Inspection on 01/10/07 for 3 Clareville Road

This inspection was carried out on 1st October 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Clareville Road 30/10/06

3 Clareville Road 25/04/06

3 Clareville Road 30/01/06

3 Clareville Road 07/11/05

3 Clareville Road 14/07/05

3 Clareville Road 27/09/04

3 Clareville Road 04/05/04

Similar services:

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 Clareville Road (3) 3 Clareville Road Caterham Surrey CR3 6LA Lead Inspector Suzanne Magnier Unannounced Inspection 1 October 2007 09:30 st Clareville Road (3) DS0000013483.V344002.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 Clareville Road (3) DS0000013483.V344002.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. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clareville Road (3) Address 3 Clareville Road Caterham Surrey CR3 6LA 01883 340181 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) clareville@regard.co.uk The Regard Partnership Ltd To Be Confirmed Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (2) of places Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The age/age range of the persons to be accommodated will be: 18-65 YEARS Two named individuals may be accommodated who are 17 years of age. Of the ten service users accommodated two named service users currently in residence may also fall within the category MD Mental Disorder in addition Of the ten service users accommodated two-named service users currently in residence may also fall within the category MD mental Disorder in addition to LD Learning Disability. 30th October 2006 Date of last inspection Brief Description of the Service: 3 Clareville Road, Caterham is a detached three-storey house within the Regard Partnership Ltd, developed to provide accommodation for 10 service users with learning disabilities. The home is sited in a residential road with similar properties, and is within walking distance of local shops and amenities in the town centre of Caterham. Individual’s bedrooms are situated on the ground and upper floors. There is a toilet on the ground floor, and all bathing and showering facilities are situated on the upper floors. This limits the homes suitability for individuals with mobility difficulties. Communal and recreational areas are situated on the ground floor. Weekly charges per person range from £1,800.00 to £1,263.00 Holidays, clothing, and ‘one to one’ support are extra and these are negotiated with the placing authority. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Some additional standards were assessed and have been included within the report. Ms S Magnier Regulation Inspector carried out the inspection and the area manager and a registered manager from another service represented the home. For the purpose of the report the individuals using the service are referred to as people living in the home. The area manager with the additional support of a registered manager from another service have been managing the day to day running of the home for eight weeks since the departure of the previous manager. The ongoing management arrangements of the home were fully explored and discussed during the inspection process and have been documented in the last section of the report. The inspector arrived at the service at 09:30 and was in the home for six hours and fifteen minutes. It was a thorough look at how well the home is doing. It took into account detailed information provided by the area manager, and any information that CSCI has received about the service since the last inspection. The inspector spent time talking and observing people living at the home in order to seek their views about the home and the care they receive. Some written responses and comments received on the telephone from individuals significant others and healthcare professionals have been included within the report. Staff comments from surveys sent by the Commission to the home have also been included within the report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, care plans, shift plans, risk assessments, medication procedures, menu plans, staff recruitment files, staff induction and training records, and several of the services policies and procedures. Following a previous key inspection in October 2006 the service has met all the requirements made. The home has submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection and it was recognised by the home that the document had not been fully completed. Some details of the AQAA have been added to the report and also confirmed with the area manager for accuracy. No complainant has contacted the Commission with information concerning a Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 6 complaint made to the service since the last inspection. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. The inspector would like to thank the people living in the home, the staff and the managers for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? What they could do better: The management and administration of the home needs to be improved. A requirement has been made that the home must inform the CSCI in writing of the proposed ongoing management arrangements of the home. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 7 The area manager explained that the Regard Partnership Trust are currently developing, in consultation with an external company, person centred planning to offer a more holistic approach, including promotion of choice, to individual’s at the home. The home must ensure that all staff wear protective clothing whilst supporting individuals with personal care in order to prevent the spread of infection in the home. The home must ensure that arrangements are made to promote appropriate staff conduct in the home, which reflects the rights of individuals to be treated with respect and dignity and encourage and assist staff to maintain good personal and professional relationships with the individuals they are supporting. The home must review the current use of the laundry facility to ensure that it is fit for purpose and a safe place for individuals to use. The home must ensure that the floor coverings throughout the home that are stained or worn must be replaced. The home must ensure that appropriate storage of individuals clothing is reviewed in order to ensure that people’s belongings are secure and the home provides adequate storage facilities. Arrangements must be made for a covering on the window in one person’s bedroom in order to ensure the individual’s rights to dignity and respect. It is required that care staff induction records are accurately maintained in order to evidence a structured induction has been undertaken. It is recommended that the home consider undertaking the LDAF (Learning Disability Award Framework) induction in order to ensure that staff have a full specialist knowledge regarding supporting individuals with learning disabilities. 