Inspection on 11/07/07 for 29 & 30 Dominion Road

This inspection was carried out on 11th July 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

29 & 30 Dominion Road 13/09/06

29 & 30 Dominion Road 25/01/06

29 & 30 Dominion Road 27/06/05

29 & 30 Dominion Road 10/03/05

29 & 30 Dominion Road 21/06/04

Similar services:

5 Seafield Road

Honeybourne House

Longrun House

Bodley Community Care Support Centre

Thomas Pocklington Trust

Chantry Gardens

Penkelly House

25-27a Alexandra Road

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

CARE HOME ADULTS 18-65 29/30 Dominion Road Twerton Bath Bath & N E Somerset BA2 1DW Lead Inspector David Smith Key Unannounced Inspection 11th July 2007 09:30 29/30 Dominion Road DS0000008186.V338978.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 29/30 Dominion Road DS0000008186.V338978.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. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 29/30 Dominion Road Address Twerton Bath Bath & N E Somerset BA2 1DW 01225 332396 01225 427261 Lee.Bull@RNID.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) RNID Mr Lee Bull Care Home 3 Category(ies) of Sensory impairment (3) registration, with number of places 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 3 persons aged 18 to 64, requiring personal care. 13th September 2006 Date of last inspection Brief Description of the Service: 29 & 30 Dominion Road, one of the services operating as part of the Royal National Institute for the Deaf (RNID), is registered to provide a service for three people who have a sensory loss. The house is in a residential setting in Twerton, a suburb of Bath, is on a bus route and close to all local amenities. The house has 4 single bedrooms, (one bedroom for staff sleeping-in), all with en-suite facilities, plus additional WCs. There is a large garden area to the rear of the home where service users can spend time relaxing, or gardening, if they wish. Ramps and rails have been provided in order to aid service users’ mobility. The current fees are a minimum of £1300.00 per week. These could be increased depending upon the support needs of service users. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home as part of a Key Inspection of this service. I gathered information during my visit through discussions with service users, the Registered Manager, one Senior Support Worker and Support Workers. I also observed interaction and communication between staff and service users at various times during the day. Care plans and associated records were examined together with Risk Assessments, accident and incident reports, the home’s complaints log, staffing and health and safety records. I was also provided with a tour of the home. Other sources of evidence have been used as part of the Key Inspection process. These include the Random Inspection of the service I conducted on 23/02/07, which was focused on the Statutory Requirements and Recommendations following the Key Inspection of this service on 13/09/06. The home’s action plans in response to both the last Key and Random CSCI inspections have also been considered together with notifications of significant events which have occurred in the home and reports of monthly audits of the service by the Residential Services Manager. The Manager completed and returned an Annual Quality Assurance Assessment (known as an AQAA, pronounced ‘aqua’). The CSCI provided the home with a range of surveys for service users, their families and friends and other professionals who are involved with the home, prior to my visit. Four surveys were completed and returned prior to my visit and two service users completed their surveys with me on the day I visited. What the service does well: Service users spoken with and those who completed surveys said they liked their home, were well supported by the staff team and wanted to continue to live here. Each family who responded by survey said that the home ‘always’ provides the support and care they expect for their relative and that they are supported to live the life they choose. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 6 Each member of staff spoken with enjoys working in the home and felt well supported to provide a good quality service to each person who lives in the home. The home actively seeks support from other professionals to help improve the quality of the service it provides to each person. The communication approaches to support each service user are clear and staff are offered specialist training to ensure this is consistent. The staff team provide choices but let the service users make decisions. What has improved since the last inspection? The Vulnerable Adults policy has been amended to give reference to the Care Standards Act 2000, rather than the Registered Homes Act 1984 and the contact at CSCI has also been updated. This ensures correct information is available to each service user. (These improvements were noted during the Random Inspection of the service on 23/02/07). The assessment of risks has been significantly improved. All Risk Assessments are now signed and have a review date. A Risk Assessment has been put in place if physical intervention or restraint forms part of any service user’s care plan. This promotes their welfare and safety. (These improvements were noted during the Random Inspection of the service on 23/02/07). The carpets on the ground floor have been replaced, which has improved the environment for service users. (This improvement was noted during the Random Inspection of the service on 23/02/07). The home has developed a clear plan to support staff to attain a National Vocational Qualification (known as an ‘NVQ’). This supports staff in their professional development and ensures they have relevant knowledge and skills to support each service user. The home’s staff training record has been updated. This ensures all staff training is clearly recorded and is easy to track. (These improvements were noted during the Random Inspection of the service on 23/02/07). A significant amount of core and other relevant specialist training has now been completed by most of the staff team. This is crucial in ensuring the safety and welfare of service users and in providing appropriate and consistent levels of support. All staff personnel and training files have now been updated and are maintained in good order. This helps to ensure a robust recruitment process, that all staff training can be easily monitored and to improve the support provided to service users and promote their welfare and safety. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 7 What they could do better: 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. 29/30 Dominion Road DS0000008186.V338978.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 29/30 Dominion Road DS0000008186.V338978.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with the information they need to make an informed choice of where to live. EVIDENCE: The home has a Statement of Purpose, which was last updated in January 2007. This provides comprehensive information on the service available including an introduction to the home, details of staffing, fee levels, how to complain and the rights and responsibilities of each individual who lives in the home. This document has been adapted into an accessible format for one service user. I did note that this updated document also contains a statement of terms and conditions, which has been developed jointly by the RNID and the CSCI. The Manager told me that these would be discussed and agreed with each Funding Authority as part of each service user’s annual review. This is good practice. There have been no new admissions to the home since the last inspection. 29/30 Dominion Road DS0000008186.V338978.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, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each individual takes into account their personal preferences, supported by both written information in care plans and risk assessments which are subject to ongoing review. Service users are consulted on, and participate in, all aspects of life in the home. EVIDENCE: I examined two care plans in detail and these provide comprehensive information on the areas of support each person requires. Care plans include a personal profile, assessment of need, personal care information and daily routines. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 11 Each care plan is reviewed regularly. Annual review meetings are held, which are attended by the service user, family members, representative from the Funding Authority and staff members. A clear record of each meeting is maintained. In addition to this, the home ensures all care plans are reviewed every six months, or sooner if this is necessary. One review meeting has been held recently and the home prepared detailed notes to present at this meeting together with reports from education services who also support this individual. This service user’s care plan was being updated following this review, at the time of my visit. Each service user has a Keyworker, who completes a monthly summary of events for each individual. These summaries are also used as part of the review process. Service users are able to make decisions, and are assisted to do so by being offered support by staff that are able to use sign language to communicate choices and opportunities. The home continues to make improvements in making information more accessible as there is now more information provided in symbol or picture symbol format and photographs are now also being used. The Manager told me the home hopes to work towards making information contained in care plans accessible, but this may be a longer-term goal. I observed interaction between staff and all three service users during the course of my visit. These show that the staff team were knowledgeable and confident in communicating with the service users and did provide choices but let the service users make decisions. There are regular ‘house meetings’, which all three service users attend, supported by two members of staff. Records examined show that the service users set the agenda for each meeting. Recent meetings have focused on planning a holiday to Minehead. Each service user and staff member who attends the meeting signs the record. This is good practice. The risk assessment processes in the home have been significantly improved. Each service user has a number of person centred Risk Assessments, which support them to take risks as part of their lifestyle. These form part of each person’s care plan and are now signed by the Manager and subject to regular review. 29/30 Dominion Road DS0000008186.V338978.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): 11, 12, 13, 14, 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. Each individual has opportunities and appropriate support to develop, access leisure and educational facilities both locally and in the wider community including holidays, day trips and visits to family and friends. Each person’s rights and responsibilities are recognised in their daily lives. A healthy and balanced diet for each individual is promoted. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 13 EVIDENCE: Each service user is given the opportunity to attend educational day services (known locally as ‘EDS’) at the main Poolemead site or the ‘workshop’ in Bath. Practical life skills are taught together with a range of other activities chosen by each service user such as printing, sculpture, art and aromatherapy. Each of the service users accesses facilities in the wider community, and during my visit various trips out of the home were made as two individuals went out to the ‘workshop’ and the other person went out shopping. The records I examined showed that each service user is being supported to take part in various activities such as horse riding, going out for meals, swimming, walks, going to the theatre and museums. The service users I spoke with liked living in the home and felt that the staff supported them to do the things they wished to do. One person told me they were going to the workshop in the morning for craft and in the afternoon they had a massage session at the main Poolemead site. The two individuals who completed a survey with me said they felt well cared for and that there are good activities provided by the home. Each service user has been supported to choose and organise a holiday, with each person enjoying a trip to Minehead last month. The Manager also told me that if the planned building work does go ahead later this year, it is likely each service user would have another holiday organised to coincide with this work. Individual’s rights and responsibilities are made clear and confirmed in writing in their guide to the service. Each person has a key to their bedroom and the individuals I spoke with said they could lock their bedroom door if they chose to do so. The two individuals who completed a survey said they felt their privacy was respected. Service users are supported to maintain close contact with their families and friends. Some regularly visit their families and visitors are welcomed to the home. Each family who responded by survey said the home ‘always’ meets the needs of their relative, supports them to live the life they choose and helps them keep in touch. One relative said the home is “very good and they always keep me updated on everything that is going on, they look after my relative very well. My relative always seems happy and looks very well” and another family said “we visit regularly and are made welcome, its like we are part of an extended family”. The home provides a choice of healthy and nutritious food and encourages each service user to help with either choosing, preparing or cooking meals. Although there is a planned weekly menu, each individual can choose a different meal if they wish and this is recorded as part of their daily records. 29/30 Dominion Road DS0000008186.V338978.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 is good. This judgement has been made using available evidence including a visit to this service. Service users are supported in their preferred manner and their personal and healthcare support needs are well met. The policy relating to administration of medication ensures each individual’s welfare and safety. EVIDENCE: The care documentation in place for service users provided clear guidance for staff on how they should support those living at the home with their personal and health care. The care plans examined showed that service users were registered with a local GP, dentist and optician. There are varying levels of support from other health care professionals such as the Consultant Psychologist, Occupational Therapist, Speech and Language Therapist and Community Physiotherapist. Contact with these professionals was clearly recorded in each service user’s file and the outcomes acted upon. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 15 The health professional who responded by survey said the home ‘always’ meets each person’s health care needs and seeks their advice and acts upon this to manage and improve individual’s health care. They added the support provided by the home is “sensitive and adaptive to service users’ needs”. The home has a gender sensitive policy, which is adhered to. At present all the service users are female and the male members of staff therefore do not support any personal care. Although there have been some changes within the staff team, a core of experienced staff remain who have a good knowledge of service users healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. The home uses the Boots Monitored Dosage System of medicine administration, which is well managed. Medication records contain a photograph of each service user, manufacturer’s notes of all prescribed medication, details of any medication taken as and when needed (known as ‘PRN’), signatures of each staff member who administers medication together with a sample of the initials they use on some of the records. Clear records of the medication entering the home and being returned to the pharmacy are maintained. Either the Manager or his deputy conducts a monthly stock check. Each member of the staff team has now completed formal medication training, ‘Protocol Training’, which is accredited by the City of Bath College. This is in the style of an NVQ unit and contains four elements; introduction to medicines, care workers role, administration and medicines of differing client groups. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Service users are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: The home has a comprehensive complaints policy. The service users handbook also explains in symbol format how complaints are dealt with, along with the action which can be taken if they remain dissatisfied with the way their complaint has been investigated. The home also has a policy in relation to the Protection of Vulnerable Adults, which has now been updated. I examined the home’s complaints log, which showed there have been no complaints or concerns raised since the last inspection. The CSCI has not received any complaints or concerns direct regarding Dominion Road. Each service user I spoke with and those who completed surveys said they knew who to speak to if they were unhappy about any issue within the home and confirmed they felt safe living here. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 17 Each relative and the health professional who responded by survey said they knew how to make a complaint if they needed to and that the home ‘always’ responds appropriately to any concerns they have. Staff are provided with training in relation to the Protection of Vulnerable Adults and are subject to Criminal Record Bureau enhanced disclosures before they start work in the home. The home has clear guidelines in place for supporting service users who are distressed or presenting behaviours which may be perceived as challenging the service provided. Each care plan has details of known trigger points and the appropriate defusing techniques. These are described as ‘Methods of Approach’. The health professional said in their survey that the staff “work well as a large team to manage difficult, dangerous and distressing behaviour. Individual’s best interests are adhered to and the beliefs of those who know them best taken into account”. Staff have received training in responding to these behaviours using both the ‘NAPPI’ (Non Abusive Psychological and Physical Intervention) and ‘MAPA’ (Management of Actual or Potential Aggression) systems, which are accredited by the British Institute of Learning Disabilities. The ‘MAPA’ system is now used in the home and has effectively replaced the ‘NAPPI’ system. The Manager and staff members spoken with told me that the ‘MAPA’ system does suit the needs of the individuals who live in the home. I did note that although each member of staff has been trained in ‘MAPA’, refresher training is now overdue. I did speak with the Manager who told me that the RNID had only just agreed to extend the use of the ‘MAPA’ system and that he would ensure all staff receive refresher training as soon as possible. The home ensures any incidents of challenging behaviour are recorded on a ‘Record of Challenging Behaviour Incident Form’. This provides information in relation to each incident, together with the outcomes of diffusion techniques or interventions which are used. The checklist at the end of the form also helps to ensure staff complete all necessary records. Although most of the forms I examined had been completed well, some needed more information or clarity. For example one report stated a service user was removed from one part of the home, but did not explain which technique had been used. Another report stated a service user had been “lowered to the floor to reduce injury” however it was not clear how this was achieved. I discussed this issue with the Manager who said he would ensure all staff provide full details of any interventions they use to support individuals during these incidents. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 18 The home has implemented Risk Assessments for individuals who may require physical interventions to be used as part of their behavioural support plan. Each assessment has been signed by the Manager and is regularly reviewed. I examined one service user’s financial records. The money deposited and withdrawn from their Bank account is monitored by the Manager. Money kept in the home is stored securely in the home’s safe, all financial transactions are clearly recorded and a receipt obtained for any expenditure, which is kept as part of these records. 29/30 Dominion Road DS0000008186.V338978.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, 27, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Dominion Road provides a reasonably homely, comfortable and safe environment for service users to live in. EVIDENCE: Dominion Road is formed by two houses, which together provide accommodation which blends in well with the local community. There are car parking spaces and a small lawned area at the front and side of the property and a large garden to the rear. There are four bedrooms, with one currently used as the staff sleeping-in room, all of which have en-suite facilities. The open plan kitchen, lounge and dining area continues to promote the service users independence. I observed service users using these areas at various times during the day. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 20 The home continues to be reasonably well maintained and provides a homely environment for the service users. New flooring has been laid in all of the communal downstairs areas, to replace the old carpeting, which is a great improvement. The home’s office has had new furniture and has been repainted. There are several pictures displayed of recent service user holidays, day trips and events which have occurred within the home. This promotes the homely feel and enables the service users to personalise their home. The kitchen still contains the home’s washing machine and tumble drier. The manager discussed the plans to create a utility room within the home. I agreed that the current facilities are not ideally located and a utility room should be developed to improve the home. Storage space within the communal areas of the home remains limited. This is a particular issue within the kitchen and dining area. The kitchen is cluttered as there is not enough cupboard space available and this leads to items being stored on top of the cooker extractor, on the worktops and on the top of cupboards, which is not satisfactory. A number of items, such as arts/crafts equipment are stored in the dining area; the home has purchased new cupboards to help with storage, however there is still not enough storage space and this area also appeared cluttered during my visit. There are plans to develop the home, which will also help to resolve the issues noted above. The Manager has provided details of the proposed changes, which are to build a conservatory onto the rear of the house, create a utility room where the washing machine and tumble drier would then be located, expand the kitchen to create more storage space, install a shower in the downstairs toilet area, convert the existing staff sleeping in room to accommodate a fourth service user and equip the office to make this suitable for staff to sleep in. It appears these plans have been agreed by the RNID and the Manager told me that he will be submitting a formal application to the CSCI in respect of accommodating one extra person, as part of this process. There is a large garden to the rear of the house. This has a patio area, clear pathways and handrails fitted to support each service user to use this area. This is well maintained and has garden furniture to enable individuals to spend time outside if they wish. There is a vegetable patch in the garden, where the home is currently growing a number of vegetables. Staff spoken with confirmed that service users are encouraged to help grow the vegetables and keep the garden area tidy. 29/30 Dominion Road DS0000008186.V338978.