robust methods to ensure service users are protected from financial abuse. Mrs Wright-Palmer said that a specific policy and procedure for the home had not yet been produced. The recording arrangements for people’s personal money were looked at with Mrs Wright-Palmer. There were individual notebooks being used. At one time a system of numbered receipts was being used, although this had lapsed. It was reported at the last inspection that Mrs Wright-Palmer had been asked to be the appointee for one person in the home. This had been discussed at the time, as it was not considered to be best practice to have this arrangement. Mrs Wright-Palmer said that her role as appointee had since been confirmed. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good overall. This judgement has been made using available evidence including the visits to the home. The accommodation is meeting people’s needs and is kept clean and tidy. The arrangements being made for fire precautions have not yet been confirmed using a risk assessment process. EVIDENCE: 26 Ladyfield Road is located in a well established residential area, not far from Chippenham town centre. It did not stand out as being a care home and the appearance was in keeping with the neighbouring properties. The home was close to a number of places that people went to regularly, either socially or for occupation. The garden at the rear of the property was being used as a recreational and working area at the time of the visits. It had been enlarged following the acquisition of the adjacent property and had potential for further development. There was one communal room, which was used as a lounge and dining area. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 20 One bedroom was on the ground floor and there were two bedrooms on the first floor. The doors to the first floor bedrooms had latch type locks that had been adapted so that they could not be deadlocked. This meant that people, who did not have keys, had to get assistance to unlock their door if it was not kept open. The bedroom on the ground floor had been fitted with a selfclosing device. Advice was given to Mr Palmer about the type of device that would need to be fitted if the occupant of the room wished to keep their door open. Records in the home showed that the fire alarm system and emergency lighting were being regularly tested. However, the suitability of the fire precaution arrangements in the home had not been the subject of a fire risk assessment. This was discussed with Mrs Wright-Palmer and Mr Palmer during the visit on 18th September. It was recommended that guidance on carrying out fire safety risk assessments in residential care premises is obtained (available from the website: www.firesafetyguides.communities.gov.uk ). Mr Palmer looked at this during the visit and confirmed that an assessment would be undertaken. Some areas of the home had been redecorated and carpeted since the last inspection. The accommodation was generally homely in character and people had personalised their own rooms. There was a domestic type kitchen and a separate laundry area. The Environmental Health Officer looked at the kitchen during a visit to the home in November 2005. It was reported at the time that it was very clean and there were good standards. The home looked clean and tidy at the time of the visits. There were several notices around the home and on doors to remind people of the jobs that need to be done. These had some practical use but tended to detract from the homely type environment. Guidance on infection control was available in the home. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate overall. This judgement has been made using available evidence including the visits to the home. Developments are being made in the provision of training, although a planned programme of staff training has not yet been fully implemented. Recruitment checks are undertaken which help to ensure that people are supported by suitable staff. EVIDENCE: There was a staff team of five support workers, some of whom were part-time or who mainly worked on a relief basis. Mrs Wright-Palmer and Mr Palmer also regularly provided support to people in conjunction with the staff team. Mrs Wright-Palmer provided some information in the AQAA about staffing. It was reported that the home provided staff with induction training and that there was a development programme that met the National Minimum Standards for the service. Two staff had obtained a National Vocational Qualification (NVQ) at level 2 or above. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 22 It was seen during the visits that the home had an induction standard manual and workbook that had been produced by a national organisation that provides services to people with learning disabilities. This had not been completed with a new permanent staff member who started in December 2006, although it would have been a relevant induction for them. An in-house induction checklist had been completed at the start of the staff member’s employment. Some ‘Performance Assessment’ checklists had also been completed. It was reported at the last inspection that a training organisation was to be used to provide training packs in the following areas; fire safety training, food hygiene, medication, nutrition, first aid and moving and handling. Mrs Wrightconfirmed the intentions in this area and the training organisation involved. A check of three staff members’ training records showed that staff had attended some relevant training, including that received with a previous employer. There was no record of any training completed to date in 2007. Mrs Wright-Palmer said that food hygiene training was currently being undertaken. Certificates for some training courses were kept on the staff members’ files. Information was recorded about some other training attended although the details were limited. It appeared that staff would need to attend some refresher training in the near future. Mrs Wright-Palmer confirmed that she would check whether the most recently appointed staff member had a first aid certificate and would take action to arrange a course if needed. The staff member’s application form indicated that they had received some training in first aid although the date of this was not confirmed. It was reported in the ‘What we could do better’ section of the AQAA that staff would be encouraged and supported to do other courses that would be beneficial to their job. The need for staff to attend training courses was also identified in a Service Review Report for 2007–2008. It was agreed with Mrs Wright-Palmer that following an assessment of training needs, a plan should be produced which sets out the intentions for training and how this is to be prioritised and provided. The recruitment records for five staff were seen at the last inspection and found to be in order. Records for two other staff were looked at during the visit on 18th September 2007 and there was evidence of appropriate checks being undertaken. These included Criminal Record Bureau disclosures and checks of the Protection of Vulnerable Adults (POVA) list. One staff member had been recruited through an employment agency. Advice was given to Mrs Wright-Palmer about developing some of the employment documentation to evidence what processes had been followed. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good overall. This judgement has been made using available evidence including the visits to the home. The manager is qualified and experienced to run the home. People are generally protected by the practices and procedures in the home, although there are shortcomings. Improvements are being identified, which will be important in view of the planned development of the home. EVIDENCE: Mrs Wright-Palmer is a registered nurse and has managed 26 Ladyfield Road since the home opened in 2004. It was reported at the last inspection that Mrs Wright-Palmer and Mr Palmer had just completed the Registered Managers Award and were awaiting external verification in order to receive their certificates. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 24 This was discussed again during the visit on 18th September 2007. Mrs Wright-Palmer said that problems with the training provider had meant that the awards had not yet been verified. The Commission will be following up the outcome of this after the inspection. Previous inspections of 26 Ladyfield Road have generally reported positively on how the home is developing. Systems are being established and improved, although as identified in this report there are areas that need to be addressed. Since the last inspection, Mrs Wright-Palmer has produced a Service Review Report for 2007–2008. This set out a number of recommendations for improvements and commented on how these could be achieved. Mrs WrightPalmer said that she had received feedback about the home from relatives and other people. One of the sections in the report concerned the service users, with recommendations made about having more recreational activities and encouraging their input in the home. Mrs Wright-Palmer has been recommended to produce a policy and procedure, which would show how quality assurance systems are implemented within the home. There was a range of checklists for staff to complete in connection with health and safety issues. These included a general health and safety check each month and checks on water temperatures and fridge and freezer temperatures. Risk assessments had been undertaken in respect of some environmental hazards and there was information about the safekeeping of hazardous materials. The fire log book showed evidence of fire drills and instruction to staff. A recommendation made at the previous inspection about the recording of instruction had not been met. Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 25 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 2 2 N/A 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 x 3 x x 3 x Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5(1)(bc) Requirement The service user’s guide must include the arrangements in place for charging and paying for any services additional to those mentioned in sub-paragraphs (b) and (ba), Regulation 5(1). Arrangements must be made for the safe administration and recording of medication. This includes ensuring that the administration of medication records are accurately maintained. A fire risk assessment must be carried out in order to ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Timescale for action 31/10/07 2 YA20 13(2) 19/09/07 3 YA24 13(4) 31/10/07 Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations That people’s personal goals and their progress with achieving these are more fully reflected in the individual plans produced in the home. That a policy on gender and personal care is produced. This is to ensure that there is a consistent approach from staff in accordance with the company’s intentions. That arrangements are made which will result in people in the home not having to pay for toenail cutting out of their own personal money. The present arrangements should be discussed with the funding authority in order to confirm their expectations with regard to this, i.e. who should provide this support and who should be paying for it. That the systems for the administration and recording of medication are reviewed in order to reduce the possibility of errors occurring. That the arrangements being made for staff members to receive training and information about safeguarding adults procedures are reviewed. This is to ensure that the guidance that staff members receive is up to date and so that service users will be better protected as a result. There should be a policy and procedure about the safe handling of service users finances in the home, reflecting the systems in use and robust methods to ensure service users are protected from financial abuse (recommendation from the previous inspection). That bedroom locks are fitted which are of a type that will enable people to close and open the doors independently. That a training plan is produced which sets out the intentions for training and how this is to be prioritised and provided. Initially, a training needs assessment should be undertaken to ensure that the training provided is matched to people’s individual needs and statutory requirements. 2 YA18 3 YA18 4 YA20 5 YA23 6 YA23 7 8 YA24 YA35 Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 28 9 YA39 That a quality assurance system policy and procedure is produced, reflecting the systems that will be used in the home (recommendation from the previous inspection). When staff receive fire instruction the person giving the instruction and the member of staff should sign and date the record in the fire log book (recommendation from the previous inspection). 10 YA42 Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Ladyfield Road (26) DS0000053430.V345048.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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