Inspection on 13/11/07 for 31 Wensum Way

This inspection was carried out on 13th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

31 Wensum Way 28/11/08

31 Wensum Way 06/06/06

31 Wensum Way 10/11/05

31 Wensum Way 03/06/05

31 Wensum Way 19/01/05

31 Wensum Way 08/07/04

31 Wensum Way 18/03/04

31 Wensum Way 18/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 31 Wensum Way Fakenham Norfolk NR21 8NZ Lead Inspector Lella Hudson Unannounced Inspection 13th November 2007 08:00 31 Wensum Way DS0000027503.V354831.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 31 Wensum Way DS0000027503.V354831.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. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 31 Wensum Way Address Fakenham Norfolk NR21 8NZ 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) 01328 863440 NO FAX # www.efitzroy.org.uk Elizabeth Fitzroy Support Simone Boatright – application pending Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: 31 Wensum Way is a modern semi-detached house providing accommodation and care for up to eight people with a learning disability. The home has accommodation on both floors and access to the first floor is by a flight of stairs or the chair lift. The home is run as two units each providing living accommodation for four people. The bedrooms are all single rooms that contain a wash basin and the ground floor of the home has been designed and adapted to deliver a service to people with special mobility needs. On each floor there is a communal kitchen/dining room, a lounge, adapted bathroom and toilet and on the ground floor there is an additional shower room. The lounge on the ground floor has been made into a sensory/games room and there is a small room on the first floor for the use of those residents that smoke. There is a large well kept garden to the rear of the property that offers access to all residents and a pleasant area to sit and parking to the front of the building. The home is sited in a residential housing estate approximately half a mile from the centre of Fakenham which offers local health amenities, leisure activities and shops. The fees for the Home are approximately £850 per week. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous Manager of the Home left approximately eighteen months ago to work elsewhere in the organisation. For approximately six months another Manager within the organisation managed this Home on a part time basis. A permanent Manager was recruited and has been working at the Home for approximately a year. This Manager is currently applying to be registered with CSCI. The last key Inspection was carried out on 6th June 2006. A random Inspection was carried out on 2nd December 2006 following a complaint that had been made about the staffing levels. The random Inspection found evidence that the staffing situation had been difficult but that it had recently been improved. However, this inspection has highlighted that there are again problems associated with poor staffing levels. The organisation need to address this situation in order to improve outcomes for the people who live at the Home. This report includes information gathered about the service since the last key inspection (June 2006) and includes information from an unannounced visit to the Home carried out on 13th October 2007 between 8am and 3.30pm. During the visit the Inspector spoke to the manager and staff, observed staff supporting clients and looked at records. The Inspector spoke briefly to three of the clients but was unable to obtain much information relating to their views of the service that they receive. Completed comment cards were received from staff, relatives and a health professional. Comment cards were also received from people who live at the Home, these had been completed with staff help. The views within the comment cards are mixed. The Inspector also spoke to two health care professionals. Some of the good things that were mentioned in the comment cards are as follows: “provides a safe and comfortable home” “…very well looked after” “am happy the way things are” the staff work well together, very good food, manager responds promptly to requests. Some of the areas which were identified as needing improvement are as follows: “staff need more support” there are not enough staff at times, clients are not going out enough, need to improve team working, lack of communication between staff. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 6 The fees for the Home are worked out for each individual client depending on their needs. These currently range from £797.36 to £883.41 per week. What the service does well: What has improved since the last inspection? What they could do better: The staffing needs to be increased so that the clients can go out more and also be supported individually within the Home on a more regular basis Some areas of the Home still need to be redecorated The care plans need to be more detailed so that staff are clear about how the meet the clients needs Please contact the provider for advice of actions taken in response to this 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 7 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. 31 Wensum Way DS0000027503.V354831.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 31 Wensum Way DS0000027503.V354831.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 adequate This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure an effective assessment process for people moving into the Home There is a need to ensure that the information about the Home is available in suitable formats and contains the necessary details EVIDENCE: No-one has moved to the Home in the last 3 years. However, the Home has suitable procedures for ensuring an effective assessment process is carried out prior to anyone moving in. The Home has a Statement of Purpose and Service User Guide but these need to be updated and available in formats which the clients are able to understand. A recommendation is made about this. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 10 The clients individual statement of term and conditions (contracts) need to include clear information about their fees and any other charges that they may be responsible for. This includes the arrangements in place for charging for transport as currently this is not clearly recorded and there is no evidence of the client, or their representative, having agreed to this. A requirement is made about this. 31 Wensum Way DS0000027503.V354831.