Inspection on 23/01/09 for 32-33 Macarthur Road

This inspection was carried out on 23rd January 2009.

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 no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

32-33 Macarthur Road 05/12/07

32-33 Macarthur Road 26/03/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

CARE HOME ADULTS 18-65 32-33 Macarthur Road 32-33 Macarthur Road Northleach Cheltenham Gloucestershire GL54 3HS Lead Inspector Mr Paul Chapman Unannounced Inspection 23rd January and 2 /13 February 2009 10:00 nd th 32-33 Macarthur Road DS0000066773.V374122.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 32-33 Macarthur Road DS0000066773.V374122.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. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 32-33 Macarthur Road Address 32-33 Macarthur Road Northleach Cheltenham Gloucestershire GL54 3HS 01451 860237 01451 860237 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) www.brandontrust.org The Brandon Trust Mr David Watson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only-Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 7. Date of last inspection 5th December 2007 Brief Description of the Service: Macarthur Road consists of two semi-detached houses connected to each other on the ground floor. The home is in the village of Northleach in the Cotswolds. Vehicles are provided to enable people to access different activities and there is some access to public transport. People using the service have single rooms either on the first or ground floor and also have access to a range of communal areas including two adjoining lounges. There is an enclosed back garden with outbuildings. Up to date information about fees was not obtained during this inspection. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before completing this site visit we reviewed the previous inspection report, other information gathered since the previous inspection and the AQAA (Annual Quality Assurance Assessment). The AQAA was dated 01/11/08 and provides us with information about what the manager feels the service does well, what has improved since the previous inspection was completed and what improvements are planned for the next 12 months. In addition to this information it also provides us with a dataset, this is information about staffing, procedures, complaints, training and health and safety. In addition to this information we received 3 completed questionnaires from people living in the home, 4 from staff and 1 from a health professional involved with the home. This inspection site visit was completed over 3 days as when we arrived on January 23rd the manager was not on duty. As a result we spent the morning with the deputy manager looking at care plans and risk assessment and interviewing 2 staff. We also completed a tour of the premises. The 2nd day of the site visit was completed with the registered manager present. We spent time reviewing the findings of the 1st site visit and the steps taken by the staff team to address a number of these issues, as well as completing another tour of the premises. Other areas we looked at were staff training and recruitment. We returned to the home on February 13th especially to speak to people living in the home about the care they received. The quality rating for this service is poor. This judgement has been made using available evidence including a visit to this service. What the service does well: People living in the home that spoke with us said that they enjoyed living in the home and that staff were nice and helpful. People that wish to move into the home are thoroughly assessed before they are offered a place and this minimises the risk of people being admitted to the service whose needs cannot be met. The daily notes and resident meetings provide some good examples of people living in the home having a choice and being asked for their opinions. The staff team are in the process of developing a range of picture-based documents to enable people with communication difficulties to make choices more easily. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 6 People lead active lifestyles in and around the local community. The staff team supported a person living in the home through a terminal illness providing them with comfort and the appropriate medical input from other professionals as required. Health and safety checks completed regularly minimise the potential risks to people living in the home. What has improved since the last inspection? What they could do better: Care plans have not been reviewed regularly and it is impossible to confirm that peoples current needs are being met. Risk assessments have not been reviewed regularly and it is impossible to confirm that people are not being put at unnecessary risks. There was no evidence of staff completing any recent training in safeguarding vulnerable adults and this may put both staff and people in the home at risk. The decoration in both of the houses look “tired” and in need of decoration/up dating. Induction of new staff is poor with limited evidence of staff receiving training, guidance or supervision by the manager and this puts people in the home and the members of staff at risk. Records of staff training are poor with a small number of training certificates present for training completed over the past 12 months. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 7 Staff do not receive regular formal supervision with the manager. 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. 32-33 Macarthur Road DS0000066773.V374122.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 32-33 Macarthur Road DS0000066773.V374122.