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. Clareville Road (3) DS0000013483.V344002.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 Clareville Road (3) DS0000013483.V344002.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, 2 & 5. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. People and their representatives have information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individual’s needs are appropriately identified and met. Terms and conditions/contracts of stay at the home are available to all individuals. EVIDENCE: The home have recently updated the homes Statement of Purpose and Service User Guide. The documents reflect the current changes of the management of the home and the additional improvements and developments made to ensure that the home meets the ongoing needs of individuals in their home. The updated Service User Guide includes the use of pictures to make it more interesting and the information more accessible to individuals in the home. The area manager explained that some individuals had not received their own copy of the service user guide yet both documents have been made available to all people in the home and are displayed in the homes front hallway. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 10 No admissions to home have been made since the last inspection. The inspector sampled two individuals care plans both of which included admission and assessment procedures, which were clear in determining that the care home could meet the needs of the individual. It was evident through sampling the documentation that the individual, their relatives and other representatives had been included in the care assessments. The inspector evidenced that each file contained the homes terms and conditions and noted that it had been signed, where possible by the individual or their representative. The ethnicity and diversity of individuals was reflected in the assessment documentation and it was evident during the inspection that the home was aware of the needs of all individuals from differing cultures and faiths. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. Improved documentation and management of individuals care plans and risk assessments have been maintained. Individuals are encouraged to make appropriate decisions and choices about their lives both inside and outside of the home. EVIDENCE: As part of the revised management of the service it was evident that the documentation in the care plans sampled by the inspector had been recently reviewed. The documents were well presented in individual files and offered the reader an insight into the individual’s life. In discussion with the managers the inspector was advised that the manager from another registered Regard Partnership service that is known by the majority of the individuals and staff at the home is offering specific support to the home due to their expertise. The support entails the reviewing the homes current practice in response to individuals behaviours that may ‘test’ the Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 12 service and assisting staff in understanding individuals communication and behaviour in order to support the individual to express themselves positively by interpreting communication more effectively. An example was given of having a snack available for an individual when they returned home as they were often hungry and the staff have recognised that having the snack available has reduced the need for the person to become distressed and agitated in order to get their needs met. The area manager explained that the Regard Partnership Trust are currently developing, in consultation with an external company, person centred planning to offer a more holistic approach to individual’s at the home. The inspector sampled two individual’s care plans. Both the documents included a variety of aspects of the individuals life including their care needs assessments, their social and cultural history, likes and dislikes, strengths and their support needs and achievements of personal goals. A variety of written comments and comments received on the telephone from healthcare professionals and individuals significant others included: ‘There are restrictions to choice due to the complexity of the needs, the home tries hard and staff are well meaning. The care service tries hard and means well and tries to be person centred.’ ‘They never support people to live the life they choose’. ‘Management need to think more about who lives with whom as difficulties have arisen by not doing so’. ‘I do not feel that ‘choice’ is always supported or delivered as informed choice for example food, physical activity, social (outside the group of residents) but this comment must be taken in context of my outside knowledge/ brief contact with the home’. ‘Living the life people choose…I find this difficult to answer. There will be constraints/ financial and staff allocation and time I would think to really make this a reality’. ‘My client needs support to make creative use of their life. They are very appreciative of chances to be individually supported outside of the regular routine. It would be unlikely I imagine to always respond to the different needs of such a mixed household so I have ticked usually as I feel some staff would certainly be trying to achieve this by responding to the different needs of individuals’. The comments were discussed with the managers of the home who were professional and reflective of the comments received. There was recognition that the home does support individuals with complex needs and this could have impact on other people’ s individual choices in their daily lives. In addition it was recognised that individuals must be supported to consider Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 13 appropriate choice in line with the balance of duty of care. The managers explained that the Regard Partnership Trust and the homes managers would be selective in the assessment of prospective individuals to the home in order that peoples rights to live the life they choose is