Inspection on 13/09/06 for 29 & 30 Dominion Road

This inspection was carried out on 13th September 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

29 & 30 Dominion Road 11/07/07

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 13 September 2006 09:30 th 29/30 Dominion Road DS0000008186.V304183.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.V304183.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.V304183.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 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.V304183.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 3 persons aged 18 to 64, requiring personal care. Staffing levels for initial for two service users to be as follows: Weekdays - 2 staff 7.30 am - 2.30 pm 1 staff 9 am - 4.30 pm 2 staff 2 pm - 9.30 pm 1 staff 9 pm - 7.30 am on a sleep-in basis Weekends - 2 staff 7.30 am - 2.30 pm 2 staff 2 pm - 9.30 pm 1 staff 9 pm - 7.30 am on a sleep-in basis 3. An on-call Manager to be on duty throughout the 24-hour period daily. The staffing structure as specified in condition 2 above to be reviewed by the RNID and CSCI at the time of admission of a third service user to this service. 25th January 2006 Date of last inspection Brief Description of the Service: 29 & 30 Dominion Road is registered to provide a service for 3 people who have a sensory loss. The house is in a residential setting in Twerton, which is 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 so 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.V304183.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 as part of a Key Inspection of this service. The inspector gathered information during this visit through discussions with service users, the Registered Manager and Support Workers. Interaction and communication between staff and service users was also observed during the course on the inspector’s visit. Care plans and associated records were examined together with Risk Assessments, accident/incident reports, complaints log and health and safety records. The inspector 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 home’s action plan in response to the last CSCI inspection, notifications of significant events and reports of monthly audits of the service by the Residential Services Manager. The Commission also provided ‘Comment Cards’ prior to visiting the home. Two have been completed and returned, one from a service user’s family and one from a Care Manager. Comments from another Care Manager were provided by e-mail. All involved with the home have worked to address the issues identified during the last inspection. Although many Statutory Requirements are repeated in this report, the timescales for action have been extended to support the improvements already made within the service to enable compliance with the National Minimum Standards and Care Homes Regulations. What the service does well: The service remains focused on the people who live in the home. Service users spoken with liked the home and wanted to continue to live here. Comments received from one family and two Care Managers were complimentary to the home and the staff team. The home actively seeks support from other professionals to help improve the quality of the service it provides to each person. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 6 Both morale and the dynamics within the staff team continue to improve. This has improved the consistency of support provided to service users. 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? Staff are now being provided with both mandatory and specialist training. This process will take several months to complete. This will provide staff with the knowledge and skills to ensure each service user is supported appropriately. Staff supervision is now provided consistently. This helps to ensure all staff are supported in their role of providing support to service users. The Registered Manager has now completed NVQ Level 4. This helps to ensure he is suitably qualified to lead the care and support provided to the service users and assists in developing existing skills to improve the management practice and structures within the service. The Commission is now informed of any incident requiring the use of a physical intervention or restraint. This ensures a comprehensive system of reporting and monitoring to ensure the safety of service users and staff. All health and safety checks are now carried out at the specified times and a clear record maintained within the home. This helps to provide a safe environment for service users and staff. The collation and storage of all information within the home has been reviewed and is being improved. This helps to ensure that all files are user friendly and information is easily located and an effective management system is in place to support service users. The Quality Assurance process has been completed and formalised. This ensures the home can monitor the quality of care and support provided to all service users and promote improvement. 29/30 Dominion Road DS0000008186.V304183.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. 29/30 Dominion Road DS0000008186.V304183.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.V304183.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): 1 The quality in this outcome area is good. 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 provides comprehensive information on the service available. This has been adapted into an accessible format for one service user. This document was last updated in January 2006. There have been no new admissions to the home since the last inspection. 29/30 Dominion Road DS0000008186.V304183.