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 adequate This judgement has been made using available evidence including a visit to this service. The care plans do not contain enough detailed information for staff to be confident that they know how to meet the clients needs The clients are encouraged to make decisions about their lives but the current staffing levels mean that these are not always able to be carried out despite the staffs best attempts to do so EVIDENCE: At the last key Inspection (June 2006) the Inspector was told that the care plan format was going to be reviewed to ensure that the information was easier to access for staff. This has not yet taken place although the care plans have been “tidied up” with older information being archived into other files. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 12 Two of the care plans were seen and although these contain a lot of information there is no clear guidance for staff about how to provide some of the basic care. For example, one of the care plans states that the client needs “all care” but there is no information about what this entails. Another entry states that the client can “do some dressing themselves” which rather contradicts the previous information about needing “all care”. The quality of the care plans is variable, with some good, clear risk assessments and guidance for staff, and other areas which are missing information or in which the information is sparse and not detailed. A requirement is made about this. The Manager is aware of the work that needs to be done to improve the care plans and risk assessments. There are also plans in place to provide further training about Person Centred Planning so that the key workers are able to develop a more person centred plan with the individual clients. This is commendable and will benefit the clients to be more involved in the process. Whatever format, or style, of care plan that is used needs to contain clear guidance for staff about how to meet the clients needs. This is particularly important for those clients who have difficulty in expressing themselves verbally. The key worker teams have recently been reviewed and the Manager is trying to ensure that the key workers meet with the clients on a regular basis to review their care plans and discuss other issues with them. The staff are currently not completing records on a daily basis about the care that the clients receive. The Manager said that this was because often it would only include very general information rather than specifics so now entries are only made for significant events. This situation needs to be monitored to ensure that the necessary information is being recorded. The management team are promoting a much more person centred approach to providing care to the clients. This means that staff are encouraged to spend more time with clients on an individual basis and move away from the more task centred approach which was previously in place. This is clearly more beneficial for the clients and moves towards them taking more control over their lives and having their individual choices respected. However, this way of providing care is clearly more time consuming and requires additional staff time which can be difficult with the current staffing levels. For example, on the day of the visit one of the clients was not up in time to go to the day centre on the transport provided. As there were enough staff on duty it was possible for them to be supported to get up and have breakfast at their own pace whereas if they had had to use the transport provided they would have been in a rush. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 13 Another of the clients had expressed a wish to attend an evening social event but there were concerns that they would not be able to go if there were not enough staff on duty and if there was not a driver on duty. Prior to the Inspector leaving the Manager confirmed that the client would be able to attend the event. Some staff have worked at the Home for several years whilst there are several who have only recently started working at the Home. Not all of the staff are happy with the new way of working which can lead to tensions within the team but the management team are aware of this and have started to address this with individual members of staff. The issue of team work was raised in the comment cards with some staff feeling that the team works well together and others feeling that some work is needed to promote better team work. The staff views within the comment cards are also mixed about the issue of communication within the team with some feeling that this is effective and others feeling that it needs improvement as information about the clients is not always passed on properly. At the previous Inspection the Inspector was told that one of the staff had attended the Communication Co-ordinators training and that they were starting to undertake communication assessments for the clients. This work has not progressed much further but additional training has been booked for the whole staff team and there is a part of each staff meeting dedicated to practising Makaton. The communication abilities and needs of the clients are varied. Staff were seen to use signs, speech and objects of reference when communicating with clients. Some of the clients have information about the way in which they communicate that they carry with them. The Home has pictures of Makaton symbols on display to encourage staff to practice. Photographs are used to display the weekly menus. The Manager said that house meetings have recently been reinstated. The records confirm this and show that the clients are encouraged to be involved in decision making about issues that affect them. These range from the daily menus to larger decisions about decorating the Home. The Manager gave examples of improvements that have been made as a result of consulting with the clients, eg staff finishing work slightly later as one of the clients had said that he wanted to go to bed later at weekends, individual front door and bedroom keys being ordered for each client. The Inspector was shown the procedure that is in place for looking after money belonging to the clients. The clients used to have their own individual bank accounts but this is in the process of being changed so that everyone has their money held within a corporate account. The bank statements will need to clearly show each individual clients money and interest. The Manager is 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 14 appointee for each of the clients. The cash held was checked against the daily expenditure record and against some receipts. These were correct. A requirement has already been made with regard to ensuring that the contracts are clear about the individual clients fees and other charges. This is particularly important as the clients are being charged a set fee for transport rather than for what they use. Clients who have their own mobility vehicle are also charged for the Homes minibus. The clients records must clearly show what these fees are and that this situation has been discussed with them and/or their representatives and the agreement for this documented. 