Inspection on 27/01/06 for 3 Moultrie Road

This inspection was carried out on 27th January 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

3 Moultrie Road 22/11/07

3 Moultrie Road 14/11/06

3 Moultrie Road 30/09/05

3 Moultrie Road 10/11/04

3 Moultrie Road 19/05/04

3 Moultrie Road 22/03/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME ADULTS 18-65 3 Moultrie Road 3 Moultrie Road Rugby Warwickshire CV21 3BD Lead Inspector Warren Clarke Unannounced Inspection 27th January 2006 09:30 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 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 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 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 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 3 Moultrie Road Address 3 Moultrie Road Rugby Warwickshire CV21 3BD 01788 547585 01788 547585 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) Rethink Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th September 2005 Brief Description of the Service: 3 Moultrie Road is a large, three-storey, Victorian town house, close to the centre of Rugby. It is owned and managed by Rethink (formerly The National Schizophrenia Fellowship). The Home is domestic in nature and is indistinguishable as a care home from the neighbouring properties. The rooms are large and airy and generally well maintained. The home caters for six service users with enduring mental health problems, providing 24-hour support and encouragement to enable service users to regain their independent living skills. The Home is within walking distance of the town centre; there are accessible gardens to the rear of the property. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted during an afternoon and into the evening and therefore the inspector was able to observe the changeover of a shift and how service users are looked after during this period. In conducting the inspection account has been taken of the findings of the last inspection visit and the Manager’s account of progress made in correcting the deficits, which were identified then. In the course of the visit, service users and staff were interviewed, the premises were assessed and relevant records were examined. The inspector was also able to devote some time directly observing the interactions between service users and the staff on duty. Where reference is made to the standards (e.g., as in standard 2.1) this relates to the National Minimum Standards for Younger Adults and if or where the regulations are referred to this means The Care Homes Regulations 2001. What the service does well: What has improved since the last inspection? What they could do better: The assessment and care planning process needs to be honed so as to establish clear long term outcomes for service users such as progress towards independent or supported living in the community and, say, restoration, or prospects, of employment. This is likely to give greater focus to some of the current objectives in service users’ individual plans and provide a more accurate measure of their effectiveness. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 6 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. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 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 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Service users currently resident at the Home benefit from having their circumstances and basic needs assessed on an ongoing basis. However, as pointed out at the last inspection, a more comprehensive assessment of the type specified in standard 2.2 would have the effect of bringing all the assessment information together in a single document and aid more precise planning and actions to meet the needs and aspirations of each service user. EVIDENCE: From examination of records and conversations with service users and interviews with the Manager and staff, there is no doubt that service users’ circumstances and needs are being assessed on an ongoing basis. The assessment tends, however, to be piecemeal aspects of which have been carried out by mental health specialists and others by staff at the Home. Together while these ensure that service users’ health and other routine activities in daily living are satisfactorily addressed, the assessments as currently presented do not contribute effectively to outcome based individual care planning. For example, it is not clear whether some service users can be rehabilitated or moved on to more independent living arrangements. The assessments do not deal adequately with service users potential for future employment or meaningful occupation outside the Home nor give any clues as to what needs to be done in this regard. In short the assessment process remains the same as reported at the last inspection: it deals adequately with service users basic needs, assesses risk, 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 9 but is not effective in identifying and informing planning to achieve long term goals for service users. What seems to be indicated for improvement is a clear understanding derived from the assessment process, of whether the service user can be rehabilitated or graduate to a more independent living situation. It might also be helpful to establish the extent to which they are individually able to look after themselves including taking some control of the management of their health so that the actions set out in their individual plans are designed to lead to clear and definite outcomes. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Service users are benefiting from a planning and action process that ensures that all their basic needs are met. It involves them in all the arrangements for their care and supports them in confidence building and reasonable risk taking to aid their recovery. The combined activities that the Home undertakes in fulfilling standards 6, 7 and 9 should be honed to identify and lead to work being done to achieve long terms goals such as rehabilitation and service users’ aspirations. EVIDENCE: Examination of service users records showed that their individual plan (or recovery plan as referred at the Home) remains much the same as was the case at the last inspection. That is, though they address adequately service users’ health and basic care needs, they are not derived from the type of single comprehensive care management assessment as specified in standard 2.3. That is to say, they could be more wide-ranging and give greater focus to rehabilitation and service users’ personal aspirations, say, in terms of employment, relationships and other self-fulfilling goals. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 11 At the last inspection it was observed that: “The plans did, in all cases, include an assessment of risk, but in order to make them more effective, they need to be informed by up-to-date assessment of the areas specified in standard 2.3. They need to reflect the overall aim of the placement (what it ultimately is intended to achieve) and the service users’ own aspirations beyond day-to-day self-care type activities, and how they are being, or are to be, supported to achieve them. It is fair to say, that the Home does have, in the Recovery Plan idea, a commendable care management system, but [to be more effective] it needs to be applied with greater clarity, systematically and focus on the immediate as well as longer term goals”. At this inspection no new evidence was found to alter the observation cited above and in response to the good practice recommendation, which was made at the last inspection in this connection, the Manager said that they had discussed it at a staff meeting where it was acknowledged that the recovery plans need to be developed with more definite strategies or outcomes in mind. The manager also explained that in relation to rehabilitation and incremental progress towards independence, the Home has access to supported accommodation in the community, to which other service users have been transferred in the past. This is confirmed by information in the Service User guide, and the inspector advised that such accommodation options should be promoted to service users whose assessment and recovery plans indicate rehabilitation or semi-independent living. In assessing the extent to which the Home supports service users to make decisions about their own lives, it was noted that all the service users are able to communicate needs, wishes and feelings. Some of those with whom the inspector had conversations said that their key workers involve them both in drawing up their recovery plans and the regular review of them. A service user who was asked about how that individual’s finances were managed said that service users have their own bank accounts and basically manage their own financial affairs. They hand money in to staff for safekeeping, but have ready access to it and accounts are kept of deposits, withdrawals and balances, which they check and sign. As was the case at the last inspection, the other ways in which service users make decisions about their lives and lifestyles is that they mostly do their own cooking and with guidance on healthy eating choose when and what they eat. They purchase their own clothes and personal requisites and are free to journey out of the Home subject to the courtesy and safety protocol letting staff know where they are headed and when they are expected to return. The freedom and relative autonomy as shown here together with the reasonable individual risk assessments, which were seen, suggests that service users are both supported to make decisions about their own lives and are not unduly restricted. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15, 16 and 17 Service users are being encouraged and enabled to live ordinary lives in which they are able: i). to pursue leisure and other activities of interest to them; ii). to become as much part of the local community as they wish; iii). to maintain links with their families and others who are important them; and, iv). to exercise such rights and responsibilities as befits their adult status. Furthermore, the acceptable provisions made for their food and nutrition contribute, in the required measure, to sustaining service users’ health and wellbeing. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 13 EVIDENCE: As was the case at the last inspection, service users continue to be provided with opportunities to become engaged in meaningful occupation and or pursue leisure and other activities of individual interest. Evidence of this is reflected in their records and confirmed by accounts, which they and staff gave the inspector. For example all service users have access to a Resource Centre that provides a range of activities and advice. It also provides a venue where service users are able to meet and associate with others of similar age, to benefit form mutual support and establish friendships. At the time of inspection two service users were making regular use of this provision. A local Further Education College is said by staff to provide courses, such as in Arts and Crafts and in other areas of personal development, which service users are encouraged to pursue. There were some examples of service users’ artwork in the Home. It was noted that arrangements have been made for one of the service users, who at the last inspection demonstrated particular interest in sewing and knitting, to join a local club of others who share this interest. This is intended not only to enable the service user to develop her interests, but to meet new people and become more involved in the community. Apart from using local amenities, those in charge of the Home make it possible for service users to be involved in other ways by, for example, registering them to vote. This evidence confirms that the Home is facilitating service users to live normal lives, but perhaps needs now to consider whether some of them might be in a position to benefit from some form of sheltered employment or voluntary work, as part of their recovery programme. A member of staff commenting to the inspector on the abilities of a particular service user highlighted that individual’s excellent cooking skills, which serves as an example of where encouragement towards training and possible employment might be targeted. Explaining how they spend their leisure time, service users told the inspector that some of them go swimming on a Thursday; they sometimes go to the cinema and at other times to the pub for meals, quizzes, etc. Two service users who were asked specifically about contact with their families and friends said that they are able to maintain such contacts through visits and telephone. They also confirmed that they have ready access to a telephone in the home. In assessing how the Home recognises and enables service users’ rights and responsibilities in regard to privacy, dignity and choice, it was also noted that bathrooms and toilets are provided in sufficient numbers, conveniently located and are capable of being locked. This ensures that service users are afforded privacy when conducting their toilet and ablutions. Other practices such as service users opening their own mail and opting in and out of group activities, 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 14 were reported by staff and, as was the case at the last inspection, confirmed by service users as usual practice. It was also noted that service users involvement in housekeeping tasks continues to be both recognised in their recovery programme as part of their treatment plan. This is by