promoted as much as possible. There was evidence that the care plans sampled had been developed with the individual and included their everyday life for example activity charts, how they wished to be addressed, whether they preferred gender specific care, and how they preferred to receive care and support from staff. The care plans included agreed working practices to support the individual and guidelines were in place if the individual should become distressed and detailed what actions staff should take to reduce the distress or anxiety. Staff were observed to offer individuals choice for example what they would like to drink and eat for breakfast/lunch and also supported an individual to the local bank as they had recently opened a bank account which they were very enthusiastic about. The area manager told the inspector that this opportunity was being arranged for the majority of individuals at the home in order that their rights to have a bank account were promoted. The home evidenced that weekly house meetings are held and people’s views about their home for example the redecoration of their bedrooms, purchasing of framed pictures and homely ornaments for their home, redecoration colour schemes for communal areas of the home, discussing menu plans, choices in activities were taken into account. During the inspection the home were undertaking care staff employment interviews in which people living in the home had an opportunity to meet with prospective staff. The area manager explained that two referrals had been made to an advocacy group and that some individuals were on a waiting list for advocacy support. A comment regarding the care provided at the home stated ‘I would like to feel that when my relatives allocated carer is in holiday or off for the day that Regard Partnership has the flexibility in staff availability and skill level to cater for her needs but to be frank I don’t always feel that this is so’. During the course of the inspection the comment was discussed with the area manager who advised that the home has a gender orientated key worker and co key worker system, which ensures, as much as possible, that consistent support, is available and offered to individuals in the home yet the comments raised would be reflected upon. Individual’s key workers meet on a monthly basis with an individual in order that they have the opportunity to discuss or indicate through prompting/body language their views about the home and any opportunities they would like to have made available to them. The inspector observed that two individuals in the home have a communication book which is used by the individuals significant others and staff to relay information about the needs, choices and activities of the Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 14 individual. Comments received relating to the use of the communication books included ‘Regard Partnership are not very good at keeping in touch with us, an example is we leave a communications book in our relative’s room that is not always used by the staff to communicate with us although we try to fill it in ourselves regularly’. The inspector discussed this comment with the area manager and two communication books for separate individuals were sampled. It was evident that specific staff members had written in the books and clarity had been sought following a recent care plan review regarding the type of information requested by relatives to be included in one communication book. The manager explained that this clarity would also be sought at the proposed care plan review meeting to be held imminently for another individual. The inspector sampled a variety of risk assessments in the individual’s files, which included peoples finances, safe procedures regarding medication, self injurious behaviour, personal care, community participation, safe use of the homes vehicle, missing person passport and health care emergencies. All the risk assessments had been signed and were current documents to ensure, as far as reasonably practicable the health and safety of individuals. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 15 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 & 17. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. The home promotes and maintains the people’s involvement in their local community and offer opportunities for personal development, appropriate activities and assists in maintaining and supporting people’s friendships. Individuals are encouraged to be involved in the running of the home and maintaining their daily living skills. A choice of a healthy diet is provided. EVIDENCE: On arrival at the inspection the inspector noted one individual was smartly dressed and was anticipating a meeting with their care manager regarding moving to another Regard Partnership Trust registered service. The individual told the inspector that they were happy to move and were looking forward to the event. The individual later showed the managers a ‘countdown’ chart they had developed which illustrated their transition plan and how many days before they moved home. The managers explained that a planned transition Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 16 had been arranged between the two homes in order that the individual would be assisted to settle into their new home smoothly. During the inspection the inspector observed individuals moving freely around their home and staff were seen to be attentive and on hand if the individuals needed them. It was evident during the inspection that the individuals were comfortable and happy in their surroundings. Later during the day the maintenance person arrived at the home to undertake some repairs and it was noted that the managers were aware of the increased noise level and the possible detrimental effect for two individuals. It was therefore arranged that the two people, if they chose to, would be supported out of the house to have a drive to the local college to collect their home companions. It was acknowledged that the managers and staff were aware of the specific needs of people and the importance of a low stimulus environment. Bulletin boards were displayed in the kitchen and in the hallway, which offered information about the home, meals and activities available. The area manager explained that one person had wanted their drawings to be part of the Regard Partnership calendar and this was currently being arranged. The manager described ways in which the home are implementing individuals to initiate