31 Wensum Way DS0000027503.V354831.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): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Opportunities for clients to take part in meaningful activities are reduced due to the staffing levels Clients are supported to maintain contact with family and friends EVIDENCE: Discussions with staff and the Manager confirm the views within some of the comment cards that the current staffing levels mean that the opportunities for clients to take part in meaningful activities are reduced. All of the clients who live in the Home require a lot of support, for example, with mobility, meals and general supervision. Currently the needs of one of the clients has increased and this means that additional staff are required to meet their needs, therefore, reducing the staff support to the other clients. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 16 The clients attend formal day services for differing amounts of time during the week. Some transport is provided externally and the staff provide transport at other times. The Home has a minibus with wheelchair access and two of the clients have their own vehicles. The clients are supported to attend leisure activities and the majority have had a holiday this year but the staffing levels allow little flexibility and so leisure activities have to be carefully planned rather than clients being able to wake up and decide what they might like to do that day. Weekends are particularly difficult with regard to clients going out. Staff do try hard to enable clients to go out and take part in activities that they enjoy and find it frustrating that they are not able to support the clients in as many activities as they would like to. Special events, such as birthdays are celebrated and the Home has recently had a big party to celebrate the fact that it was the tenth anniversary of the Home opening. Clients are supported to maintain contact with their relatives and friends and relatives are made to feel welcome when they visit. Several of the clients go to stay with relatives at weekends and are due to visit over Christmas. The care plans contain information about the nutritional needs of the clients but would benefit from further detail. Information is displayed in the kitchen about the specific needs of one of the clients. The menus are displayed using photographs. Staff said that the clients are involved in shopping and cooking on occasion also. Records confirm the clients involvement in the choosing of menus. The Inspector sat with clients at breakfast time and clients were supported appropriately by staff. Staff offered choices in a variety of ways and clearly knew how and where the clients liked to have breakfast. The client who required staff support during the meal received this in a respectful and appropriate manner. Clients were given lots of time to eat their meal at their own pace. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 17 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 available evidence including a visit to this service. Staff work hard to meet the personal and healthcare needs of the clients but improved levels of staffing and clearer care plans would benefit the clients There have been occasions when the medication has not been managed safely but the Manager has taken action to address this EVIDENCE: The staff who spoke to the Inspector were enthusiastic and positive about working with the clients. Staff are clear about the support that the clients need and are keen to be able to provide this in an individualised way. Staff on duty were keen to learn from the physiotherapist who was present on the day of the visit and understood the importance of following her advice about exercises for one of the clients. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 18 The clients who live downstairs all have complex physical needs and in order to provide good quality care with regard to these needs, in particular mobility, the staff need to have time to do this without having to leave and carry out other tasks as well. The current staffing levels can make this difficult. As previously mentioned in this report the care plans would benefit from containing clearer information for staff about how to meet individual clients needs. There also needs to be better monitoring of situations, for example, the significant event report states that a client had a possible urine infection but there are no further entries about whether they received treatment for this or not. The staff comment cards again contained mixed views, this time about whether they receive up to date information about the clients needs and about whether they feel that they have the right support, knowledge and experience to meet the clients needs. Some additional comments made by staff are that they feel that the clients are well looked after and that they receive excellent care. The relatives comment cards are positive and state that the needs of the clients are met and that the staff have the right skills and experience to do this. The needs of one of the clients has greatly increased in the last few months and this is having a negative impact on the other clients due to the staffing support that is needed for the one client at this time. When the client needs additional staffing then the organisation has agreed to provide it but this provides additional staff in the Home and does not address the problem of staff then not being able to leave the Home to support other clients. This situation is having a negative impact on the other clients who live upstairs as they, on occasion, have to spend time downstairs for their own safety. This particularly affects one client who is very vulnerable. The views of the healthcare professionals who had contact with the Inspector are also mixed, with one feeling that there are good relationships with the staff and that the staff follow the advice given and the other feeling that this is not always the case and that this could be improved. The Manager is aware of situations where communication could be improved and has plans in place to deal with this. The Commission has received notification about four medication errors in the last few months. The Manager has taken action to deal with this which includes preventing some staff from administering medication until they have received additional training and also commencing disciplinary proceedings for staff who do not follow procedures. The system for administering medication was looked at during the visit and this was appropriate and as per the organisations procedures. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 19 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. Clients feel that their views are listened to Procedures are in place to protect individuals from abuse EVIDENCE: The Manager said that she has not received any complaints about the Home. As previously mentioned in this report the Commission received one complaint which was about the staffing levels. The client who spoke to the Inspector said that he knew who to talk to if he was unhappy about something and gave examples of how action has been taken following his suggestions about improvements or changes that he would like. The implementation of meetings between the clients and their key workers as well as the reintroduction of house meetings provides the clients with additional opportunities to raise any concerns they may have. The clients also have the opportunity to attend the clients forum which is chaired by the Regional Manager. The work that is being done to improve communication within the Home will also assist clients to be able to raise issues. All of the staffs completed comment cards state that they know what to do if someone wished to make a complaint. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 20 The staff all receive training with regard to Safeguarding adults and the Manager is aware of the procedure for reporting any concerns/allegations about abuse. The organisations policies and procedures are written with a view to protecting the clients from any form of abuse. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 21 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. The accommodation meets the needs of the clients and improvements have been made in the last year. EVIDENCE: The Inspector was shown around the communal areas of the Home. At the random Inspection in December 2006 it was noted that the requirements about improvements needing to be carried out had not been met. However, they have now been met. The accommodation is on two floors with four clients living on each floor. There is a chairlift to the first floor but currently none of the clients need to use this. The clients living on the ground floor have mobility difficulties and there is appropriate equipment to assist them, such as hoists and specialist baths. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 22 Some areas of the Home have been redecorated and there are plans to redecorate other areas. New furniture has been bought to replace that which was very shabby. New flooring has been laid in some areas and the broken window restrictor has been mended. There is a small smoking room for clients on the first floor and the flooring in this room has been replaced but needs to be replaced again with more appropriate flooring for the hard use that it receives. The room on the ground floor that was not being used has had new flooring and has now been turned into an activity room with the sensory equipment also being improved so that the clients can use it more easily. The bedroom doors do not have proper door handles and one of the clients has requested that this is addressed. The Manager said that this is being dealt with by the Housing Association who own the property but that they can take a long time to take action following requests. It is pleasing to see the improvements but it is not acceptable that it has takes so long for improvements to be made. Some of the delays are due to the Housing Association and some due to the organisations own procedures for redecoration and renewal of furniture and fittings. It is required that the bedroom doors have handles and locks on that are suitable for each client It is recommended that the bathroom on the ground floor is made more homely Improvements have been made to the garden with garden furniture purchased and this is now an attractive place for clients to spend time. The clients have recently acquired a rabbit and so clients spend time outside looking after her. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 23 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, 33, 34 & 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are ongoing concerns about the staffing levels which mean that it is difficult for staff to enable clients to take part in meaningful activities Staff receive relevant training and support in order to carry out their roles Appropriate recruitment process are followed and the clients are involved in a meaningful way EVIDENCE: The clients who live at the Home have complex needs and require a lot of staff support in a variety of ways, including with regard to mobility and mental health needs. The usual staffing levels are for there to be three staff on duty during the morning and afternoon/evening periods which is when all of the clients are at home. This allows for one staff to work upstairs and two staff to work downstairs. This staffing level allows for basic care to be provided but makes it difficult for staff to support clients on an individual basis to go out. It 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 24 can also make it difficult for staff to spend time with clients on an individual basis to carry out additional support such as physical exercises. The staff are also responsible for all of the shopping, cooking and cleaning. Most staff are positive about the plans to increase the amount of involvement that the clients have in the day to day running of their Home and to increase their opportunities to take part in meaningful activities. However, there are limits to how far these plans can be implemented without additional staffing. The staffing is particularly difficult at the moment due to the increased needs of one of the clients. The staff do work hard to meet the needs of all of the clients and the majority of the staff are flexible in their working hours if a client needs support outside of the usual hours. Following a clients request the hours that staff are available in the evenings have been slightly extended so that the client does not have go to bed so early. The usual staffing levels at night are for there to be one waking staff and one member of staff who is sleeping in. Due to the increased needs of one of the clients there have been two waking night staff on occasions. It is required that the staffing is adequate to meet the needs of the clients The recruitment files were not seen on this occasion but at the previous Inspections these have contained the necessary information. Recruitment is carried out by the