Inspection on 05/12/07 for 32-33 Macarthur Road

This inspection was carried out on 5th December 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

32-33 Macarthur Road 23/01/09

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 08/07/2008.

CARE HOME ADULTS 18-65 32-33 Macarthur Road 32-33 Macarthur Road Northleach Cheltenham Gloucestershire GL54 3HS Lead Inspector Mr Richard Leech 5 , 14 & 16 December 2007 th th th Unannounced Inspection 10:00 – 16:00, 13:20 – 19:00 & 13:10 – 15:40 32-33 Macarthur Road DS0000066773.V352022.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.V352022.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.V352022.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.V352022.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 21/05/07 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.V352022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection the manager completed an Annual Quality Assurance Assessment (AQAA) providing information about the service. Surveys were also sent to different people with an interest in the home such as healthcare professionals and family members. People living in the home also had the opportunity to complete a survey form about the service. Three visits were made to Macarthur Road. These took place on a Wednesday, Friday and Sunday during the daytime or early evening. Many of the staff team were met during these visits, as well as all of the people living on the home. The manager was also present for the majority of the time. During the visits examples of different documents were looked at. These included care plans, risk assessments, medication charts, staffing files, minutes from meetings and healthcare notes. Following the site visits there was also a discussion with the service development manager (the line manager of the registered manager). What the service does well: People living in the home gave generally positive feedback about the staff and the support they received. One person said, “I’m happy here”. Other people indicated that they were happy with their care and support when asked. One person described the staff as ‘caring’. Much positive interaction and support was seen, with people being included in the day-to-day running of the home and being offered choices. People were also happy about their rooms and are able to personalise these according to their own tastes. The environment is homely, clean and comfortable. People were positive about the food they were offered. Menus are flexible and balanced and reflect people’s preferences. There was mostly positive feedback about the activities that people were supported to take part in. People living in the home are asked what they think about the service and are also involved in the running of the home. A good approach to admissions means that people moving into the home can be confident that their needs will be appropriately assessed. People receive support with personal care and to stay well. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 6 People who use the service are enabled to take forward concerns and complaints, helping to make them feel valued and listened to. Recruitment procedures help to protect the people living in the home and also give them a say about who supports them. What has improved since the last inspection? The AQAA noted some of the improvements that had taken place in the home. This included: • • • • • • The people living at Macarthur Road having more input into recruitment. Developing equality and diversity in the home, such as through celebrating different religious festivals. Improvements to the handling of people’s money and medication. Further developing links with appropriate teams in the community. Introducing a social work student to the home for a placement. The development of new policies and procedures. There was evidence for the above during the visits to the service and through written feedback about the home. The manager has become registered and has started to introduce changes, including beginning to tackle some poor practice. Some progress has been made with providing staff with the training that they need for the role. What they could do better: People living in the home commented on short staffing. Team members also expressed concern about this. There was some concern from people living and working in the home that at times the residents were not treated with respect and that people’s rights were not always upheld. Although people are offered real choices and control over their lives there was some evidence of the possible inappropriate use of restrictions and sanctions. Although people were generally positive about how they spent their time there was some feedback about there not always being enough to do. Staff also felt that there were not always enough activities provided, particularly on a one to one basis. Higher staffing levels would benefit the people living in the home in areas such as morning routine and activity provision. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 7 A reasonable care planning framework is in place but more attention should be paid to keeping the information up to date and to reflecting people’s goals and wishes. Similarly some risk assessments need more frequent review to make sure that they are up to date and that risks are properly identified and managed. Some further improvements need to be made to the handling of medication in the home to promote people’s safety. Whilst there have been changes in the way that people’s money is handled there is potential for further improvement to make sure that the systems are sound. Certain parts of the home would benefit from redecoration and maintenance. Improvements are needed both to provision of training and to the recordkeeping in order to ensure that staff have the training they require to meet the needs of the people living in the home. Some aspects of health and safety in the home need attention so that service users are as safe as possible. 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.V352022.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.V352022.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A good approach to admissions means that people moving into the home can be confident that their needs will be appropriately assessed. EVIDENCE: In the last key inspection report requirements were made to review and update the Statement of Purpose and Service Users Guide. The manager said that this had been done. Copies were forwarded following the inspection, although these were not studied in detail for compliance with the relevant regulations. The manager said that copies of the amended documents would be given to the people living in the home. In previous reports for other Brandon Trust homes it has been recommended that the admissions policy dating from 2000 be reviewed and updated to take into account the National Minimum Standards. A new handbook had been issued but the admissions policy had not been updated. The Statement of Purpose described the steps that would be taken around referrals and admissions, including assessment, visits and stays. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 10 There had been no new admissions since the last key inspection. The manager and staff described how the most recent admission had been handled. This had included assessment work, information gathering, introductory visits and overnight stays. The manager said that there had been some pressure to fill vacancies but said that he felt confident about turning down inappropriate referrals. He believed that the service was meeting the needs of the person most recently admitted to the home, and that steps were being taken to provide appropriate support in respect of a health issue which had begun to present. There was some feedback that there could have been more visits to the home over a longer period, although the manager said that time pressure had been a factor. In the AQAA the manager described how compatibility with people already living in the home was considered. However, during the visit it was acknowledged that there were some fundamental issues around compatibility which presented ongoing challenges to the team. During the previous visit records relating to the two most recently admitted people were checked and found to be satisfactory. 32-33 Macarthur Road DS0000066773.V352022.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst a reasonable care planning framework is in place, more attention should be paid to keeping the information up to date and to reflecting people’s goals and wishes. This should help to ensure that people’s changing needs are identified and met and that care is person-centred. Although people are offered real choices, possible inappropriate use of restrictions and sanctions needs to be addressed in order that people are more empowered to take control of their lives. Reviewing and updating risk assessments more frequently would help to ensure that risks are appropriately identified and managed, and that people’s independence is maximised. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care planning files for two of the people living in the home were looked at. These included information about the person and their background, likes and dislikes, what was a good day for them, daily routines and communication. In some cases there were also agreements signed by the person about specific issues relating to their care. Some of the information in these sections was undated. Some contained information that was out of date, such as a communication profile stating that one person used a Dictaphone. Other documents were in need of routine review, in some cases there being no evidence of review since 2005. The files also contained numbered care plans covering specific areas such as about independent living skills, activities, managing money, health and personal care. These generally provided clear guidance about the support people needed in different areas. Again, in some cases there was no evidence of recent review. For example, one document relating to challenging behaviour was last reviewed in April 2006 according to the records. There was also scope for the plans to be more person-centred in terms of reflecting people’s goals and wishes. At the time of the visits some work was taking place around making the service more person-centred. A facilitator was reported to be working with the team and the people living in the home to help create more person-centred approach to care planning. A system of producing a monthly summary based on daily notes and relating these to the care plans had been in place, although this appeared to have ceased in Autumn 2007. The manager acknowledged this, relating it to short staffing, but said that that he was questioning whether this monthly summary served a purpose. Ideas for making it a more useful tool were discussed. Examples of the way that ‘Total Communication’ works in the home were seen. This included one person having a communication book with pictures and symbols, and another person using signing. People living in the home described the kinds of choices that they were offered. These included choosing what they ate, how they spent their time and around their personal appearance. However, there was also feedback about choices being restricted on occasions. In certain cases there were documents signed by the person whereby they agreed to a particular restriction. However, some people also described situations such as not being given their money until they had completed a household task, or having an activity cancelled in response to incidents. Daily notes also suggested that at times people’s choices and rights may be infringed. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 13 For example, on 26/11/07 daily notes indicated that one person had been refused their money until they had completed their chores. During November 2007 the same person’s daily notes referred to being told or reminded to stay in their room as they were unwell. There was also reference to a shopping trip being cancelled apparently as a consequence of an incident of challenging behaviour. Another person’s notes for 07/11/07 stated, “sent to her room...as she got aggressive”. Some staff expressed concern about certain limitations and practices that imposed upon the rights of people living in the home to make choices, citing examples which corresponded to the above. The manager agreed that the tone of some of the daily notes suggested that choices and rights may be being infringed at times without a sufficiently clear explanation of the reason, and with inappropriate emphasis/terminology. He reported that there was some other evidence of sanctions and restrictions being imposed. He described the steps were being taken to try to address this. The service development manager was also contacted about this and described the steps being taken to promote a change of culture, including a teambuilding day with more planned for the New Year. Related to the above, there should be more explicit consideration given to the Mental Capacity Act and accompanying code of practice in documentation. This may include, for example, acknowledgement of the presumption of capacity and people’s right to make choices which may be seen as unwise where they have the capacity to make a given decision. The code of practice also provides a framework for making and documenting decisions in people’s best interests. At the time of the visit at least one person was expressing their choice to no longer live in the home. The manager described the steps that were being taken to look into different options. The home has a missing person’s policy. Information about each person living in the home is available, along with a photograph, should they go missing. Risk assessments were checked for two of the people living in the home. Whilst these appeared to cover appropriate areas and to provide reasonable guidance, many were in need of review. Some were not recorded as having been reviewed since May or June 2006. This increases the likelihood that the information and guidance may be out of date and that risks may not be identified and managed as they should be. ‘Live’ risk assessments are also an essential part of safely promoting people’s independence. Discussion with staff and the people living in the home, along with observation, provided evidence of people being supported to take measured risks as part of being independent. For example, one person informed staff that they were 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 14 going out to the local village and then did so. Another person arrived back at the home having taken a bus from a nearby town. 32-33 Macarthur Road DS0000066773.V352022.