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. The quality in this outcome area is adequate. The care plans examined provided good information in how to support each service user. There is an effective review process in place. The home continues to review the accessibility of information for each service user. Service users are regularly consulted on all aspects of life within the home. There are Risk Assessments in place to support service users to take risks as part of their lifestyle. However, these must be used more proactively and each Risk Assessment must be signed by the manager and have a review date added. EVIDENCE: 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 11 Two service user care plans were examined in detail and these provided comprehensive information on the areas of support each person required. Care plans include a personal profile, assessment of need, personal care information and daily routines. 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 service user told the inspector she was involved in her review meetings. She had attended a meeting recently and discussed things which are important to her. She likes living in this home and wishes to stay here. The two Care Managers who responded said they had attended review meetings are were complimentary towards the care planning and review process operated by the home. 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 has made improvements in making information more accessible as there is now more information provided in symbol/picture symbol format and photographs are now also being used, for examples on service users’ daily planners and the new pictorial staff rota. The inspector observed interaction between staff and all three service users during the course of this visit. This demonstrated 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 monthly service user 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 ‘house rules’, new items required for the house, menu choices, interesting places to visit and holiday plans. Each service user and staff member who attends the meeting signs the record. This is good practice. 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. The home must however take a more proactive approach in using risk assessments as part of the care planning process and ensure that all risk assessments are signed and have a review date. For example, one service user who currently leaves the home without staff support has not had a risk assessment completed, where the risks appear 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 12 reasonably high due to her lack of awareness of the dangers posed by traffic /crossing roads and the staffing levels within the home which can prevent staff from leaving the home to support her. Although each risk assessment currently in place had been reviewed in May 2006, none had been signed by the manager or had a date for their next review noted. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15 and 17. The quality in this outcome area is good. Service users have opportunities for social and educational development and appropriate leisure activities. Service users are supported by staff to use community facilities, enjoy holidays and visit families and friends. The home promotes a well-balanced and healthy menu. EVIDENCE: All three service users continue to attend Educational Development Studies at the main Poolemead site. Practical life skills are taught together with a range of other activities chosen by each service user such as printing, sculpture, art and aromatherapy. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 14 Each of the service users accesses facilities in the wider community, and during the inspection various trips out of the home were made. The records examined showed that each service user was being supported to take part in various activities such as music sessions, going out for meals, swimming, walks, going to the theatre and museums. Service users spoken with told the inspector they liked the activities and staff helped them to do the things they enjoy. Each service user is currently being supported to choose and organise a holiday. Discussions with both service users and staff confirmed that each individual would be going abroad in October, to destinations of their choice. 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. One service user told the inspector they regularly visit their family and stay with them one weekend per month. The family who responded were extremely complimentary toward the service their relative receives, the staff team who support her and had noted the significant progress they had made. Their relative had ‘become an entirely different individual since going to Dominion Road’. The home promotes healthy eating with each service user. During the inspector’s visit both lunch and the evening meal were prepared. Through both observation and examination of the menus, it was apparent that the home provides a choice of healthy and nutritious food and encourages each service user to help with either choosing, preparing or cooking meals 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 15 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. The quality in this outcome area is good. The care plans clearly explain the support each service users requires in relation to their personal and health care. Staff have a good knowledge of each service user and how to provide appropriate levels of support. A monitored dosage system of medication is in place for the service users. Some staff still require training in this area and the management of this system requires further improvement. 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/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 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 16 Therapist and Community Physiotherapist. Contact with these professionals was clearly recorded in each service user’s file and the outcomes acted upon. There is a core of experienced staff who have a good knowledge of service users healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. 