having their needs met in a positive way by the use of small laminated pictures of objects of reference for example a picture of the car or snack to indicate what the individual would like. Whilst sampling the homes shift plans it was noted that the home promotes individuals to attend local colleges, go swimming and walking, have art therapy and aromatherapy, watch TV, go bowling or to the cinema and have day trips and holidays, go shopping and go out for lunch to the pub or restaurant of their choice. With the proposed implementation of person centred planning the home hopes to provide increased opportunities to build on peoples existing skills and assist individuals to develop new skills. The area manager advised that as the local town is within walking distance individuals are supported to their local shops and are well known in the local area. Individuals are involved in planning menus and the inspector spoke with one individual and staff member regarding menu planning and choices. The inspector was told that a dietician had recently attended a meeting in the home and explained the importance of healthy eating and exercise. As a result the home have started to review the menus and the inspector was advised that each week a new food stuff/dish will be incorporated into the menu and taster nights have been arranged. The home use a pictorial menu board which the inspecor was advised is being updated to include photographs of meals as opposed to pictures so these can be more easily recognised by individuals living in the home. During the inspection individuals at the home were supported to make cakes and help with the preparation of the midday meal. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 17 The area manager explained that the home has links with people’s friends and family and several individuals visit their relative’s homes and have overnight stays. One comment from relatives stated ‘they never refuse contact with family and friends’. Comments received by the commission regarding the activities and promotion of people’s opportunities in the home included ‘They have a good relationship with local colleges so my relative has access to education’. ‘They need to improve greatly in their communication skills, they should approach us a lot more and not just wait for us to raise issues’. ‘My relative needs more activities instead of colouring all the time, different hobbies to change their mind’. Documents in the home evidenced that all individuals had been supported to have time away from home and have a holiday. During the inspection it was noted that the garden was attractive and accessible for people to use. The managers explained that recently the home had purchased a bouncy castle and a new barbeque and a party was held in the garden. Friends and relatives were invited and individuals did painting and had a lovely day. The homes fridges and freezers were well stocked with fresh dairy products and vegetables and the kitchen area was accessible to some individuals. The dining area comprised of three dining tables and the inspector was advised that in general people sat where they chose to at meal times. The inspector was told by one of the individuals at the home that he enjoyed the food and had a nice roast dinner at the weekend and particularly liked eating burgers. The inspector did not observe the midday meal yet sufficient staff were on duty to support people at meal times. Records of fridge and freezer temperatures and food temperatures were available and well recorded. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. The home has consistent recording and documentation to evidence that individuals attend health care appointments to ensure their wellbeing and welfare. Individuals must be supported at all times in a way, which promotes their rights to dignity and respect. The homes medication procedures are robust to ensure the safety and wellbeing of all people in the home. EVIDENCE: Comments from health care professionals and people’s significant others regarding the care provided at the home included that they felt the individual is given privacy and dignity and two or three close staff remain for the individual’s continuity of care and they respect the individual. During the inspection the inspector observed a staff member supporting an individual in the bath. It was observed that the staff member was not wearing a protective apron, did not knock on the bathroom door upon re entry to the room, spoke on the telephone in the bathroom whilst supporting the individual and it was noted that there was minimal verbal interaction with the individual whilst they were having their bath. This incident was discussed Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 19 with the manager who advised that it would be addressed with the staff member concerned. It is required that the home must ensure that all staff wear protective clothing whilst supporting individuals with personal care in order to prevent the spread of infection in the home. Additionally the home must ensure that arrangements are made to promote appropriate conduct in the home, which reflects the rights of individuals to be treated with respect and dignity and encourage and assist staff to maintain good personal and professional relationships with the individuals they are supporting. During the tour of the premises whilst walking to the outside laundry area it was noted that one persons bedroom was overlooked by the walkway which did not offer them privacy and dignity. This was brought to the area manager’s attention who agreed that arrangements must be made for a covering on the window to ensure the individuals dignity and respect in their bedroom. The inspector observed other staff members and the manager positively engaging with individuals, which included general banter and discussing things of interest and enquiring how individuals were feeling and what they had been doing at college. One health care professional reported that the home usually meets individuals health care needs yet there have been delays in coordinating and follow up from their understanding as the homes GP has not been proactive or sympathetic to concerns raised. The area manager advised that she was aware of this concern and it is currently being addressed. The health care professional stated that feedback/information was satisfactory when it was sought but it was not consistently followed up by the management for example dietetic support yet since then actions