Inspection on 17/06/08 for 3 Hesding Close

This inspection was carried out on 17th June 2008.

CSCI found this care home to be providing an Adequate service.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Hesding Close 25/10/05

3 Hesding Close 28/01/05

3 Hesding Close 04/08/04

3 Hesding Close 04/03/04

Similar services:

32 Beaumont Way

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 3 Hesding Close Hanham South Glos BS15 3LP Lead Inspector Kath Houson Unannounced Inspection 17th June 2008 10:45 3 Hesding Close DS0000003346.V359127.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 3 Hesding Close DS0000003346.V359127.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. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 3 Hesding Close Address Hanham South Glos BS15 3LP 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) 0117 9607858 0117 970 9301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust ****Post Vacant**** Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Home may accommodate up to 5 persons aged 45 years and over and 1 person aged 40 years and over with learning disabilities The Manager, Mrs Swain, to undertake NVQ training at Level 4 in Care & Management by 2005 3rd October 2006 Date of last inspection Brief Description of the Service: 3 Hesding Close is a 1970’s detached, extended house that provides accommodation for people with learning disabilities. The main aim of this service is to promote independence and to enable residents to lead a more fulfilling and person centred life. The home has 24 hour staffing structure, which include staff sleeping in to provide added support to residents during the nighttime. The property is arranged over two floors; there are four bedrooms, two bathrooms upstairs and one bedroom with another large bathroom downstairs. The communal areas are the lounge/diner that provide quiet space, another lounge where residents can sit and watch TV and the kitchen. The garden is landscaped and low maintenance. The property can be found in a quite cul-de sac in the Hanham area within South Gloucestershire. There are bus routes into Bristol City centre and the surrounding areas such as Cribbs Causeway, St George, Downend, Kingswood, Fishponds and Yate. Residents have access to the local community, shops and other amenities. Aspects and Milestones Trust operate the home and are responsible for the repairs and décor. The home currently has a temporary manager in place. The fees are arranged according to resident’s individual assessment. The fees for a placement at Hesding Close range between £750-£900 for a total care package. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is adequate 1 star. This means the people who use the service experience adequate outcomes. The judgements that are in this report have been made from evidence collected together during the inspection. This unannounced inspection lasted 1 day and involved a visit to the service. A temporary manager, staff team and residents helped with the inspection. We did this done by: • • • • • Looking at the home’s written records. Tracking the care of three people living at the home to see how well their individual needs are being met. Talking with the manager and staff. The residents sent in their completed surveys. A tour of the home to look at how the accommodation meets the residents’ needs. Getting the views of relatives, residents living in the home and professionals such as the local Dr and members of the staff team. The surveys and informal discussions also gave information that supported the inspection visit. 100 return response of the surveys were sent into the Commission and have been included throughout this report. What the service does well: The residents are well cared for in an individualised and consistent way. The staff are good at helping them to make choices. Some residents said when asked, do you make decisions about what you do each day? All the residents said “Always”. Some of the relatives said, “The home is very good at caring for my friend, both in taking her out to outside classes and events and in providing a happy atmosphere for her at home.” Consultant Psychiatrist said the home “Provide individual personal care, which is person centred and supportive”. The home has a team of long-standing staff who have good knowledge of the residents to help with giving care and support and a temporary manager who has been with the service a short while but is making strong changes. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 7 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 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 8 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): 2&5 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Potential residents have enough information to make an informed choice about where they wish to live; their goals and aspirations are individually assessed which promotes independence for people who choose to live in the home. EVIDENCE: The residents currently living at the home have been there for a long time therefore their admission process was not fully assessed. However, the feedback comments from the residents and their relatives state that when asked Did you get enough information about this home before you moved in so you could decide if it was the right place for you? The residents said, “Yes”. When the relatives were asked Do you feel that the care home meets the needs of your relative? One relative said, “My daughter seems quite happy at the moment.” The rest of the relatives said “always”. This is a good indicator that shows that the home only admits people whose needs can be met. Goals and aspirations are planned with a number of professionals from different organisations and are based on individual needs and assessments. The home’s admission process shows that Social Workers and other care agencies are involved in the referral of a placement. An individual need assessment is conducted before admission and it was evident that the home 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 9 took part in a detailed assessment of need. Overnight stays are also arranged so that the potential residents can try out the service before a placement is accepted. Information obtained from the Annual Quality Assurance Assessment (AQAA) further states; Clients are given information in order to make an informed choice about where they would like to live. Every client’s needs are continually assessed in order to make sure that the home meets the individual’s needs. All clients living at Hesding Close are in possession of a Service User Guide (pictorial format) and the homes Statement of Purpose. Each client also has their own contract stating terms and conditions. It was evident that the home is following the admissions procedure. Resident’s files that were looked at had a copy of the Aspects & Milestones Trust Statement of terms & conditions. This document outlines the terms and the conditions that are expected from the resident and the Trust. For instance, the ‘Trust will provide the service that are outlined in the agreement, also the staff will review my needs with me and the people who I choose to help’. The home’s manager confirmed that the emphasis is on the overnight stays, which can last up to a month and would ensure that the potential residents are satisfied about their place of residence; Once funding has been agreed and the terms and conditions are acceptable to all parties the admission procedure is then completed. The future plan for this service is based on the information obtained from the homes Annual Quality Assurance Assessment (AQAA): “We are considering turning Hesding Close into a Supported Living scheme for the three existing residents.This will enable clients to lead a more fulfilling and person centred life.This work will be done by involving outside agencies and facilitators”. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Resident’s individual needs and choices are regularly reviewed and are reflected in their care plans, which are well written and person centred; residents are supported to take risks and participate with their own decision making about their lives. EVIDENCE: Three selected care plans were seen. These include medical records; daily dairies, activities programme and risk assessments. The care plans were well recorded and show regular review dates, the most recent re-evaluation was 14.05.08. This shows that the home maintains it’s part of the contract and residents changing needs are taken on board. Information obtained from the recent AQAA states: Each client has their own care folder. Each folder contains detailed information about how individuals would like to be supported. The care plans were indivdualised and person centered. Residents were also consulted and know that their assessed, changing needs and goals were reflected in their care plans; residents’ signatures were seen as evidence that 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 11 they too were consulted and took part in the decision making about their care and preferences. When residents were aksed if they make decisions about what you do each day? The residents responses were “always”. When the relatives were asked in their feedback forms; Are you kept up to date with important issues affecting your relative (e.g. if they have been admitted to hospital or had an accident)? “Dorothy’s sister- they do keep in touch with my daughter who lives in Bristol…” (Names have been changed to maintain anonymity). The keyworker scheme in the home also helps the residents to make decisions and enhance their independence. Information from the AQAA states that: Clients are consulted on, and participate in, all aspects of their life. All clients have their own risk assessments, considering different aspects of the individuals life, but still maximising the individuals independence and quality of life. All clients participate in a monthly residents meeting which enables everyone to express their opinion or make suggestions. This was also confimed and the residents care files showed to have risk assessments in place which supports an indpedent lifestyle. For instance some of the residents participate in a number of activities outside of the home such as arts and crafts. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents take part in activities of their choice and participate in their community; family contact is encouraged and maintained which enhances residents independence. The home offers a balanced diet, which is based on individual preferences. EVIDENCE: The care plans show that the residents have a varied opportunity to take part in appropriate activities. For instance, some residents would attend a group session that involves looking at different communities, religions and countries. Other residents would be involved in sports, sewing and making craft items of their choice. The activities are based on residents’ preferences and their interests. It was also evident from discussions with members of staff and reading the residents’ person centred plans that they were supported to participate in a number of activities within the community. Information from the AQAA also states “clients take part in the local community life and the 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 13 home has excellent relationships with the local people and clients family and friends. All clients are supported to live an independent life, offering choices and respecting the individuals values and choices”. This was also evident from the feedback surveys from the relatives and the health professionals. Relatives when asked, Does the care service support people to live the life they choose? One relative said “my daughter is looked after dressed well and her room is good. That is the main thing.” Health professionals’ state in their feedback forms “ a good service-wish had more like this”. The residents’ daily diaries were also made available and show regular entries of residents’ activities. The dairies were well recorded and show how often residents attend to their chosen activities. The home has its own transport to take the residents out on day trips but also has the opportunity to share a larger vehicle with another home in the community. This shows that the staff team encourage the residents to make and form relationships with other members of the community. Regular family contact is maintained. This was also evident from the surveys and the letters seen in residents’ care files. The manager is in the process of finding alternative day centres, as there is the possibility that the local Resources and Activities Centre (RAC) is closing down. This would be a sad loss to many of those who attend and look forward to their regular visits. The manager is arranging to have in-house activities in the very near future but is at the moment considering all options. During the inspection staff were seen talking to the residents respectfully and in a calm manner. Staff knocked on residents’ doors before entering their rooms. Resident’s rights are respected and written in their care plans. The home offers a varied and balanced range of meals that are cooked according to resident’s preferences. There was a well-stocked fruit bowl in the lounge and an organised shopping list on the wall. Each menu is tailored to resident’s choice of food. The menus have been written with the help of the local dietician. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents healthcare needs are regularly recorded in their care plans and give a comprehensive guidance to how their needs can be met; personal support is responsive and individualised; a medication procedure exists which is supported by policies and procedures that enhance the safe administration of residents medication. EVIDENCE: Resident’s care plans show that they had access to their local GP and other health care services. When health care professionals were asked in the recent survey, does the care service seek advice and act upon it to manage and improve individuals’ health care needs? One GP response was “Always.” The local GP and other health care services were complimentary about the service residents received. When the local GP was asked, has the care service responded appropriately if you or the person using the service have raised concerns about their care? One GP said “always”. Information from the home’s AQAA also states; All clients personal support needs are respected and their individual preferences adhered to. This was also confirmed in the residents’ care plans and in discussion with the manager who explained in 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 15 detail the health needs of the residents. Further information from the home’s AQAA states; ‘Networking with other professional services is of a very good standard. All clients are supported to attend appointments with GPs, dentists, opticians’. A good procedure for the administration of medication exists at the home. None of the residents self medicate. The home is currently using the pharmacist’s medication dosage system, which is delivered on a monthly basis. This is a system where the medicines are pre-packed for residents use. All the resident’s mediation charts were looked at and no omissions were detected. There were strict guidelines to residents preference when taking medication. For instance some residents prefer to take their medicine with juice. Information from the AQAA states; ‘Staff are aware and adhere to Policies and Procedures in relation to medication and complete an annual medication competency’. This was also confirmed during the inspection and the manager was able to show the recent medication competency test that the staff had completed which qualifies them to administer medication within the home. Discussion with a member of staff also confirmed that they completed a medication competency test and had yearly updates to increase their knowledge on the medicine the residents use. This can be seen as good practice. An examination of the home’s medication cabinet was conducted. All the medicines were found to be stored correctly. However it would be good practice to put the date of opening on the eardrops and to discard any out of date medication that was no longer in use. This was discussed with the manager who also made a note that their British National Formulary (BNF) was also out of date. An up dated copy of the BNF would keep the manager and staff informed of any recent changes to medications, contra indications and any new medication on the market. All staff have received epilepsy training and are able to administer emergency drugs for those who have regular seizures. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The home’s complaint procedure is clearly written and easy to understand. The home keeps full account of any investigations and outcomes. Residents would benefit from a staff team who had regular up dates in the protection of vulnerable adults this would ensure that good practice is maintained and keep residents safe from potential harm. EVIDENCE: The home has a complaints procedure, which is in an accessible format, and residents have copies in their care plans. When residents were asked, do you know how to make a complaint? Residents said, “Yes”. The complaints logbook was made available and contained the nature and number of in-house complaints that had been dealt with in a timely manner. Complaints were well recorded and contained correspondence from the Trust and other agencies such as Bristol Social Services that was also seen to support the complainant that means the residents opinion is taken onboard. Information from the AQAA also states, A complaints log book is kept in the home, describing the complaint, the action taken and the outcome. Contact details of the Commission is available to everyone. The Commission has recieved no complaints at the time of the inspection. When residents were asked, do you know who to speak to if you are not happy? Residents said, “Yes”. This was also confirmed during several house meetings the last meeting was 31.05.08. The agenda consisted of a number of 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 17 items for discussion such as; follow up the issue of sharing an allotment with another service, possible trip to Longleat, BBQ in the summer, alternative arrangements due to the RAC closing down. Further information from the home’s AQAA states, All clients living at Hesding Close are aware of the homes complaints procedure and some clients have been supported to use it. Through that, all clients are confident that their concerns/complaints will be listened to and acted on. It was evident that residents get support with their budgeting and there are good systems in place to account for the handling of resident’s monies. The home’s AQAA states that ‘there are excellent systems in place to ensure individuals safety and protection. The financial procedures ensure that clients finances are safe-guarded’. This was confirmed by choosing a number of random receipts and checking them against the home audit sheet. No ommissions or mistakes were found and residents finances were well recorded. The staff training file showed that a number of staff had been trained in the Protection of Vunerable Adults (POVA) between 2004 –2005. It is important to continue with regular POVA updates to ensure that good practice is maintained. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 18 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 good, This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, homely environment; that is well maintained. Independence is encouraged in a non-institutional place where residents live together. EVIDENCE: The home is close to a number of amenities such as the local shops and pubs. There are bus routes into other neighbouring areas such as Broomhill, St George, Bristol City Centre and Cribbs Causeway. The communal areas consist of a quiet space and a lounge/diner, and kitchen, which were clean and tidy. During the inspection the manager had discussed the need for a hand wash sink be installed in a small area in the kitchen, so that hand washing did not take place in the same sink that is being used for food preparation. There is also a downstairs bathroom, which has now been ventilated and was clean and tidy with no offensive smells during the inspection. There is a well3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 19 organised laundry room the cupboards are now used to store files and were securely fixed to the walls. The garden is paved, landscaped and well maintained with easy access for residents. There is an ongoing discussion between the home’s manager and the Commission’s Central Registration Team (CRT). The manager explained the reason for an application for variation is due to the house being a five-bedded house and that people used to share rooms. The issue of sharing rooms is no longer the case and therefore the Trust would like the registration to read 5 and not 6 as the house can only accommodate five residents. There is currently one vacancy as there are only four residents living at the home. Information from the AQAA states; “all clients bedrooms are personalised in an individual manner and suit the clients present needs. Staff and clients are fully aware of respecting individuals privacy. All clients make full use of their own bedroom and the communal areas. Specialist equipment for one client had been acquired in order to support the clients needs and maximise her independence”. This was confirmed during the inspection a new hoist was seen with a recent saftey check recorded. Disposable gloves and paper hand towels were availabe throughout the house which encourage staff to work towards minimising the risk of infection. This can be seen as good practice. Resident’s surveys show that when asked, is the home clean and fresh? All the residents said “Always”. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 20 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 available evidence including a visit to this service. The staff team are skilled and able to meet the needs of residents, there is a long standing staff team who are effective in their job role; the home’s recruitment and selection procedures are followed in practice and protects residents from harm. EVIDENCE: The home has a team of long standing members of staff. On the day of the inspection there was enough staff to meet the residents needs. Feedback from the residents surveys state when asked, Do the staff treat you well? All the residents responded “Always” residents were also asked; Do the carers listen & act on what you say? The residents said “Always” and “sometimes”. There was mixed feeling among the staff team; this could be due to the frequent change in the manager that the home is experiencing at the moment. Staff reported that there have been 3 mangers in the last four years this would create instability within the staff team and residents. Staff surveys showed when asked; Does your manager meet with you to give you support and discuss how you are working? Some staff members said “Sometimes” “ due to 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 21 changing managers it is difficult to maintain regular support/discussions with management” others said “Regularly”. However the staff team were complimentary about the current manager. A selected staff file was looked at to assess the home’s recruitment and selection procedure. The manager said, “that much of the CRB checks are completed at the Trust headquarters and that copies of the findings are sent to the home”. A letter from the Trust head office states: “to comply with NMS we are required to keep a copy of the disclosure on personal file” the letter was dated 18.03.04. The letter confirms that head office complies with the regulatory body and staffs CRB certificate numbers are sent to the home each time a new staff application has been accepted. This further ensures that residents are protected from potential risk and harm. This was confirmed, during the inspection. An application form was seen and this contained relevant information such as previous and past employment, reasons for leaving, two written references and the training and development plans. The Trusts terms and conditions were available with the induction and the probation period detailed for the staffs’ information. The Trust recruitment and selection process protects residents from any potential harm. Recent epilepsy training, first aid and medication up dates, food hygiene, and moving and handling, staff health and safety records were seen in the stafftraining file and dated 18.01.08. This ensures that competent and qualified staff are able to meet and supports residents needs. A random staff file was chosen and the file notes were well documented. All staff original training certificates were seen and made available. Relatives when asked; Do the care staff have the right skills and experience to look after people properly? “Dorothy seems quite happy with the staff” (name has been changed to protect confidentiality). Some of the other relatives said “usually” and “always”. Information from the AQAA states, “Accident/incidents records are maintained and followed up promptly. All staff have undertaken first aid and manual handling training and it is ensured that periodic updates are undertaken.” Although the standard for staff supervision was not fully assessed the manager was able to show that staff supervision and support happens every 4-6 weeks staff discussion and review of the supervision notes confirmed this. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Working practices in the home are safe and the residents benefit from a home that is managed well. Safety measurements for the home have been met that makes it a safe place for both residents and staff. An effective monitoring system would help to maintain good practice in the delivery of service provision. EVIDENCE: The temporary manager is managing the home well and has several years experience in the care industry. The manager was helpful during the inspection process and was able to show documents on request. The staff team were complimentary about the manager and would like to see her stay on in the home. There have been recent changes in the management of the home on a number of occasions. The home currently does not have a permanent registered manager. A recent letter was sent into the Commission’s 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 23 Central Registration Team (CRT) which states; Anja Behnsche will remain as temporary manager of the above home until 15th June 2008; this will give time for Aspects & Milestones to close two of its homes and redeploy staff & home managers into appropriate vacancies and support residents into their new homes. It is important to create stability in the home, which would be beneficial for both the staff and the residents. Whilst speaking with the manager during the inspection it was clear that she had some good ideas about moving the residents and staff team forward; such as; all staff to have a Personal Development Plan in place, to be reviewed every 6 months. Staff member to pass NVQ3, to be assessed by new Home Manager. Residents meetings need to be held regularly in a 4-6 week interval. All clients to have an accessible Person Centred Plan, staff to be trained by Person Centred Facilitator. (information taken from AQAA). The home is currently well run and managed this was confirmed by the comments made by the relatives and healthcare professionals in their surveys. For example relatives said, “My daughter seems quite comfortable with no complaints.” “My daughter as far as I know is treated with kindness and respect as I and my son have always been also and always informed of any illness Dorothy may suffer or starting on different medication. They also keep in touch with my other son Robert who lives in Australia and is made very welcome when he and my daughter in law visit. All the staff do all they can for Dorothy although that may be difficult at times”. (Name has been changed to protect identity). The manager was able to show that staff meetings take place in the home and issues discussed range from application for funding residents’ holidays, the recent idea to open a dementia café, the freezing of all staff vacancies, residents needs and preferences. Discussion with the manager took place about implementing regular quality assurance monitoring of the service. The manager said that she would like to seek the views of the relatives and healthcare professionals. The role of effective monitoring is to ensure that systems are in place to measure the success and progress of the service provision based on the home’s Statement of Purpose. However the home does complete several other audits such as care planning, supervision and health and safety. In addition the home regularly sends into the Commission the monthly visits (Regulation 26) this informs the Commission of any events that are happening in the home. The home is safe and secure and has recently been given its yearly audit for health and safety. The certificate was seen during the inspection and awarded an ‘A’ Grade pass 21.03.08. The home is measured on the condition of the building, training, and specialist equipment such as the hoist, health and safety checks within the home, monthly wheelchair checks, legal compliance, risk 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 24 assessments. A letter which explains the reason behind the audit; the purpose of this audit is to provide support and reassurance so that you know your health and safety information is appropriate and adequate (information taken from a letter from the Trust). All fire training for both staff and residents has been completed and this is written in care plans. Residents are trained in evacuation procedures and know what to do if there is a fire drill. This would maintain their safety. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 (6) Requirement Timescale for action 17/06/08 2. YA37 8 (1,a) 3. YA39 24 (1,a) The registered person must make arrangements to regularly update staff to prevent residents from being harmed or suffering abuse or being place at risk of harm, this is to ensure that residents are safe from potential abuse and neglect. The registered person must 17/06/08 appoint an individual to manage the care home where there is no registered manager in respect of the care home. This would create stability for the residents and the staff team. The registered person must seek 17/06/08 to establish and maintain a system for reviewing the quality of the service the home provides at appropriate intervals. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000003346.V359127.R01.S.doc Version 5.2 Page 27 3 Hesding Close 1. 2. Standard YA20 YA23 To label, date of opening, medication especially used for the eyes or ears and to discard any medicine that is no longer in use or out of date. Registered manager to regularly up date themself in safeguarding measures and cascade this to the staff team every 2-3 years. This is to ensure that residents are protected from abuse and neglect. 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 3 Hesding Close DS0000003346.V359127.R01.S.doc Version 5.2 Page 29 - 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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