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. The home uses the Boots Monitored Dosage System of medicine administration. The records have been improved as they now contain a profile and photograph of each service user. However, the home still needs to obtain manufacturer’s notes of all prescribed medication for staff to access. 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. Staff records examined show that most staff have now received 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. Staff spoken with feel this is an excellent training course and has helped improve their knowledge base in this area. All staff are required to complete this training and the remaining staff will complete this as soon as possible. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The quality in this outcome area is adequate. The complaints policy and procedure is robust, clear and effective and there is every indication that service users feel their views are listened to and acted on. Clear reactive strategies are in place for each service user who presents challenging behaviour. Risk Assessments must be put in place for any service user who requires physical intervention or restraint. This will promote the safety of both service users and staff. The staff team are provided with training and support to ensure the welfare and safety of service users. This training must be completed by all staff. EVIDENCE: The home’s complaints policy and procedure is comprehensive in detail, and the service users handbook also fully explains in symbol format how complaints are dealt with, along with the action can be taken if they remain dissatisfied with the way their complaint has been investigated. There has been one complaint from a service user since the last inspection. The records examined show that the complaint was taken seriously, investigated in accordance with the complaints policy and the outcome recorded. The inspector noted that it was resolved to the service user’s satisfaction. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 18 One service user spoken with confirmed she would speak to staff members if she was unhappy or had a problem. She could also speak to the manager as well as the staff team. She said they would be able to help her. 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’. One service user has shown a recent escalation in challenging behaviour, which the home has responded to. It is clear that the home had taken appropriate action to support this individual by accessing support from the Behavioural Specialist from the Community Learning Disabilities Team and regularly reviewing the support plan. The Care Manager for this service user complimented the home in their ‘high professional standards’ of support. Staff now receive training in responding to these behaviours using the ‘MAPA’ (Management of Actual or Potential Aggression) system, which is accredited by the British Institute of Learning Disabilities. This has recently replaced the NAPPI system previously used by the home. The Manager and staff members spoken with confirmed that this has improved the support provided to service users, as they feel it is better suited to their needs. They have also noted a reduction in the number of incidents, which require staff to physically intervene. The home has improved record keeping in this area by introducing a more comprehensive ‘Record of Challenging Behaviour Incident Form’. This provides much more 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. The inspector however could still find no evidence of Risk Assessments relating to physical intervention or restraint of service users. These must be implemented to form part of a safe behavioural support plan for service users and staff. The home has a policy in relation to the Protection of Vulnerable Adults. This still requires some amendments to ensure accurate information is provided to the reader. Staff are also provided with training in relation to the Protection of Vulnerable Adults and are subject to Criminal Record Bureau enhanced disclosures. Both examination of training records and discussions with the Manager confirmed that some staff still require training in Protection of Vulnerable Adults and MAPA. This must be completed as soon as possible. 29/30 Dominion Road DS0000008186.V304183.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30. The quality in this outcome area is adequate. The house provides a homely environment for the service users. However, the home would benefit from new carpets, the development of a utility room and increased storage space. This would improve the environment for the service users. Each person has decorated and furnished their bedrooms to suit their individual tastes and needs. The house was clean and tidy on the day of the inspector’s visit. EVIDENCE: The home continues to be reasonably well maintained and provides a homely environment for the service users. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 20 The open plan kitchen/lounge/dining area continues to promote the service users independence. The inspector observed service users using these areas at various times during the day. The manager told the inspector all of the home’s carpets have been professionally cleaned since the last inspection. However, they still appear to be stained or dirty in some areas. Either the home should replace the carpets, as mentioned in the last inspection report, or they should be professionally cleaned on a regular basis. The service users’ bedrooms have been redecorated recently. One individual showed the inspector their room and confirmed they chose the colour scheme. They ‘really liked their room’; it is ‘much better than before’. The kitchen still contains the home’s washing machine and tumble drier. The manager confirmed plans remain to create a utility room within the home. The inspector agrees 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 is 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; however there is not enough storage space. During the last inspection the Manager told the inspector he would like to develop part of the patio area and provide a conservatory. This could be used as a games/arts and crafts room. This would provide useful additional space for all service users and useful storage space. The inspector again agrees this would be beneficial within this home and improve the homely environment for each person who lives at Dominion Road. There is a large garden to the rear of the house. This has a patio area, clear pathways and handrails fitted to support all three service users to use this area. This is well maintained and has garden furniture to enable service users 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.V304183.