way of enabling them to acquire or maintain independent living skills, and is outlined in the Service User Guide. These tasks include keeping their own bedroom clean and assisting with the upkeep of the communal areas. House rules, with which service users are expected to comply, are set out in detail in the Service User guide. Those rules include issues such as smoking, possession of illegal drugs and consumption of alcohol. The inspector considered the rules are reasonable in that they are intended to promote safety and the comfort and wellbeing of all. At the last inspection, there was evidence that some service users were smoking in their bedrooms. The potential risk of fire in this being allowed to continue was highlighted. In response that Manger said that service users have been reminded of this risk. Although not all bedrooms were seen on this occasion, there was no smell of cigarette smoke or other evidence of smoking in the bedrooms, which were seen. In line with the Home’s purpose of enabling service users to maintain independent living skills, the catering arrangements are organised on a different basis to most other care homes. That is, service users are given a weekly provisions allowance from which they purchase and prepare their own meals. The kitchen has been equipped to facilitate this and, where required, staff support service users to plan menus and shop for the ingredients. This does not mean that there are no opportunities for them to dine communally. Service users were seen to organise the purchase of a ‘takeaway’ meal and dined as a group. Further, the Manager explained and service users confirmed that staff prepare a communal meal each week (usually Sunday lunch). Three service users who were asked about this aspect of care confirmed that this arrangement works well and there was evidence in the form of literature in the kitchen to indicate that healthy eating is being promoted. A service user made her food store available for observation and it was noted that it contained a variety of provisions of sufficient quantities and quality. On this occasion, as on the previous inspection visit, it was noted that there were displays of posters and other materials promoting healthy eating from which it was concluded that service users are being encouraged to eat healthily. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Although none of the service users have any significant physical disabilities and are therefore able to attend their own personal and intimate care, such guidance and support that they need in doing this is provided. It has also been concluded that all the necessary arrangements, practices and procedures are in place to respond appropriately to service users’ physical and mental health care needs including medication regiments where relevant. EVIDENCE: The Home specialises in the care and support of service users recovering from mental illness and all those resident at the time of inspection had this in common. The facilities and services are therefore principally geared towards addressing each individual’s mental health care needs. Since all the service users are active, they are supported in self-care. Where guidance and support is necessary this was seen to be identified in the ongoing assessments, which were reported on earlier and the means by which this is provided is detailed in their individual plans. Staff being present at the Home around the clock means that care can be provided flexibly thus avoiding service users being subjected to an institutionalised regime. Flexibility in routines and how these impact on individual choice has been assessed as in keeping with the stated principles and methods on which it is intended to be run (i.e., its Statement of Purpose). For example, the Service 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 16 User Guide suggests that the times when each services user rises in the morning and retires to bed at night is by agreement in respect of their individual plans. The records and what service users said confirmed that this happens in practice. In this connection, it was also noted that the responsibility for the purchase of clothing, choice of dress and any personal style that service users adopt remain their responsibility and choice. Examination of service users records revealed that they are all registered with GPs and are receiving such specialist psychiatric and medical services, as they need. This includes monitoring of their general health and review of their medication. Those service users, who were seen, appeared to be in good health, clean, comfortably dressed and well looked after. With this in mind it has been concluded service users’ personal support and physical and emotional health needs are being met. Inspection of the management of medication at the Home showed that medicines are stored in a safe place and in a secure medicine cabinet. There is a clear written medication procedure, which was last reviewed in April 2005. It sets out how staff must approach the safe ordering, storage of medication in use and the disposal of that which is discontinued or unused. It also guides staff on what to do in the event of any error in medicines given to, or taken by, service users. The medication records for the current month were checked and found to be up-to-date. It was also noted that the records of the doses given were reconciled with the quantities of medication in store at the time of inspection. At the last inspection it was noted that there were reports of medication errors and as a result a requirement was made for the medication procedure to be reviewed and for staff to receive training in the safe handling and administration of medicines. In response, the manager said that the medication procedure has been amended and all staff members received training in August 2005. The Manager also advised that arrangements are to be made for a Pharmacist to conduct periodic audits as a further safeguard. The Manager reported that, at the time of inspection, only one service user had responsibility for keeping and administering his or her medication and similar arrangements were being made for another. All service users have a secure cupboard in their bedrooms for this purpose. This shows that, subject to risk management, service users are encouraged to take control of their own health care including their medication regimen in line with the desired outcomes for standards 18, 19 and 20. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The Home has acceptable means for protecting service users from abuse and other forms of adverse treatment. Service users also have opportunities to be able to voice their views or concerns in the knowledge that the procedures and practices in place will ensure that, in so doing, they will be regarded seriously and action taken accordingly. EVIDENCE: The arrangements that the Home makes for service users to complain or express concerns remains the same as reported at the last inspection and, as then, are acceptable. That is to say, there is a complaints procedure setting out in clear terms the process for making, considering and resolving complaints the details of which are in accordance with quality indicators of standard 22. The complaints procedure is openly promoted to service users in the Service User Guide and together with complaints forms is displayed prominently in the Home on service users’ notice board. Promotional information in this regard, ensures that service users are made aware of sources outside the Home, including the Commission, to which they might direct their complaints. The records showed that no complaints have been made since the last inspection, but also provided evidence that the procedure has been invoked in the past and has proved to be effective. In seeking to protect service users from abuse the Registered Person introduced a policy and procedure, which together define abuse and other unfavourable treatment. It is made clear that abuse in its various forms is not acceptable and actions must be taken if it is observed or suspected. A copy of 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 18 the local multi-agency procedures is now available in the Home, but needs to be promoted to staff through training and checked against the Home’s own procedure to ensure that they are in accord. Taking account of the measures reported above together with others such as the Whistle blowing policy and the guidance given to staff on advocacy, confirmed that the Registered Person has taken reasonable steps to ensure the protection of service users from abuse. No incidents of abuse were either reported or observed during the course of this inspection. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The Home provides service users with a comfortable environment for living and in which there are facilities to promote their independence and preserve their privacy and dignity. Good housekeeping practices ensures that the Home is maintained in clean and hygienic condition. EVIDENCE: There has been no change to the premises since the last inspection therefore the Home continues to afford service users facilities that provide each of them with a spacious bedroom. All of the bedrooms seen are in good decorative order, adequately furnished and with fittings such as curtains, floor covering to ensure privacy and comfort. It was noted that the windows on the upper floors can be opened to their fullest extent thus posing a potential risk should any service user attempt to exit the building by this means. Taking account of cases in other care facilities where service users are known to have injured themselves in such a circumstance, it is advised that a risk assessment be conducted and restrictors fitted if this is indicated. Communal facilities include: two sitting rooms one of which is designated the smoking area, a bathroom/shower room on each of the three floors and a toilet separate from that in the bathroom on the ground and first floors. There is a modern and well-equipped kitchen/dining area and suitable laundry facility for 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 20 the number of service users accommodated. All these facilities are domestic in scale, are properly maintained, equipped and with due regard given to decoration, floor coverings, curtains. These and other adornments combined, create a comfortable and home-like ambience. The manager reported that more comfortable armchairs replaced those that were in the first floor sitting room at the last inspection. The inspection was conducted during cold weather and it was noted that the central heating system was working efficiently maintaining a comfortable ambient temperature in the Home. A large well maintained rear garden provides ample outdoor space for service users and the garden furniture provided means that it is used as a valued additional facility. There were no obvious hazards inside the building and externally it appeared to be in sound condition. The most recent fire safety inspection of the Home carried out by Warwickshire Fire and Rescue Service concluded that the fire safety measures in place were “Satisfactory”. Arrangements are in place for addressing any immediate repairs as might from time to time become necessary and there is a maintenance programme. All areas of the Home were found in clean condition and there is a cleaning schedule and other hygiene measures such as provision of wash basins, soap and towels to encourage hand washing as means of controlling any spread of inspection, thereby minimising risk to service users’ health. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Staff members remain committed to providing effective care and support to service users and though they mostly do not possess the required National Vocational Qualifications (NVQ), their personal attributes, experience and foundation training equip them to do this competently. Service users’ welfare is being further safeguarded by the effectiveness of the Home’s staff selection practices and the supervision and training they are given. EVIDENCE: Currently 10 people are employed in various capacities at the Home. The Manager is employed on a full time basis and four members of care staff who are employed permanently on a part-time basis, among them, work 92.5 hours per week. Other staff members are retained to work a variable number of hours each week, as required. At the last inspection there was only one member of staff on duty for a substantial period during service users waking hours and the inspector recommended that this practice is risk assessed. The Manager advised the inspector that this has been done with the outcome that at least two members of staff are rostered for duty for most of service users’ waking hours; the exception being from 8 pm – 10 pm when there is only one member of staff. This was corroborated by the current duty rota, which was seen. Note, one member of staff is on duty on a sleep-in basis throughout the night with the established arrangement to be able to call on the support of others, if necessary. This is usual and acceptable practice for a care home of its size and needs of the service users. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 22 A sample of staff records, which was examined, showed that due care has been taken with their selection. That is, checks have been made of their fitness to work safely and competently with service users and those checks were seen, among others, to include written references and enquiry to establish whether the person has a criminal or work history that might make him or her unfit to work with vulnerable adults. Staff members who were on duty during the inspection, and whose interactions with service users were observed, were courteous and respectful in their approach to service users. They were seen to guide and advise rather than direct service users and made efforts to create a calm, harmonious atmosphere. All the service users present seemed entirely at ease and approached staff with confidence. This, in part, demonstrates that staff have the necessary personal attributes, have received, as reported, their induction and foundation training and are able to put these into effect. Records were seen and the Manager confirmed that all staff members have undertaken an induction and foundation training programme. This is intended to orientate them in the purpose, principles and practices of the Home and equip them with the basic competencies necessary to do their jobs safely. The inspector was shown a copy of the programme, which was seen to conform to that required by standard 35.3, except in relation to training in the protection of vulnerable adults, which has elsewhere been highlighted as a lack that needs to be addressed. All new staff are reported to serve a probationary period during which their competence and conduct is assessed. This is linked to ongoing supervision and appraisal of which there were also written records. In relation to staff training and development, the Manager explained that the induction and foundation training programme for staff of the Home is organised on a corporate basis and provided in house by the Registered Provider. The Manager explained that although the Home does not have a devolved and dedicated training budget, it has access to the corporate budget from which the cost of external training comes. For example, the Manager is being funded to undertake NVQ level 4 (the Managers Award) and three members of care staff have been enrolled in the NVQ level 2/3 accreditation programme. The Manager said that, currently, only one member of care staff holds the required NVQ. This means that the requirement (standard 32) for 50 of the staff team to achieve said qualifications by 2005 has not been realized, but it is anticipated that this will be remedied once the those currently engaged in the programme have achieved their accreditation sometime this year. The Manager is aware of the need for individual staff assessment and training profiles and from the evidence seen such training that staff have had is assessed as relevant to the Home’s objectives and service users needs. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The whole ethos of the Home is one in which service users views individually and collectively influence the way it is run and the care it provides. EVIDENCE: As reported at the last inspection, a quality monitoring system has been introduced by the Registered Provider to complement some of the existing monitoring arrangements such as the visits conducted in relation to regulation 26 and the contributions of the Advisory Group of stakeholders including service users representation. The quality monitoring system is intended to assess the Home’s performance in all aspects of service users care and application of the principles that the Registered Person expects to underpin this. When considered against existing arrangements such as service users’ meetings and the opportunity that they have to express views about their care in individual counselling and guidance sessions with their key workers, it was deemed that sufficient is being done to satisfy the essential requirements of Standard 39. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 24 In assessing the Home’s performance in promoting and safeguarding the health, safety and welfare of service users account was taken of evidence provided by the Manager at the last inspection. This confirmed that all staff members received initial or refresher training in First Aid and in Manual Handling last April so as to be able to respond appropriately to any medical emergencies in the Home and to be able assist safely any service user who might have mobility difficulties. The Manager has also declared that she has attended a course on Health and Safety and that since no substances deemed hazardous to health are kept in the Home, no special storage provision has been made in this regard. Although not checked on this occasion, evidence was seen at the inspection in September 2005, that tests were being done on the water supply to the Home in line with the Provider’s Water-safe management System and as a precaution against waterborne contaminants and to ensure that the hot water temperature is regulated to a safe degree. Checks were made of the all the fire precautionary measures and planned responses for the event of an outbreak of fire on the premises. All the records related to this were current and in order. At its inspection on 25/01/06, Warwickshire Fire and Rescue service declared the Home safe based upon a ten points inspection matrix. 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 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 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 26 CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 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 X 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X 3 X X 3 X No Are there any outstanding requirements from the last inspection? 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 27 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. Standard Regulation Requirement Timescale for action 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 YA2 Good Practice Recommendations In the ongoing assessment of service users’ circumstances and needs establish whether they are to be permanently resident at the Home or to be assisted to move on to independent or supported living in the community. In any event, this should be reflected in their individual (Recovery) plans and relevant objectives of the plan be shown to contribute towards its achievement. Consideration should be given to assessing and as appropriate steps taken to support service users to benefit from sheltered employment or schemes which might restore or enhance their employment prospects. The Registered Provider should ensure that all staff of the Home receive training in the protection of vulnerable adults. The Registered Person should assess whether there are any risks associated with the first floor windows opening to their fullest extent and, if indicated, fit restrictors to them. 2. YA12 3. YA23 4. YA24 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 3 Moultrie Road DS0000004314.V285468.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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