Inspection on 19/10/06 for 267 Old Shoreham Road

This inspection was carried out on 19th October 2006.

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

The inspector found 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

267 Old Shoreham Road 13/06/07

267 Old Shoreham Road 20/10/05

267 Old Shoreham Road 05/05/05

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Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 267 Old Shoreham Road 267 Old Shoreham Road Portslade East Sussex BN41 1XF Lead Inspector Jenny Blackwell Key Unannounced Inspection 19th October 2006 11:30 267 Old Shoreham Road DS0000058271.V299302.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 267 Old Shoreham Road DS0000058271.V299302.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. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 267 Old Shoreham Road Address 267 Old Shoreham Road Portslade East Sussex BN41 1XF 01273 295477 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) Brighton & Hove City Council Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is (3) three. Service users should be between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. Date of last inspection 20th October 2005 Brief Description of the Service: The home is set in a residential area of Portslade, on a main road. The building is semi-detached and has three storeys, with the office and staff sleeping in rooms on the top floor. The home is domestic in scale and is situated near local shops and amenities. Hard standing parking space is available at the front of the home. The home can accommodate up to 3 people with learning disabilities who are physically able. Each person has their own individually decorated bedroom and shared communal space, a lounge, kitchen/dining room and bathroom facilities. The home was designed around the needs of the current 3 people but one bedroom has been adapted to reduce noise levels that no longer meet the standard. The fee information for 267 Old Shoreham Road is yet to be passed to the Commission. As the home is run by Brighton and Hove City Council specific set fee amounts had not been calculated. This information will be required for the next published report. More detailed information about the services provided at 267 Old Shoreham Road can be found in the home’s Statement of Purpose and Service User Guide – copies of these documents can be obtained directly from the Provider. Latest CSCI inspection reports are kept in the homes office. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at 267 Old Shoreham Road are referred to as “people” or “person”. People working at the home will be referred to as “staff” or by their job title. This report reflects a key inspection based on the collation of information received since the last inspection, feedback from representatives and visiting professionals and an unannounced site visit, which lasted a total of seven hours on Thursday 19th October 2006. The site visit included a tour of the premises and an examination of medication, care and staffing records. Throughout the inspection process, the Inspector spent time with all of the three people, one person individually and observed the way the people were supported in communal areas. Telephone conversations were held with one relative. Written feedback was received from three relatives. The manager was present during the inspection. The deputy manager was met with during the site visit. In addition, six staff were spoken to, one staff member individually. What the service does well: The inspection process has identified the home as operating good in five areas and adequate in three. The staff support a group of people who have complex support needs. They are well trained and committed to improving the life experience for the people. They have developed good team working skills and were seen to communicate effectively during the visit with the people living at the home and each other. They worked hard at supporting people with complex needs to be part of their local community and encouraged them to make choices and develop new skills. Relatives of the three people filled in surveys and returned them to the Commission. One said of staff “I couldn’t wish for better carers for my daughter”. Another said the staff were caring. The staff spoken to enjoyed working at the home and as part of the team. They showed commitment to their work and were seen to treat the people with respect. They individually and collectively raised concern over the compatibility of two of the people living together. This demonstrated a good understanding of the difficulties they faced when supporting people with complex needs. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 6 The new manager had been received well by the staff team and was observed spending time with the people who lived at the home who appeared to be comfortable in her presence. The training and support the staff receive from the organisation was of a good standard. In addition the home worked well with outside professionals to gain further expertise. What has improved since the last inspection? What they could do better: The main issues for the home is the compatibility of two people living at the home which has resulted in the need to restrict parts of the home and freedom of movement around it. These issues were raised in the last inspection report in October 2005. The staff team had continued to develop new ways to distract individuals from raised levels of anxiety, however the situation had not improved. One person’s bedroom no longer meets the National Minimum Standard because of the changes made to reduce the noise levels. The registered provider, Brighton and Hove City Council have not ensured the suitability of the placements have been kept under review. The placing authority had not conducted the annual review of the people’s community care assessments. An increased level of self-harm had been noted for one through observation and discussion with the manager, staff and relatives. The organisation and 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 7 manager have been required to protect people from harming themselves wherever possible. Some areas of the environment needed improving, including replacement of the carpet in the hallway and on the stairs, repairing a shower cubical and cleaning it. The manager needed to review the recruitment records for the staff to ensure all the required documentation was in place. 