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The records for the last admission to the service showed that the person was thoroughly assessed before they entered the home. EVIDENCE: Since the previous inspection was completed only 1 person has been admitted to the service. We looked at the admission assessment completed by the deputy manager before the person moved in. This was the standard Brandon Trust assessment document. This provides assessment covering areas including: - Personal care requirements, sleeping, mobility, health, continence, personal skills, Social/leisure/work, communication and language. The information recorded was detailed and provided the reader with a good level of detail about the person’s needs. In addition to this assessment there was also a community care assessment completed by the funding authority. Examining this document with staff showed it was not completely accurate, it was dated 29/06/2006 and there was no evidence of review. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 10 We spoke to the person about their assessment process, they explained that the deputy manager had visited them at their parent’s house and “asked lots of questions about me”. 32-33 Macarthur Road DS0000066773.V374122.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, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are not reviewed regularly by staff and this puts people living in the home at unacceptable risks. People living in the home are empowered to make decisions about their lives and staff provide support where it is required. EVIDENCE: The previous inspection report made 2 good practice recommendations against standards 6 and 9. These recommendations were to review peoples care plans documents at suitable intervals and revise them as necessary in order that they are up to date as possible. And, that risk assessments are kept up to date as possible. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 12 We examined the personal files for all of the people living in the home. Firstly we looked at the information for the last person admitted to the home. Examination of their personal file showed that although they were admitted to the service at the beginning of December 2008 there were no plans of care, or any guidelines in place. We spoke to the deputy manager about this and he agreed that plans “should be in place”. Speaking to other staff it was agreed that they had learnt how to support the person from talking to other staff, and from supporting the person. As a result of this we decided to examine the personal files for all of the other people living in the home. Our findings showed that care plans were in place for the other 4 people living in the home and these covered a range of areas and peoples needs. Unfortunately 3 out of 4 peoples care plans had not been reviewed since 2006. 1 person’s care plans had been reviewed by the deputy manager in March 2008, but not since that date. Reading the care plans it was clear that they focused on maintaining people’s skills with little evidence of promoting people to learn new skills. We spoke to 2 people about their care plans when we visited the home on February 13th. Both people agreed that staff had sat with them and reviewed their care. Both people said that they were happy with their care. The biggest concern to us is that the care plans were in most cases over 2 years out of date. It is impossible to confirm from the plans of care that people’s needs are being met. This is seen as poor practice. Staff complete daily notes for each person that detail their activities and any concerns, this at least provides some evidence of peoples needs being met. The deputy manager explained that they are in the process of implementing a new care planning system. They showed us an example of this. Speaking to staff and observations during our 2 site visits showed that people are able to make choices. When speaking with staff they showed a good awareness of making sure people were given choices and how staff may “influence” people’s choice. To aid choices staff are currently developing a picture menu system to make it easier for people to make choices. Reading peoples notes we were able to see numerous examples of people making choices from day to day. On our second site visit 1 person asked to go into town shopping and staff supported her to do this while we were there. Another good example of people being empowered to make choices was the resident meeting minutes. This showed people being asked about activities they wished to complete and issues around the house. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 13 In a questionnaire completed by a person living in the home they stated “I have a new communication system which enables me to make more decisions for myself”. From speaking to people living in the home it is clear that people have choices about activities and make day to day decisions about their lives. Risk assessments are an effective tool used to identify and minimise potential risks to people. Again, looking at records for the last person to be admitted to the home there were no risk assessments in place. Looking at records for the other 4 people showed that risk assessments were in place, but as with peoples care plans the majority of these had not been reviewed since 2006, except for 1 person’s that the deputy manager reviewed in March 2008. This is poor practice and is placing people living in the home at unnecessary risk. After considering these findings we decided to finish the site visit and return when the manager was on duty. We returned to the home on February 2nd and met the manager to discuss our findings to this point. Please see standard 37 for details of our conversation with the manager. As a result of our first site visit the staff team had worked hard to review all peoples care plans and risk assessments. We looked at a sample of 3 people’s personal files and these showed that care plans and risk assessments were now in place for the person admitted to the home in December 2008, and other people’s plans and risk assessments had been reviewed. Some of the samples we examined are now a little confusing due to the re-writing required to make them accurately reflect people’s current needs. The manager re-stated their intention to implement a new format for care planning and showed us an example of this format which is being used for the person admitted in December. Looking at the example provided we recommend that the manager reviews the format of the new care plans as it could be confusing to the reader. The new care plans format identifies an aim, and then actions (steps for staff to follow when completing the care plan). These steps are written in a paragraph. After identifying actions there is a section named “guidelines and procedures”. The example we saw was confusing as actions were also identified under the title “guidelines and procedures”. As a result of these findings for this outcome area we make a number of recommendations: • The manager must review the level of detail contained in peoples care plans to ensure that staff have sufficient information to meet peoples needs consistently. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 14 • • As well as maintaining peoples current skills the plans should also identify steps to support people with developing skills. The titles of the new format should be reviewed to ensure that the information recorded under them is appropriate. Two requirements are made as a result of our findings: • • All care plans must be reviewed at least twice (or as required depending on changing needs) in a 12-month period. All risk assessments must be reviewed at least twice (or as required depending on changing needs) in a 12-month period. Summarising these findings, the majority of the staff team have worked closely with people in the home for a number of years and have a good knowledge of them. But, it is clearly unacceptable that care plans and risk assessments are not reviewed for a period of over 2 years (in the majority of cases). This is poor practice and places people at unacceptable risks to their health and safety, and their care needs not being met. We appreciate that after the first site visit staff completed reviews of care plans and risk assessments and this has in effect at least ensured that peoples needs are reflected in their care plans and risk assessments are still appropriate. It is only due to this work by the staff team that this outcome group is being scored as adequate; otherwise it would have been rated as poor. Speaking with the deputy manager at our first site visit has given us encouragement for the future of care planning/person centred panning (PCP) within the service. They spent time explaining, and showing us an example of the new file system the home is going to introduce. This makes greater use of pictures for people with communication difficulties. Other documents that will be used include a “Listen to me” work book (this is a person centred plan), and Health Action Plans (identifies peoples medical needs). We saw examples of both of these documents being completed with people. 32-33 Macarthur Road DS0000066773.V374122.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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lead active lifestyles and they are empowered by staff to choose what they would like to do. There is a good range of meals and food made available to people and staff are reviewing practices to enable people to have greater choice. EVIDENCE: Speaking to staff and examining daily records showed that the following activities take place regularly: • • • Attending day services Computer lessons Pottery DS0000066773.V374122.R01.S.doc Version 5.2 Page 16 32-33 Macarthur Road • • • • • • • • Horse riding Martial arts Cookery Music Dancing Attending a local church once a month Going out to local pubs Eating out More seasonal activities include attending local fetes, visiting attractions and going for walks. People living in the home are able to go on holidays of their choice (finances permitting) and these will be planned in the near future. One person is a member of the local rambling club and regularly goes out walking with them. As well as activities outside the home activities are arranged in the home. On the weekend after our first site visit a “Burns night” had been arranged and people had invited family and friend to attend. During both of our visits people were seen being supported by staff to attend day services and as mentioned earlier in the report 1 person was supported to go shopping locally (1 to 1). Our observations showed that the relationships were friendly, caring, respectful and good humoured. When we spoke to people about the activities that regularly take place they agreed with the evidence we found in records. Both of the people we spoke to said that they enjoyed living at MacArthur Road. They agreed that they enjoyed living with other people in the home and that the staff were nice and helpful. As identified earlier in this report staff are presently developing a system of photos of meals to help people choose what they would like to eat. People living in the home plan meals for the week ahead and are encouraged to go out shopping for the various ingredients. We recommended that as well as developing a photo menu that staff could also develop a photo shopping list for people with communication difficulties. This would enable them to have more input in the shopping. Examination of the available menus showed that people have a varied and healthy diet. People are encouraged to be involved in preparing meals. Both of the people we spoke to were happy with the food in the home. 32-33 Macarthur Road DS0000066773.V374122.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. Care plans/guidelines and risk assessments are not reviewed regularly by staff and this puts people living in the home at unacceptable risks. Peoples medical needs are met by appropriately trained staff. Medication administration is well managed and minimises potential risks to people. EVIDENCE: As identified earlier in the outcome area “Individual needs and choices” care planning and review is poor. This is also reflected in plans to meet people’s personal care needs. Before our first site visit the majority of people’s plans were over 2 years old (without being reviewed), and 1 person had no guidelines. After our first site visit this was addressed. The requirements for care planning and risk assessment also relate to this outcome section. The previous inspection report made a recommendation to note that female staff can sometimes feel very rushed when supporting people