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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person that lives in the home is supported by a cohesive and effective staff team that is committed to providing a good service. The home’s recruitment policy promotes both service users’ rights and their safety. The clarity of staff roles and responsibilities along with staff training and supervision helps to provide a consistent approach to the support of staff and service users. EVIDENCE: There have been some changes within the staff team, however there remains a core of experienced staff who are skilled and experienced to meet the needs of those living in the home. Staff spoken with were able to demonstrate a clear understanding of their role and responsibilities within the team and their own personal role and accountability. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 22 I spoke with four members of staff who told me that the team continues to work well together to provide a good quality of service to each person who lives in the home. Each staff member told me they enjoyed their job, liked working at Dominion Road and felt well supported. The service users I spoke with and those who completed a survey said the staff treated them well and they felt well cared for. Families and the health care professional who responded by survey said they felt the staff team ‘always’ had the right skills and experience to support each person. One relative said the staff team “do everything my relative asks of them, the staff always give 100 ” and another said “they are very concerned about everything to do with my relative’s life and well being and help as much as possible”. The staff team meets regularly. All meetings are recorded and appropriate subjects are discussed in order to guide and direct staff practice. It was evident through observation and discussion with staff, that the team operates effectively and are supportive of each other, communicating openly. The Manager told me that he would still like to arrange a ‘Team Day’ to help build upon the progress made within the staff team, although this may now be arranged when new staff are recruited. I agree that this would still appear useful and again recommend that this should be organised as soon as possible. The home has a robust recruitment policy. The personnel files I examined contained copies of application forms, interview questions and answers, induction training records, contracts of employment, satisfactory references and enhanced Criminal Record Bureau Disclosures. There has been significant progress in providing staff with both mandatory and more specialist training. The home now ensures the staff training matrix is regularly updated and that copies of certificates each member of staff receives when they have completed a training course are kept on their training records. Both of these methods enable staff training to be planned and monitored more effectively. Since my last visit staff have attended training in Fire Safety, Food Hygiene, First Aid, the Mental Capacity Act and Financial Awareness. One new member of staff also completed comprehensive induction training during May 2007. Four staff still require Manual Handling training to complete their core-training programme. There are also other training dates planned such as First Aid, Working with People Who Self Harm, Epilepsy and History of Learning Disabilities. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 23 The home has now developed a ‘Workforce Development Plan 2007/2008’, which provides clear details of how staff are to be supported to gain a National Vocational Qualification (known as an ‘NVQ’). Two staff have already attained an NVQ, with another two staff members currently working towards their awards and two further staff are scheduled to commence NVQ Level 3 Awards in September 2007. These awards are currently being supported by assessors from Norton Radstock College, although one staff member is now working towards the A1 NVQ Assessors Award is also supporting staff with their awards as part of this process. Each member of staff is provided with regular, formal supervision. I did not examine supervision notes in detail, however the records I did look at confirmed that all staff are now being formally supervised every 8 weeks as described in their revised supervision contract. Each staff member told me they continue to find supervision helpful and supportive. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and service users benefit from the ongoing development and improvement of the management systems in place. Service users benefit from the ethos, leadership and management approach of the home and their views are central to the monitoring and review of the service provided by the home. Each person’s rights and best interests are promoted by the quality of the home’s record keeping and the organisations’ policies and procedures. The health, safety and welfare of people living in the home is promoted and protected. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Registered Manager, Mr.Bull, has attained NVQ Level 4 and has a number of years experience working within the care profession, including six years as a Registered Care Manager supporting Deaf and DeafBlind adults. He also attends various training courses, which complement his role and responsibilities and which help to ensure his knowledge and work practice is regularly updated. The management approach is open and positive, now with a much clearer sense of direction and leadership. Staff spoken with said their views are listened to, and that they are well supported by the manager. The considerable efforts made to improve the management systems and structures have certainly continued since my last visit. The management team has focussed strongly on the issues raised during the last CSCI inspections and the Residential Services Manager has continued to support this process. The home’s office has been improved further. This area has been redecorated and both the collation and storage of records is now of a good standard. The records I required during my visit were quickly located and easy to follow. The Manager told me the only issue was now to improve storage by replacing the existing shelving, so that all files may be locked away when not in use. The RNID have comprehensive policies and procedures to support the home, to ensure it complies the law and remains aware of good practice guidelines. Full details of each RNID policy was provided by the Manager as part of the AQAA he completed for the CSCI. The management team now consists of the Registered Manager and two Senior Support Workers, one of whom has ‘Deputising Responsibilities’. This structure appears to work well, with each member of this team having their own area of responsibility, which allows the management duties to be shared. The views of each service user remain central to the development and improvements in the service. Their views are sought during house meetings, reviews and meeting with Keyworkers. The home continues to review its progress in how it supports each service user to express their views and also how they access information. The Manager completed the AQAA, provided by the CSCI, in some detail and returned this prior to my visit. The home also conducted a ‘Quality Review’ in May 2007. This involved sending questionnaires to service users, staff members, friends, relatives and healthcare professionals. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 26 All of the information was read through and used to identify both things the home does well and areas for improvement. One relative said in their CSCI survey “they (the home) don’t need to improve but every time I visit there have always been improvements in all aspects”. One service user I spoke with told me they did feel staff asked them about the service they received and they felt they could say if they felt anything needed to be improved. They told me they did like the staff and the Manager and were happy living at Dominion Road. The home is planning to develop the environment, as described earlier in this report, and increase the number of service users it can accommodate from three to four. The Manager has provided the CSCI with detailed proposals, which looked at various options depending on the additional service user’s needs and the extra staffing which would be required. The Manager told me that proposals have been agreed in principle within the RNID and that an application to agree these plans would be made to the CSCI in due course. Organisational monitoring of the service remains robust. Monthly visits by a representative of the organisation are conducted and although a copy of each audit is no longer routinely forwarded to the CSCI, I did examine them during my visit. Both service users and staff members are consulted as part of this process and their views are clearly reflected in each report. There are systems in place to support health and safety within the home, which are now being used consistently. I examined the fire log, which shows that the home now has a current Fire Risk Assessment, tests on the alarm system and visual checks of fire fighting equipment are now carried out each week and the emergency lighting is tested regularly. Each staff member has also taken part in a recent fire drill. The home uses a monthly Health and Safety checklist, to ensure that all checks are carried out at the appropriate times. This includes water, fridge and freezer temperatures, vehicle checks, medication and food. Records examined showed that all checks are carried out consistently, as all of the records examined during my visit were up to date. There are both generic and person centred Risk Assessments in place. These are all in date, regularly reviewed and have been signed by the Manager. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 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 3 28 3 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 3 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 28 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 YA23 Regulation 18(1) Requirement All staff must be provided with refresher training in relation to responding to challenging behaviour. All staff must be provided with training in relation to manual handling tasks. Timescale for action 11/09/07 11/09/07 2. YA35 18(1) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA6 YA23 YA24 YA32 Good Practice Recommendations The home should continue to review its progress in adapting information into accessible formats for each service user. The Manager should review records of incidents of challenging behaviour to ensure all members of staff complete them consistently. The home should consider extending and developing the communal areas in line with the Manager’s recommendations. Consideration should be given for a team building exercise being organised. 29/30 Dominion Road DS0000008186.V338978.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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