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. The quality in this outcome area is adequate. The staff team continues to become more cohesive and effective in supporting the service users. Staff are provided with training both by the organisation and external agencies. Staff training requires completion/updating in some areas and staff training records need to be updated regularly to accurately reflect the training they have received to enable them to support service users. There needs to be a clear action plan in relation to supporting staff to obtain a National Vocational Qualification. All staff files need to contain all relevant information to ensure a robust recruitment process, which protects service users. All staff are now supervised on a regular basis and a clear record maintained in their personnel files. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 22 EVIDENCE: There continues to be improvements within the dynamics and morale within the team. The Manager told the inspector that while it has taken some time, and tensions have resurfaced at times, the team is now working well together and the morale is currently high. The inspector spoke with four members of staff who confirmed there had indeed been a significant improvement in these areas. The team is working well together and communication had improved. This has led to a more consistent approach in supporting each service user and made it possible to discuss issues openly at team meetings and supervisions. The staff team meets regularly. Records examined show that attendance is generally high and a variety of topics are discussed. These records have been improved since the last inspection and now provide an accurate record of each meeting and also describe the outcomes in detail. The manager confirmed that a ‘Team Day’ was still essential to build upon the progress made within the staff team. The inspector concurs with this opinion and again recommends that this should be organised as soon as possible. There has been some progress in providing additional training to the staff team. Several staff members have now received training in Learning Disabilities, Medication and updated their Food Hygiene Certificates. This must be provided to all remaining staff to ensure the team are sufficiently skilled and able to provide consistent support to each service user. It is also essential that staff receive all mandatory training. This should include First Aid, Manual Handling, Fire Procedures, MAPA and Protection of Vulnerable Adults. It was not clear from some staff files whether they had attended all mandatory training. This could not be checked using the staff-training matrix, as this had not been updated recently and many training certificates of training courses staff had completed were not evident. The training matrix in use in the home must be regularly updated. This will ensure all staff are provided with training to maintain or update their knowledge and skills to enable them to provide support to the service users. It could also provide the manager with a useful tool in tracking all staff training requirements, if it were to be kept up to date. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 23 The home currently has only one member of staff working towards an NVQ. It is anticipated that they will also complete their A1/A2 NVQ Assessors award and may therefore be able to support other staff with their NVQs. The standards expect at least 50 of the team to be trained or working towards these qualifications. A revised plan must now be developed describing how staff are to be supported to gain these qualifications, including the anticipated timescales and a copy supplied to the Commission. The manager told the inspector that some personnel files still did not include all of the required documentation. Files examined showed that some do not have copies of application forms, staff photographs or satisfactory references. All staff personnel files kept in the home must include all relevant information as part of a robust recruitment process. This should include proof of identity, a recent photograph, a copy of the staff members application form, two written references and proof of any relevant qualifications. The records of staff supervision examined showed that all staff are now being formally supervised every 8 weeks as described in their revised supervision contract. The records of supervision meetings have been improved and now provide a clear record of discussions and the outcomes, which had been agreed upon. 29/30 Dominion Road DS0000008186.V304183.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 43 and 43. The quality in this outcome area is adequate. Service users benefit from the ongoing development and improvement of the management systems in place. The records maintained as part of this process are being significantly improved to ensure accuracy, consistency and that outcomes are recorded and acted upon. The manager ensures the service users continue to remain the focus of the service. They are supported to express their views and the home continues to review how each individual is able to access information. The home has procedures in place, which are designed to provide a safe environment for service users. The management of these procedures has improved which helps to ensure all service users’ welfare and safety. The service users now benefit from the Manager having completing his NVQ Level 4. This is supporting the significant improvements in the management systems and structures currently being implemented within the home. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Registered Manager, Mr.Bull, has now completed NVQ Level 4. 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. There have been considerable efforts made to improve the management systems and structures in place. The management team has focussed strongly on the issues raised during the last CSCI inspection. The Residential Services Manager has also supported this process. The office environment has been greatly improved. New desks and a new computer have been provided. The collation and storage of all files is being improved. This ensures that the new systems being implemented make it easier for the Manager to monitor all procedures. Although this work is yet to be completed, the benefits are already apparent. The Manager told the inspector that the improvements within the dynamics and morale of the staff team has assisted him in his role. He is now able to delegate work to members of the team, where he was not able to before. This helps Support Workers to feel valued and included and also assists the Manager by reducing his workload. The home’s 2006/2007 Operational Plan is currently used as part of a Quality Assurance process to measure the home against its stated aims and objectives. This process is supplemented by the audit each year, which measures the service against the National Minimum Standards. The manager confirms he also uses Review Meetings, monthly Audits, Service Users Meetings, Questionnaires and Team Meetings as part of the Quality process. Service users’ views are sought during house meetings, reviews and meeting with Keyworkers. The home continues to review its progress in how it supports each service users to express their views and also how they access information. One service user spoken with confirmed that she was able to talk about the home, support form the staff team, any problems she has, what changes she would like to see. She did feel that she continues to be spoken with about her service and confirmed to the inspector that she was happy to live in the home and that she liked the staff and the manager. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 26 There are both generic and person centred Risk Assessments in place. These had all been updated in May 2006 but they still need to be signed by the manager and have the next review dates added to each one. The home uses a monthly Health and Safety checklist, to ensure that all checks are carried out at the appropriate times. This includes fire checks, water and fridge/freezer temperatures, vehicle checks, medication and food. Records examined showed that all checks are now carried out consistently, as all of the records examined during this visit were up to date. 29/30 Dominion Road DS0000008186.V304183.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 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X 2 2 3 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 28 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 YA20 Regulation 18(1) Requirement All staff who administer medication must receive accredited training. (This requirement is repeated from the last inspection report) 2. YA35 18(1) Training for staff on the management of service users with learning disabilities to be completed. (This requirement is repeated from the last inspection report) 3. YA42 18(1) All staff must update food hygiene certificates where necessary. (This requirement is repeated from the last inspection report) 4. YA35 18(1) All staff must be provided with training:Which meets all RNID core standards. 29/30 Dominion Road DS0000008186.V304183.R01.S.doc Version 5.2 Page 29 Timescale for action 13/03/07 13/03/07 13/03/07 Which provides all staff with additional relevant skills to support service users. 5. YA42 13(4) All Risk Assessments must be signed by the manager and dates of review added. (This requirement is repeated from the last inspection report) 6. YA23 13(7) Risk Assessments must be put in place for each service user who requires physical intervention or restraint. (This requirement is repeated from the last inspection report) 7. YA23 13(6) The Protection of Vulnerable Adults Policy must be amended to reflect the Care Standards Act 2000, rather than Registered Homes Act and update CSCI contact. (This requirement is repeated from the last inspection report) 8. YA35 18(1) Develop a clear plan to support staff to gain a National Vocational Qualification and supply a copy to the Commission. (This requirement is repeated from the last inspection report) 9. YA35 17(3) Staff training matrix to be updated, and maintained in good order. (This requirement is repeated 29/30 Dominion Road DS0000008186.V304183.R01.S.doc 13/03/07 13/11/06 13/11/06 13/11/06 13/11/06 13/12/06 Version 5.2 Page 30 from the last inspection report) 10. YA34 19(1) Sch 2 All staff personnel files must contain all relevant information as required by the regulations. (This requirement is repeated from the last inspection report) 11. YA24 23(2) The communal carpets must either be professionally cleaned again or replaced. 13/12/06 13/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA24 YA32 Good Practice Recommendations The home should continue to review its progress in adapting information into accessible formats for each service user. The home should consider extending/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.V304183.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 29/30 Dominion Road DS0000008186.V304183.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. 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