with personal care in 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 18 the mornings. Comments from questionnaires completed by staff on this occasion state “up until recently I feel we have been doing a containing role and this is really frustrating”. With the service now having less people living in it this has become better. Over the past year the staff team have worked hard supporting a person living in the home through a terminal illness. They supported the person throughout their illness accessing the input of other professionals where required to meet the person’s needs. People attend appointments with other health professionals as required. Notes were present showing appointments with GPs, Dentists and other health related specialist. As identified earlier in this report it is planned that Health Action Plans will be completed for each person. This was a recommendation of the previous inspection report. Medication administration is managed by trained staff. The home use MDS (Monitored Dosage System). Medication is checked for errors by staff when it is brought in to the home and when medication needs to be returned to the pharmacist they sign to confirm they have received it. Before staff are able to administer medication they must complete training and we saw examples of where this had been done. Since the previous inspection was completed 2 medication errors have been reported to us under regulation 37. The previous inspection report made a requirement that the medication training be reviewed. The deputy manager has completed this. 32-33 Macarthur Road DS0000066773.V374122.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 adequate. This judgement has been made using available evidence including a visit to this service. If people are unhappy staff would provide the appropriate support to ensure they were safe and their complaint is heard. People are being put at unnecessary risks as staff training records show that safeguarding adults training has not been completed by the staff team. EVIDENCE: In total there have been three complaints made to the home/CSCI since the previous inspection was completed One complaint was made directly to the CSCI. The CSCI asked the service provider to complete this investigation. The service development manager for the home carried out the investigation and submitted their findings to the complainant and the CSCI. No further action was required. The other two complaints were addressed by the manager. The home has a complaints procedure to enable people to make a complaint if they are unhappy. We spoke to staff about the actions they would take if a complaint was made to them. Their responses confirmed they would ensure that people were safe and that their complaint would be taken seriously. We spoke to 2 people living in the home about the complaints procedure, 1 person said that they were aware of it and could make a complaint if they 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 20 wished. The other person was able to give a good example of the steps they would take if they were unhappy, but were unclear if the home had a complaints procedure. It is recommended that the manager ensures that all people are aware of the complaints procedure and how they go about using it. Examining staff training records we were unable to find any record of staff receiving safeguarding adults training in the past 3 years. As part of the Brandon Trust’s induction for new staff they will complete this training. Unfortunately neither of the new staff’s records provided evidence of this training being completed. Other long-term staff members had no records of completing this training. It was a good practice recommendation of the previous inspection report that all staff complete this training. It becomes a requirement of this inspection report that all staff complete this training. None of the people living in the home manage their own finances and the staff team are responsible for doing this. We examined the records of people’s income and expenditure which provided evidence of good recording. At shift handover staff check all of the monies to ensure there are no discrepancies. A good practice recommendation of the previous inspection report was to ensure that financial records are clear, this has been achieved. 32-33 Macarthur Road DS0000066773.V374122.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, 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides people with a comfortable, homely environment that meets their current needs. The standard of decoration throughout both houses is adequate but a programme of decoration must be implemented to raise the current standard. EVIDENCE: 32 – 33 McArthur Road is made up of 2 houses with a joining internal door. At the time of this site visit the premises is under review as part of the Brandon Trust’s estate strategy. The AQAA completed by the manager states that there needs to be “clear timescales implemented regarding the move from Northleach to Cirencester”. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 22 At the 1st site visit we completed a tour of the premises with the deputy manager. A new kitchen has been installed in no. 32 and this is a significant improvement for people. No. 33 also has a kitchen but this is rarely used and no longer contains a working oven or hob. We saw all of the communal areas, toilets and bathrooms in both houses. Communal areas include 2 lounges with a range of comfortable furniture, TV, DVD and stereos. There is 1 dining room and this is situated in no. 33. The communal areas we saw were personalised with peoples pictures and belongings and reflected the characters of people living in the home. On this occasion we did not see any of the bedrooms being used by people living in the home. We saw the 2 bedrooms (not in use) on the ground floor of house 33. 