taken to use extra services have gone well. Two relatives raised concerns in writing regarding their relatives weight gain and this was discussed with the area manager during the inspection. As previously documented the home has reviewed the menus and whilst sampling individuals care plans it was noted that body weight charts were being completed which indicated controlled weight loss. The area manager advised that the home are developing ways in which to support individual’s with exercise which includes active computer games and meaningful and goal orientated local walks and advised that one individual was enthusiastic and excited about their weight loss which had increased their self esteem. Documents within individuals care plans indicated that appointments to health care professionals to ensure individuals health care needs are met. The inspector sampled the medication procedures of the home and noted that the home has a monitored dosage system for the safe administration of medicines. Medication is stored within the home in locked cabinets and the Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 20 homes medication policy and procedures have been reviewed in August 2007. It was evidenced that homely remedies were available and authorised by individuals GP’s and accurate recording of medicines received into the home were available. The medication administration charts were well presented and accurate recording noted. Whilst sampling some individuals care plans it was noted that individual’s medication had been reviewed to ensure their health. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. People living in the home are encouraged to able to express their concerns and have access to a complaints procedure and are protected from abuse and have their rights protected. EVIDENCE: The home has a clear corporate complaints procedure. The area manager advised that the homes complaints procedure has been further developed in order that it is more accessible for people for example the use of pictures. One individual advised the inspector that ‘I would telephone the area manager to make a complaint’. The area manager explained that at each weekly meeting the individuals living at the home are reminded what to do if they need to speak with someone if they are concerned about something or are unhappy. No complainant has contacted the commission with information concerning a complaint made to the service since the last inspection. The AQAA details that one complaint ha been received since the last key inspection yet the area manager confirmed that this was an error as the homes records indicate that no complaints have been received. The comment cards received by the commission indicated that all people knew how to make a complaint and would feel free to openly express their opinions and views and any concerns about the service. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 22 The home has the most recent local authority multi agency procedures for safeguarding vulnerable adults and the inspector was advised that the home follows the local authorities multi agency procedures for safeguarding adults. The homes safeguarding policy is in line with the multi agency policy and procedures and the home has a whistle blowing policy and procedure, which is available to staff in order to safeguard people in their care. The AQAA details were incomplete regarding safeguarding referrals under these procedures since the last inspection. It was confirmed with the area manager and also CSCI records that a safeguarding referral had been made and following a senior strategy meeting had been closed with the home taking agreed actions to ensure the safety and well being of all people in the home. Staff spoken with during the inspection demonstrated an understanding of the procedures for safeguarding adults and the inspector noted in the homes office postcard size safeguarding documented guidance in order to offer an open atmosphere with regard to detecting and reporting bad practice. The staff training records detailed that all staff, apart from one who had been supporting an individual on holiday, had received safeguarding vulnerable adults training. For the one member of staff that had not attended the training a plan was in place, which evidenced that their attendance at the training was booked. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 23 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 & 30. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. The physical layout of the home enables the people to live in a safe environment. Further improvements to the homes décor and review of the laundry facilities must be made. The home is generally clean, pleasant and hygienic throughout. EVIDENCE: It was evident that the home have spent some time reviewing the homes environment and as a result during the tour of the premises the inspector noted that the majority of areas of the home were well decorated which promoted a pleasing environment for individuals in their home. The area manager explained that individuals have been included to choose paint colours for their bedrooms and communal areas of their home and have been involved in going shopping to purchase homely ornaments for example framed pictures, flower arrangements, new bedding and furniture and hanging baskets for the garden. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 24 The home has monthly plans for maintenance and repairs, which were sampled by the inspector and confirmed that the work had been completed. Several individual’s bedrooms have been decorated to their choice, although one room had taken the home a significant time to redecorate and furnish appropriately. A quiet room has been organised and pleasantly decorated, a bathroom has been more personalised to include ornaments to make it feel more homely. Where individuals like sensory and tactile materials these have been purchased in order to offer pleasure and stimulation. The lounge area had been recently decorated and included homely items to make the space comfortable. The area manager explained that the care staffs undertake the household tasks with the support of the individuals in the home and the duties are included on a documented plan seen by the inspector. Some comments received by the commission indicated that the Regard Partnership should employ independent housekeeping staff to work some hours a week for the cleaning maintenance of the communal areas. The inspector observed that the