Manager with support from the organisations HR department. One of the clients told the Inspector about his involvement in the recruitment process which includes being part of the interview panel and contacting the successful candidate by telephone to offer them the post. He said that he really enjoys being part of this process. This is a very good way for clients to feel that they have some control about who actually provides support to them. Staff confirmed that the necessary checks were carried out prior to them starting work at the Home. Training is provided by the organisations training department which is based in Norwich. All staff attend a formal two week induction and undertake LDAF units which are then continued once they start to work in the individual services. Staff said that they enjoyed their induction and that it provided them with good information for which to start work. Staff comment cards confirmed this also. All of the staff comment cards state that they receive training which is relevant and up to date. The training record provided by the Manager confirms that staff receive updated mandatory training. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 25 The organisation is currently changing the way in which NVQ training is provided and it is expected that additional staff will commence NVQ Level 2 very shortly. The Home does not have 50 of staff with this award but expects to within the next year. Regular staff meetings are taking place at which a variety of issues are discussed. These include organisational, client and house issues. Minutes are available for those staff unable to attend. Staff comment cards are mixed in their views about whether staff receive regular supervision or not and this was confirmed by the Manager. Some staff are receiving more regular supervision than others and the Manager has plans to ensure that all staff receive this on a regular basis. A recommendation is made about this. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home now has a settled management team with plans in place to make improvements in outcomes for the clients The clients views about the service are sought on a regular basis EVIDENCE: The Home has had an unsettled period of management over the last eighteen months but has now got a permanent Manager and deputy manager who work well together as a management team. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 27 The current Manager has many years experience of working with people with learning disabilities and of managing a team. She is currently working towards the Registered Managers Award. It was recommended in December 2006 that the Manager start the process of registering with the Commission but this did not take place until recently and is currently being processed. Discussions with staff and a review of the comment cards show that there are mixed views about the support provided by the Manager to staff. The majority feel that the Manager provides good support and are positive about the changes that she is implementing. There are some staff, however, who feel that the Manager is not positive in her approach to staff and who are not supportive of the changes being implemented. The Manager is aware of this and is dealing with the situation. The Manager said that she receives regular supervision and good support from the Operational Manager. The Manager is part of the group of managers within the organisation who meet regularly. The Manager currently works three management shifts and two care shifts a week. She works two out of three weekends and therefore these weeks has days off during the week. The assistant manager only has one management shift per week. Whilst it is important for the management team to work alongside staff there is a real need for them to be enabled to have additional management time to undertake the initial work that needs to be done to address some of the issues that have been highlighted in this report. It is recommended that consideration is given to increasing the hours of management input into the Home, even if this is on a temporary basis. The Home has increased the ways in which the views of the clients are sought and these have been described previously in this report. Additional ways of measuring the quality of the service are the monthly visits carried out by the Operational Manager, the use of the REACH standards and the annual quality questionnaires that are sent to relatives. The Manager is considering extending the use of the questionnaires to staff, clients and health/social care professionals. The Home has an annual development plan which includes a review of the quality of the service in some areas and the Manager is considering ways of producing a more client focused report about the quality of the service on an annual basis. The Inspector saw a selection of maintenance and service certificates which show that the fire safety and mobility equipment is serviced on a regular basis. Staff receive health and safety training, fire safety, food hygiene, moving and handling and first aid training during their induction and then receive regular updates. The staff team have recently reviewed the fire safety video during their team meeting. The Home has a fire risk assessment. 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 X 4 X 5 2 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 2 33 1 34 4 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 2 2 X X 3 X 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5 Requirement It is required that the clients have an individualised contract which includes the fees and other charges It is required that the care plans contain detailed guidance about how to meet the clients needs It is required that risks are identified, assessed and recorded effectively It is required that the bedroom doors have handles and locks that are appropriate for each client It is required that the staffing levels are adequate to meet the needs of the clients Timescale for action 31/01/08 2 3 4 YA6 YA9 YA24 15 13 23 31/01/08 31/01/08 31/01/08 5 YA33 18 31/12/07 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA1 YA24 YA36 YA37 Good Practice Recommendations It is recommended that the Statement of Purpose and Service User Guide and available in a format which the clients are able to understand It is recommended that the bathroom on the ground floor is decorated to make it more homely and less institutionalised It is recommended that all staff have supervision on a regular basis It is recommended that the management time in the Home is increased 31 Wensum Way DS0000027503.V354831.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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