1 had a hole in the ceiling from a water leak, and the manager said this had been reported to the landlord and they were awaiting repair. The other bedroom had become a “store” room where various items had been left. The deputy manager agreed that it was untidy and needed to be cleaned up. Outside the bedroom of 1 person staff have created a picture activity board that they complete with the person weekly. This is good practice and helps to lower anxieties. With the service being 2 houses it provides people with a good range of toilets and bathrooms. No. 32 provides people with an assisted bath (serviced in October 2008). No. 33 also has a bathroom and the manager said that it is rarely used with people preferring to use the facilities in no. 32. At our first visit we found that no. 33 was becoming a place to store items of furniture. An example of this was a table situated in the hallway. Across both houses the paintwork looks “tired” and in need of decoration, no. 33 feels less homely than no. 32 and the manager stated that it is difficult to create a warm atmosphere. The manager stated that the carpets are cleaned 6 weekly, but it was noticed that the lounge carpet in no. 32 had a hole in it, and a mark where a hot iron had been placed. This should be replaced. In between our 2 site visits the staff worked hard around the houses. Staff cleaned and tidied no.33 which looked a lot better when we returned for the second visit. We appreciate that this home is part of Brandon Trust’s review of estates strategy but with no timescale for the proposed move to Cirencester this property should still be maintained to a good standard. It becomes a requirement of this report that both of the properties are decorated throughout, and the carpet in the lounge of no. 32 is replaced. The previous inspection report made recommendations for the bathrooms to be decorated and for the carpets to be replaced. 32-33 Macarthur Road DS0000066773.V374122.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, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff induction is poor with little evidence of support/input by the manager and training being provided to meet the needs of people in the home. Training records are poor with a limited number of recent training certificates available making it impossible to confirm whether staff have the up to date knowledge to meet people’s needs. EVIDENCE: Speaking with staff they agreed that since there has been a reduction in the number of people living in the home it has become easier to spend more time with people. At present the staff team are in the process of creating a photo rota for people living in the home. Examination of the rota showed that there are 2 staff on each shift and one other staff member sleeps in. The manager said that sometimes they go down to one member of staff for a couple of hrs. This happens infrequently, as does 3 staff per shift. Speaking with staff they confirmed this. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 24 Many of the staff have worked at the home for a number of years and have a lot of experience working with this client group. Since the previous inspection was completed 2 staff have been employed. We examined their recruitment records which were seen to be in order and meet the criteria of these standards and regulations. Examining training records for staff we firstly looked at the induction training for the 2 newest staff. There is an Induction training pack developed specifically for MacArthur Road which focuses on local procedures and important information needed to work at the home. In addition to this staff also complete Brandon Trust induction training. Records for the 2 newest staff showed that neither person’s MacArthur Road induction pack had not been completed. One had very little evidence of being completed, whilst the other was slightly better. The manager stated that both people had completed the Brandon Trust induction training but we were unable to find any certificates to support this. Continuing to look at these records showed that since the staff had started in June and November 2008 they had only received 1 supervision session each and these had taken place after our first site visit. We asked the manager what the Brandon Trust’s procedure was for managing staff through their induction and how often the manager is supposed to meet them. They stated that the procedure stated there should be regular meetings. Staff comments in questionnaires and interviews included “I didn’t receive much of an induction and had to find out most by trial and error”. From the analysis of these 2 staff inductions they appear poorly organised putting both the staff and people living in the home at risk. It becomes a recommendation of this report that all future inductions are in line with Brandon Trust policy/procedure. These standards recommend that staff receive supervision at least 6 times in a period of 12 months. Records sampled showed that the manager completes “ad hoc” supervisions with the majority of the team, but the frequency varies and their “ad hoc” nature makes it difficult for staff to prepare for them. It becomes a requirement of this inspection report that all staff receive regular formal supervision sessions. We asked the manager for a copy of the staff training plan. The manager stated that they do not have a plan. They had created a list of training courses completed by each staff member. According to the lists we sampled staff have completed courses in Person Centred Planning, equality and diversity, autism, medication administration and makaton. Unfortunately, these lists were not supported by certificates. It becomes a requirement of this inspection report that the manager ensures that all training certificates are present. We asked the manager how they monitor what training staff need to complete, they replied that staff inform him. It becomes a requirement of this report that the manager develops a plan for the team’s future training needs. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 25 Staff commented on training in the questionnaires we received, comments included, “The appropriate training is there but I feel we don’t have enough opportunity to participate in certain things that interest us as individuals in our work”, “training needs to be made more accessible”. The manager stated that all staff will have received a formal appraisal by April 2009. 