home was generally clean and free from malodour. One individual told the inspector ‘some time’s the home is clean and tidy’. During the tour of the premises the inspector noted several shortfalls, which were brought to the area managers attention. These included a broken flushing system for a toilet, which was repaired during the inspection. It was observed that some carpets throughout the home were stained and in need of replacing for example the carpet on the second floor landing. The area manager explained that the home had identified five individual’s bedroom carpets/flooring and the office flooring that needed to be replaced and the inspector sampled plans, which indicated that financial quotes had been obtained or were being pursued. The laundry area is situated outside the main building. The laundry consists of a washing machine and dryer and some shelving units. The atmosphere in the laundry was damp and it was observed that no individual’s clothes were stored in the laundry. In discussion with the manager it was agreed that the facility needs to be reviewed, as it may not offer a safe place for individuals to use to take part, with staff support, to do their laundry. The pathways leading to the laundry were observed as unsafe due to slip hazards and included steps. The area manager following the inspection has advised CSCI that a review of the laundry arrangements will be discussed with the senior management of the Regard Partnership. During the tour of the inspection it was noted that individual’s clothing had been left in plastic containers in the dining area. It was apparent that there was a lack of space within the home for the storage of the clean clothing and it has been required that the storage of individuals clothing is reviewed in order to ensure that peoples belongings are secure and the home provides adequate storage facilities. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are skilled and in sufficient numbers to provide support to the individuals living at the home. Accurate records must be maintained regarding staff induction to ensure the peoples needs are met appropriately and safely. EVIDENCE: Comments from staff regarding the home included several staff commenting that the home supports and provides good activities, including attendance to college for individuals and provides good care through staff teamwork and has good relationships with individuals being supported. Some staff stated that the home was cold at nighttime. Regarding staff training staff commented that some did not feel happy that scheduled training had been cancelled, some would like more training specific to supporting people with learning disabilities/autism and LDAF (Learning Disability Award Framework). Some staff commented that they would like to feel more confident or supported in completing paperwork for example risk assessments and support plans. Some staff advised that there has been a lack Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 26 of manager’s and deputy manager’s time as they are busy yet the supervisions are more regular than they used to be. Comments from other people associated with the home included ‘Sometimes the staff are better skilled than others’. ‘There are always new faces of the new staff so the home never has the right skills and experience to look after people properly’. ‘I feel staff are ‘usually’ doing their best to follow up what was needed and are very caring’. ‘No staff have proper training with people with learning disabilities’. ‘The staff I have met and spoken to in recent months certainly want to achieve the right skills and experience’. ‘ The staff don’t work as a team there’s a lack of communication to each other. Several times plans have been cancelled at the last time because staff shortage’. ‘Carers never listen or act on what I say. Staff always treat me well.’ The home currently employs ten full time care staff and one part time staff member. On the day of the inspection there were adequate staff on duty including an agency staff member. All staff were knowledgeable regarding the specific needs of individuals to ensure their safety, well being and offer reassurance. The area manager advised that the home have currently five support worker vacancies and as previously documented interviews were taking place in the home during the afternoon of the inspection. The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector sampled one staff file, which contained an application form, with two references, evidence that face- to -face interviews had taken place, criminal records clearance, evidence of attendance of statutory training, and specialist training, and a job description in order that the staff member was clear about their roles and responsibilities. As a measure of good practice the home had also obtained updated information for example a full application, training records, references and CRB clearance for a staff member being transferred to the home from another Regard Partnership home. It was noted that the deputy manager had signed a staff member’s induction Common Induction Standards programme/booklet yet this had not been signed by the staff member to verify learning. It is required that care staff induction records are accurately maintained in order to evidence a structured induction has been undertaken. The inspector sampled the homes training needs assessment for the staff team, which was sampled as a current document and highlighted planned training and refresher courses. The AQAA identifies that 90 of staff are currently involved in achieving their National Vocational Qualification in Care (NVQ) awards. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. The management and administration of the home needs to be improved. The home is run in the best interests of the individuals. Health and safety in the home requires further development. EVIDENCE: The pace of the home was designed to meet the needs of the individuals. It was evident through observation and talking with staff that the area manager had good knowledge about managing the care home and had the skills and experience to ensure the safety and well being of all persons in the home. During discussions with the area manager, people’s relatives and staff it was apparent that the home has not had a stable management team over several years and this has had an impact on the service generally. The area manager Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 28 has advised CSCI that the service as a whole is currently under review. The review includes the documentation related to the care of individuals, holding care plan reviews, recruiting staff and ensuring staff supervision and staff management performance is monitored and maintained. A requirement has been made that the home must inform the CSCI in writing of the proposed ongoing management arrangements of the home. Comments received regarding the overall management of the home included ‘It would be nice for the care home to keep me updated and informed of what is going on in my relatives home. They do not keep my relative informed with me if they go into hospital and other health issues’. ‘They need to improve greatly in their communication skills. They should approach us a lot more and not just wait for us to raise issues. They need to get a settled management in place who can motivate and retain staff’. ‘We get the impression that the Regard Partnership Trust are overly concerned with profit. We do not argue with the need for a large firm to make a profit otherwise they would go out of business but too often when we raise matters it seems to come back to costs as if the managers are on an extremely tight budget’. This matter was discussed with the area manager at some length and the inspector was assured that the financial viability of the service was not in question and that an adequate budget was available to the home. Other comments included ‘We have voiced to the Regard Partnership and Social Services our strong concerns about the high staff turnover in the past and particularly the turnover of house managers which is five in five years’. ‘New management since May 2006 has led to disruption for some of the support staff who consequently left. Clients have also gone through this change’. These comments were broadly raised with the area manager who advised the inspector that the Regard Partnership Trust were aware of the previous management complexities and as a result are seeking to recruit a suitable manager who will be able to maintain the work currently being undertaken by the management team in order to provide an more efficient and effective service in keeping with the homes aims/objectives and potential. The area manager explained that in the light of the review of the service quality assurance questionnaires have been sent out to people associated with the home in order to gain their views and opinions about the home. The inspector sampled the letter sent to individuals and also sampled that the home has implemented a system to obtain the views of people living in the home for example at resident meetings and recording responses about the home during peoples daily lives. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 29 The inspector noted that food stored in the home refrigerator was labelled and stored in compliance with food hygiene standards and hot food temperatures had been recorded to ensure as far as reasonably practicable the home is free from hazards to all individuals. Water temperatures throughout the home were tested and recorded and it was noted that the home has a safe bathing policy and procedure which includes staff checking water temperatures before individuals are supported into baths. The inspector sampled the accident and incident records within the home and noted that incidents had been reported to the Commission for Social Care Inspection (CSCI) without delay. Hand washing facilities were available throughout the home and furnished with paper towels, or other hygienic means for individuals to dry their hands. Fire records were sampled and evidenced that regular checks are maintained and equipment serviced. The home has a current insurance liability certificate. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 30 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 3 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 3 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 2 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 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 2 3 3 X 2 X 3 X X 3 X Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 31 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 YA18 Regulation 13.(3) Requirement The home must ensure that all staff wear protective clothing whilst supporting individuals with personal care in order to prevent the spread of infection in the home. The home must ensure that arrangements are made to promote appropriate staff conduct in the home, which reflects the rights of individuals to be treated with respect and dignity and encourage and assist staff to maintain good personal and professional relationships with the individuals they are supporting. Arrangements must be made for a covering on the window in one person’s bedroom in order to ensure the individual’s rights to dignity and respect. The home must review the current use of the laundry facility to ensure that it is fit for purpose and a safe place for individuals to use. The home must ensure that DS0000013483.V344002.R01.S.doc Timescale for action 07/10/07 2 YA18 12.(4)(a) 07/10/07 3 YA18 12.(4)(a) 07/10/07 4 YA24 16.(2)(f) 07/11/07 5 YA24 16.(2) (c) 07/01/08 Page 32 Clareville Road (3) Version 5.2 6 YA24 23.(2)(m) 7 YA35 17.(2) Schedule 4 6.(g) 8 YA42 24A 9 YA43 39.(a) (b) the floor coverings throughout the home that are stained or worn must be replaced. The home must ensure that appropriate storage of individuals clothing is reviewed in order to ensure that people’s belongings are secure and the home provides adequate storage facilities. It is required that care staff induction records are accurately maintained in order to evidence a structured induction has been undertaken. The registered person must provide the CSCI with an improvement plan detailing how the home intends to improve the services provided in the home. The home must inform the CSCI in writing of the proposed ongoing management arrangements of the home. 07/11/07 14/11/07 07/11/07 22/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA35 Good Practice Recommendations It is recommended that the home consider undertaking the LDAF (Learning Disability Award Framework) induction in order to ensure that staff have a full specialist knowledge regarding supporting individuals with learning disabilities. Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clareville Road (3) DS0000013483.V344002.R01.S.doc Version 5.2 Page 34 - 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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