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. 267 Old Shoreham Road DS0000058271.V299302.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 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager and staff reviewed the daily aspirations and needs of the people, however the placements had not been reviewed since people moved to the home in January ’04. Contracts were now developed and were generally accessible although each person did not have a copy signed as yet. EVIDENCE: At the last two inspections a requirement was made that the manager contact the placing authorities (Brighton and Hove) assessment team to have the three people placement assessed. The manager and staff have now had contact back from the team and a social worker had visited the home in preparation for undertaking reviews of each person’s placement. The placement had not been reviewed since the people moved into the home in January ’04. A discussion was held with the deputy manager about the compatibility of the three people who lived at the home. Emphasis was placed on ensuring that each person was not adversely affected by the routines or behaviours of the other people. It was important for the staff team to contribute to the assessment of the placements and look at the compatibility of the people living at the home as some issues and concerns were raised during the inspection visit. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 10 It is required the manager provides evidence of the completion of the placement review conducted by the social worker. At the last inspection a requirement was made to ensure each person had a contract with the home setting out the terms and conditions of residency. The manager had forwarded a new Licence Agreement that Brighton and Hove had developed for people. The document had been developed to be accessible by using a combination of written words, photo’s and symbols. Effort had been made to make the document easy to understand. The people living at the home or their representatives had not as yet signed their agreements. A discussion was held with the manager about ensuring that as far as possible the documents were adapted to suit each persons understanding. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people’s needs are covered in their plans including risk assessment. People were seen to make choices throughout the inspection. The staff supported their decision-making. Continued work is needed to were appropriate, reduce restrictive practices in the home. EVIDENCE: The staff had been using a care planning system since the home opened. People had an individual plan that contained information about their support requirements. All three plans were looked at during the visit. Each had a photo of the particular person in. They were comprehensive with information about the person’s interests, routines and guidelines to support them to participate in activities and accessing the community. One person had a detailed monthly planner of activities and outings. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 12 Information about the people and their family history and contacts was recorded. The peoples preferred routines were broken down into morning afternoon and nighttime. Guidelines were written up for staff to follow to ensure a continuity of support. In one persons plan a “did you know” sheet was being used. As staff worked with the person, if they found out something about her that was new this would be written down to help other staff provide continuity. An example was that a staff member had found whilst preparing dinner with the person she had said didn’t like a particular food. This demonstrated the staff were open to continue to learn from the people about who they are as people and their preferences. It was noted that all of the plans contained many guidelines about activities and managing behaviour that challenged. A discussion was held with the manager about ensuring the guidelines were reviewed and those that were no longer in use removed and that they did not repeat themselves or become overwhelming for staff. In addition the manager and deputy plan to split the care plans into two files, one, which contained information about supporting people on a daily basis the other, had the more in-depth information. This should help staff to have access to essential up to date information about supporting each person. During the visit, staff were seen to work to the guidelines that were in the plans. One staff member was asked how she supported one person when they become distressed. She responded in line with the persons guidelines. Each person was approached as individuals and they were seen to be supported with making choices and decisions. The staff were seen to be sensitive with people when they found making choices difficult as on some occasions this lead to raised anxiety. When a person was due to go out or have a meal they were given advanced notice by staff of the change about to happen to them. All the staff present were seen to do this for people at some point during the visit. Since the set up of the home the management and staff have worked towards reducing restrictive practice that reduce the opportunity for the people to move freely around the home and exercise their rights. Many improvements have been made for example reduction of intrusive monitoring devises. The organisation (Brighton and Hove City Council) has developed a restrictive practice policy for all its services. The home had a file that assessed practices in the home that was restrictive. The file was looked at and found to be accurate in highlighting areas that needed to be improved, for example access to the home that is through electronically controlled gates. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 13 A discussion was held with the manager and deputy about the need to continue to reduce these restrictions through a measured risk assessment process. At the previous inspection a requirement to record changes made to one person’s bedroom and review its purpose to reduce noise levels had been made. A statement in the persons file was noted although the adaptations had not been reviewed. It was required that the manager continues to assess the affect on the person of the restrictions made in her bedroom. Comprehensive risk assessments had been undertaken for each person. The areas covered were access to parts of the home, travelling out in the community, and for staff to safely work with the people on a 1:1 basis. The staff were aware of when it was important to review and update risk assessments. The risk assessments were kept under review. 267 Old Shoreham Road DS0000058271.V299302.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 at least once during a 12 month period. 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 a visit to this service. The staff ensured that the people took part in meaningful appropriate activities both at home and in their local community. The people were able to continue their family relationships. The rights of the people were respected and the home and provider although concern was raised about the compatibility of people living at the home and how it impacted on peoples’ rights. Meals were prepared well and appeared to provide a balanced diet. EVIDENCE: The staff team supported each person to engage in activities in and outside of the home. The support plans had information about activities each person like to take part in. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 15 On the day of the visit three people went out for an activity. One person went out to the library with a staff member and the other two people went swimming, taking different transport to get there. One person went on the train whilst the other person went by bus. The staff have with the people, devised a range of activities and opportunities throughout their week. This included attending day centres, walks and picnics, hydrotherapy, cinema and the theatre, and cooking. Two of the people were seen to participate in the household tasks such as making drinks, cooking and clearing up after lunch. As part of the monthly monitoring visits to the home conducted by a representative of the provider (Brighton and Hove City Council) called the Care Standards Officer, the variety and regularity of activities offered to the people are looked at. This is recorded in a report and passed to the manager and the Commission. During the visit, time was spent with the three people, one person briefly. One person was asked what she was going to do for the day, she said she was going swimming and was getting there by train. Another person was asked and she signed she was going swimming on the bus. She had a pictorial rota board so she could see what staff would be working with her that day. The staff spoken to said that they had to take into consideration the timing and mix of people attended the activities as one persons behaviour could effect another person. The staff and manager raised this concern at different times during the visit. Freedom of movement around the home for one person was not possible as when noise levels from another person became raised this would cause distress to her. This has been of such a concern to the staff team that they take the person out of the house during the other person’s incidences. Guidelines were in place in her plan that advised staff to take this action. In addition the deputy manager spoke about having to ensure that at certain times people did not meet in the hallways or communal areas of the home as this could cause distress to the person. Staff were seen to work in small teams with each person monitoring their whereabouts to try to reduce anxiety levels or conflict. Although the staff were well organised and committed in reducing anxiety for the person, this approach could not be sustainable in a small home. The lifestyles of the individuals were subject to limitations on their freedom of movement around the house due to the apparent incompatibility of two people. If these issues were to be resolved the outcome is this area would be good. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 16 The three people continue to have contact with their families and the staff support them to maintain their relationships. Written feedback was received from a relative of each person and telephone contact was made with one relative. All said they were able to see their relatives and had regular contact with home. The staff prepared the meals at the home and encouraged the people to participate. Each staff member attends a food hygiene course before they get involved in food preparation. The people who live at the home contribute to choosing the menu where possible. The staff make up the menus based on direct choice of the individuals and known preferences. The meals are balanced and appeared to be enjoyed by the people. Time was spent with two people and three staff during dinner, everyone present at dinner together which was the meal selected for that evening from the menu. The atmosphere was relaxed and the conversations included every one around the table. The staff were respectful to the individuals and ensured they were not left out of any conversation. Staff encourage the people to clear up after themselves and be part of the tidying up activity. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people received personal support from the staff in a way that was identified in their individual plan. The manager and staff ensured that the health needs of the people are monitored and supported. The medication was stored, administered and recorded appropriately. Staff training was organised regularly and staff are tested on their competency before administering medication. EVIDENCE: The people’s care plans describe the personal support that they required. Their preferences were recorded and some detailed information about the importance of maintaining routines was noted. Each person is registered with a G.P and attends community-based appointments for dentists and opticians. Health care monitoring for each person is recorded in the daily records and is looked at formally in Brighton and Hove six monthly review process. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 18 The deputy manager said that the staff worked closely with the G.P psychiatrist and community learning disability team who support the current group of people. The people’s G.P was written to seeking her opinion of the home although the Commission did not receive a response. Staff had been trained in supporting particular health care issues such as epilepsy and all staff that administers the medication are trained and then assessed as competent. A check of the medication systems was conducted with a member of staff. He showed the inspector new techniques the staff had implemented to reduce the risks of errors. People’s medication sheet had their photo on. Each medication written on the sheet had been highlighted in the corresponding colour to the time the medication was due to be given. He explained this was a visual prompt for staff to ensure medications were given at the correct times. Liquid medication has been organised to ensure good stock control. The bottles were labelled 1st, 2nd and 3rd to prompt staff to use the medication in expiry date order. P.R.N (as and when) medication were recorded appropriately and stock books were filled which were checked during each handover of shift. 267 Old Shoreham Road DS0000058271.V299302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager and staff were responsive to the concerns of the people living at the home. A formalised complaints procedure is in place for the home that adheres to the organisation’s policy. The organisation and manager emphasised the importance of protecting vulnerable adults, through policy, training and supervision. However further attention is currently needed to reduce the levels of self-harm. EVIDENCE: The organisation has a complaints leaflet that has been designed to be more accessible to some people by using pictorial information. The current group of people living at the home would need varying levels of support to make a complaint. Two relative’s replied in their surveys that they knew how to make a complaint, one stated “this is only very rarely necessary”. Another relative responding on behalf of her relative said “no”. The Care Standards Officer checks complaints during the monthly visits. The home had not received a complaint since May 06 that was dealt with appropriately. The Commission had not received any complaints about the home. New staff to the home were instructed in Adult Protection during their induction period. The training plan sent in by the manager as part of the pre inspection questionnaire was looked at and this showed regular and organised Adult Protection training for staff. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 20 As previously discussed the staff had raised some concern over the raised anxiety levels one person was experiencing at the home. A brief time was spent with the person when she was relaxed. It was noted that she had two wounds that was a result of self-injurious actions. This was discussed with the manager deputy manager and a senior. The deputy stated that the injuries had worsened over the previous few days with the persons increased anxieties. The manager stated that they would seek a medical check of the wounds. The staff have strategies in place to help distract the person form self harm and had been trained to work with the person in particular ways having support from psychology input. The staff were knowledgably about “triggers” that could raise the persons anxieties. The staff spoken to were committed to the principles and tried to engage with the person each time. However there was collective agreement that the person was not currently responding to them as intended, causing a concerning level of self harm. Again, if these issues were to be resolved the outcome is this area would be good. It was required the organisation and the manager ensures that strategies are put in place, regularly reviewed and where they are not working, identify other options to protect people from self-harm. A check of one persons money was conducted. The cash amounts were correct and records of any expenditure were correct. The money totals were checked as part of the handover procedures. 267 Old Shoreham Road DS0000058271.V299302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was generally homely, comfortable and safe. Two people’s bedrooms were adapted to suit their needs and effort had been made to personalise them. Toilet and bathroom facilities were private and had been designed to meet the needs of the individuals although were bare. The home was generally clean and hygienic in most areas. EVIDENCE: The home is domestic in scale and each person has their own bedroom. The home was generally homely in appearance and staff had made efforts to improve some items of furniture that were showing wear and tear. For example the lounge coffee table was having the top covered in a mosaic that was being made by the people with help from staff. A brief conversation was had with one person about the contribution she had made to the table, which needed completing. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 22 A tour of the premises took place during the visit. The detached and arranged over three floors. Each person and the are two large bathrooms one on the first floor ground floor. The office and staff sleeping in room are building is semihas their own bedroom and the other on the on the third floor. As stated at the last inspection one person’s bedroom had been redesigned and part of the window had been boarded up. This was to reduce the noise levels. The person’s bedroom does not meet the National Minimum Standards and has not been directly implemented from her assessed needs; the action was taken to respond to a complaint. The effect this has on the individual needs to be part of the review of her placement assessment conducted by her placing authority. The other two bedrooms were personalised and had items of interest to the people in them. One person had photos and some of her artwork on display. An air conditioning unit had been installed in one person’s room as the staff were unable to use the windows as ventilation because of the noise levels from the busy road outside. The unit was floor standing and had been boxed in but was not painted at the time of the visit. The person has been identified as someone who finds change and noise levels difficult. The manager and staff will need to monitor the person’s acceptance of the unit in her room. The staff had ensured that rooms were private spaces for people and were seen to knock on bedroom doors before entering. A listening device was noted in one persons room. This was raised with the deputy manager who stated that it was used to monitor a health care issue but now they had received information about a less intrusive device that was specifically designed for monitoring the health care issue. It was noted that people had their wardrobe doors locked. This is a restrictive practice and needs to be assessed as being absolutely necessary for each person. It is required that the manager ensures restrictive practices are assessed, reviewed and reduced where possible. The shower in the first floor bathroom was in a poor condition. Some work had been done in the adjoining laundry room, which resulted in a panel being removed in the shower. This had not been repaired properly and was joined up by tape. The deputy manager said that a works order was in to have the shower repaired permanently. It was noted that mould had grown in the corner of the shower and it was required that the shower be cleaned and treated for mould. The other downstairs bathroom was clean and in a good condition although the room was stark. One small picture was up that was made by a person living at the home otherwise the room was empty of any personal items. In comparison the kitchen and dining room was bright and full of objects relating to the people. Each person had a communications board up. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 23 Photos and symbols were put up on each person’s board to help them understand were and with whom they were going out with. It was noted that some kitchen cupboards are locked. A discussion was held with the manager about ensuring that resection for one person does not impact on the others sharing the home and as previously stated restrictive practices need to be reviewed. The carpet in the hallway and up the stairs was in a poor condition and it is required that the carpet be replaced. The laundry facilities in the home were suitable for the needs of the individuals. It was noted the laundry room was an enclosed room and did not have any external ventilation relying on an extractor fan to take heat away from the room. A staff member did so that on occasions the room was hot to work in. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The services recruitment policies and procedures protected the people who used the service. The evidence provided during the inspection indicates staff were appropriately trained to meet the needs of the people. EVIDENCE: Relatives of the three people filled in surveys and returned them to the Commission. They said of staff “I couldn’t wish for better carers for my daughter” and two answered “always” and one as “usually” to the question do staff treat you well. One relative spoken to by phone said that staff were caring. The recruitment records of the staff were checked for three staff members. The records were appropriately stored. The new manager said she needed to familiarise herself with the records. None of the staff members had application forms in their files. One staff had a written reference from previous employers. Criminal Records Bureau (C.R.B) checks had been carried out for all of the staff and records of 1:1 supervision with senior managers were recorded all three staff. It is required the manager review the recruitment records of all the staff to ensure they are complete. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 25 The organisation had robust recruitment policies and procedures based on protecting vulnerable adults. A staff member spoken to spoke about his recruitment to the organisation and to the home. He felt that the current delay in getting new staff C.R.B checks in place was putting a strain on the home as they were having to wait many weeks for the new staff to start work. He said that the home provided good induction and he had specific inductions with each person to get to know them and for them to get to know him. All the staff present through the visit were spoken to, some at more length than others due to their commitments with the people. All staff including the relief staff demonstrated knowledge and understanding of the support needs of the people. In the last report written by the Care Standards Officer in August ’06 a staff member described morale as good despite the changes with the manager leaving. One staff member spoken to individually, said the team had adjusted to the changes and he felt the team worked well together. The staff work with situations in the home that can be challenging. All the staff were seen to respond respectfully and professionally to the people when their levels of anxiety were increased. Three people expressed some concern over the compatibility of two of the people, although they had built many strategies to guard one person for being effected by the actions of the other they did not feel the long term situation would improve. The staff were asked about the training they had since working at the home. One staff member had recently attended training in the Disability Discrimination Act and had attended training in the protection of vulnerable adults. Another staff had attended a Makaton (specialist sign language) course. The manager provided information in the pre-inspection questionnaire that showed the staff were accessing training needed to support the individuals. The staff spoken to during the visits confirmed that they had attended the training. 267 Old Shoreham Road DS0000058271.V299302.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home benefited form the service being well run with clear lines of accountability. Self-monitoring in the home is being developed but is not in place in full. The home ensures it promotes the health safety and welfare of the people and staff. EVIDENCE: The manager is new to the post at the home and has been working on her induction to familiarise her self with the people who live at the home. She has is qualified and holds an N.V.Q level 4 and a Registered Managers Award. She was previously a manager at another service that provided support to people with learning disabilities. She stated she is currently preparing her application to become registered with the Commission as the home manager. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 27 A relative spoken to by phone was asked about her views of the new manager. She said she was approachable and gave her the impression that “she understands were I’m coming from” when raising issues about her daughter. The staff team were spoken to about her and all were positive about her arrival at the home. One staff said he really appreciated the time she had spent learning about the people and the routines of the shifts in the home. Time was spent with the manager discussing the work at the home and her role as new manager. She presented as a knowledgeable and competent manager who was keen to implement changes to continue to improve the quality of the service. She praised the deputy manager of the home who had acted up during the absence of the previous manager, finding her helpful in settling in. At the last inspection a requirement was made for the to provide evidence that it monitored the quality in the home. Brighton and Hove had developed some tools to check the quality in their services including information about incidents and accidents, staffing issues such as sickness and supervision, compliance with health and safety checks and the peoples records like their individual plans. This information needed to be put together with feedback from the people and their relatives to produce a report to evidence that the home self monitors the quality of the service. The staff conduct weekly and monthly health and safety checks of the premises. This includes weekly fire detection system checks and hot water checks. The fire file was looked at. It was found that the systems had been checked and outcome recorded in line with the services procedures. On the day of the visits the fire detection system was checked. Staff went around the building to warn the people that the fire alarms were to be tested. A fire risk assessment was in place for the home and had been reviewed in ’05 and ’06. The Care Standards Office checks health and safety records during the monthly visits. 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 3 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 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 YA2 Regulation Requirement Timescale for action 30/12/06 2. YA7 YA16 3. YA23 4. YA24 5. YA24 6. YA34 14(2)(a,b) It is required the manager provides evidence of the completion of the placement review conducted by the social worker. (Out standing from previous inspection May 2005) 12 (1)(a) It was required that the manager 15(1) ensure that the restrictive (2)(b) changes made to one person’s bedroom is kept under review. (From previous inspection October ’05) 13(6) It was required the organisation and the manager ensures that strategies are put in place, regularly reviewed and where they are not working, identify other options to protect people from self-harm. 23(2)(d) It was required that the first floor shower be cleaned and treated for mould and the carpet in the hallway and on the stairs is replaced. 17(1)(a) It is required that the manager schd ensures restrictive practices are 3(3)(q) assessed, reviewed and reduced were possible. 19(1) It is required the manager DS0000058271.V299302.R01.S.doc 19/10/06 19/10/06 30/12/06 19/10/06 19/10/06 Page 30 267 Old Shoreham Road Version 5.2 review the recruitment records off all the staff to ensure they are complete. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 267 Old Shoreham Road DS0000058271.V299302.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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