32-33 Macarthur Road DS0000066773.V374122.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, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service is poorly managed and this puts both people living in the home and staff at significant risks. Health and safety checks regularly completed by staff minimise potential risks to people living in the home. EVIDENCE: The registered manager has been in post since December 2007. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 27 As we identified in the outcome section for Individual needs and choices our findings when examining care plans and risk assessments was of a significant concern. At our second visit to the service we spoke to the manager about our findings. They were unable to offer any valid reason for the failure to review peoples care documents in over 2 years. During the second site visit we identified shortfalls in staff induction, training and supervision. The manager agreed with our findings and was unable to give a reason for these shortfalls. As a result of our first visit the manager sent us an action plan to address some of the shortfalls identified. Considering all of our findings we are very concerned about the management of this service with there being substantial evidence of poor management. As a result of our findings we will arrange to meet the provider to discuss the findings and the provider will have to supply us with an improvement plan to address these issues. As the provider is not in day to day charge of the service they are expected to complete monthly visits to the service where they examine a range of documents and speak to people in the home and staff. We examined the records kept in the home for these visits and it showed that on the whole visits are completed each month, although we were unable to find any record of visits between August and November 2008. It is recommended that these visits are reviewed to ensure that they are always completed. The previous inspection report made a requirement that copies of these reports are kept in the home. This has been achieved. The manager stated that he completes an annual quality assurance audit for his line manager. Looking at the minutes for resident meetings we were able to see evidence of people’s views being taken into account. Speaking to the manager about quality assurance we suggested a format they could use for identifying goals for the future and developing a culture of continuous improvement. It becomes a recommendation of this inspection report that the manager identifies a method that enables the views of the people in the home to be central to future service developments. The manager completes monthly health and safety checks around the houses. These checks involve completing a tour of the premises and checking everything is in working order, any shortfalls are then addressed. It was a recommendation of the previous inspection report that the manager reinstate this check. Other regular health and safety checks include: • • • PAT (Portable Appliance Testing) was completed in December 2008 Fire Extinguishers were serviced by an engineer in July 2008. Legionella water test was completed in September 2007. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 28 • • • • A qualified fire engineer completed a test of the home’s alarm system in Sept 2008. Staff complete weekly checks of the hot water outlets and record the temperature. Fridge and freezer temperatures are recorded daily. Fire safety equipment around the home is regularly tested and checked by staff. 2 fire drills have been completed in the past 6 months. A fire risk assessment was in place. 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 29 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 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 1 3 3 X 1 X 2 X X 3 X 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2) b Requirement All care plans must be reviewed regularly and updates must be made as required. All risk assessments must be reviewed regularly and updates must be made as required. All care plans/guidelines must be reviewed regularly and updates must be made as required. All staff who have not received safeguarding adults training in the past 3 years must now complete it. Both of the houses must be decorated throughout. The carpet must be replaced in the lounge of house 32. The manager must develop a training plan for the staff team. Staff training records must accurately reflect the training completed by staff. Timescale for action 03/04/09 2. YA9 13 (4) b, c 15 (2) b 03/04/09 3. YA18 03/04/09 4. YA23 13 (6) 01/05/09 5. 6. 7. 8. YA24 YA24 YA32 YA35 23 (2) b, d 23 (2) c 18 (1) c 17 (2) a, Schedule 4 (6, f) 03/07/09 03/04/09 03/04/09 03/04/09 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 31 9. YA36 18 (2) Staff must receive formal supervision regularly. 03/04/09 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 YA6 Good Practice Recommendations All of the care plans need to be reviewed to ensure that they contain enough information to enable staff to meet peoples needs consistently. A number of care plans now need to be re-written as the recent reviews by staff have changed significant amounts of information making them confusing. Care plans goals should be reviewed to ensure that where ever possible people are being encouraged to develop new skills as well as maintain skills. The manager should review the proposed new format for care planning to ensure that it clearly identifies what actions staff must take. In addition to having a picture menu for people the service could develop a picture shopping list to enable people to have more input in purchasing ingredients for meals. The manager should ensure that all people have a good understanding of the home’s complaints procedure. 2. YA6 3. YA6 4. YA6 5. YA17 6. YA22 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West 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 32-33 Macarthur Road DS0000066773.V374122.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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