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have full and busy lives, although there is scope to further improve the support that people get to help them to lead the lifestyles of their choice. Menus are flexible and balanced and reflect people’s preferences, enhancing their enjoyment of mealtimes and their general wellbeing. EVIDENCE: Some of the people living in the home described how they spent their time. This included going to college, shopping, social clubs, having parties in the home or lunch out and seeing family and friends. People were seen listening to music, watching TV and doing puzzles during the visits to the home. Some of the residents were also observed helping out with domestic tasks. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 16 During the visits to the home there was also a trip to Westonbirt arboretum and a buffet to which family and friends were invited. The AQAA noted that there had a celebration in the home for Diwali. Staff and people living in the home said that this had been enjoyable. Daily records for two people were checked over two weeks in November. These provided evidence of people taking part in a range of different activities in the home and community, and of people having regular contact with family. Activity timetables were on display in the office and these were seen to generally correspond to recorded activities. People expressed general satisfaction with their activities. However, some people said that they would like to be doing more. One person said that they would like to go clubbing. Some people cited short staffing as having an impact on activity provision. Some staff spoken with also felt that, whilst people had busy lives, more could be offered, particularly on a one to one basis if staffing levels improved. The manager shared this view, adding that the rota sometimes posed problems too such as the staff sleep-in beginning from 10pm. On the AQAA it was stated that it was difficult to provide as much as one to one time as the team would wish. As noted, there was some evidence that activities were at times cancelled as a sanction. Relations with the neighbours were described as generally ok. Staff and the people living in the home reported that, although some use was made of facilities in the village, the main destinations were Cirencester and Cheltenham. This resulted in long periods being spent driving. The Trust was beginning to look at the possibility of relocating the service to Cirencester. People were seen moving freely around the home, choosing whether to be alone or in company, and were also observed helping out with household chores. One person put some music on in the lounge, clearly feeling able to do this without asking the staff, indicating that they saw Macarthur Road as their home. As noted, another person informed the staff that they were going out to the village and proceeded to do so. People were seen to have drinks on request and to be in control of what they had for lunch. The above was seen as evidence of people’s rights being respected. As indicated, however, there was some evidence of people’s rights being transgressed at times. The manager said that this had been discussed at a recent team-building day as well as on a one-to-one basis. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 17 It was agreed that this may also represent a training issue, perhaps covered by input around anti-oppressive practice, rights, adult protection, LDQ work (Learning Disability Qualification), values and attitudes or other sources. It was also agreed that if not resolved then other action may be required to address the issues. Some staff expressed concerns that one person’s name was being shortened by other staff, saying that the person liked to be known by their full name. The person confirmed this in discussion. Staff should pay more attention to people’s preferred form of address. The people living in the home expressed satisfaction with the food provided. They confirmed that they were given choice about what they ate on a day-today basis and also at regular meetings when the menu was discussed. People said that they could have alternatives to what was on the menu if they wished. Staff spoken with confirmed that this was the case. Examples of menus were seen. These provided evidence of a varied, balanced diet being provided. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst people’s personal and healthcare needs are generally met, there is potential to improve some aspects of practice in these areas in order to optimise people’s health and wellbeing. Some further improvements need to be made to the handling of medication in the home to promote people’s safety. EVIDENCE: Care plans described how people’s personal care needs were to be met. The service has a policy of people being supported by staff of the same gender for their personal care needs. Staff reported that that this could present difficulties at times, particularly on busy mornings when there was one female staff member working with a male member of staff given that the majority of residents were female. It was stated that this resulted in personal care being rushed at times, with insufficient time to attend to people’s preferences around appearance, make-up and accessories. See also section about staffing. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 19 The adoption of a more person-centred form of care planning should help to ensure that people’s needs and preferences around personal care are fully identified and met. Discussion with people living in the home provided evidence that independence with personal care was being promoted. People were seen to be dressed individually in ways which reflected their preferences. Healthcare notes for two people were checked. These provided evidence of people accessing routine and specialist healthcare services according to individual needs. There was documentary evidence of good links with the local Community Learning Disability Team. This was also evidenced by discussion with the manager and staff and by observation of visits from CLDT members. Files included ‘health profiles’. However, these were out of date and, in some cases, judgemental. For example, including out of date information about personal relationships and phrases such as ‘[service user] is a faddy eater’. These should be fully reviewed and updated. The manager stated that health action planning had not yet been introduced but that he was about to arrange for this. The adoption of health action plans may mean that health profiles are no longer needed in any case. Some healthcare records had the day and month of an appointment or intervention but no year. The AQAA noted plans for improving the monitoring of people’s weight. The manager explained that some people did have issues around weight. One person’s records indicated that they had last been weighed in late 2006. Another person’s file had the last entry for weight in March 2007. At an appointment on 26/11/07 it had been recommended that one person be weighed weekly. However, this had not happened to date and the manager was unaware of this recommendation. The manager said that a dietician was due to visit the team to provide some training and guidance for staff. This is good practice. One person’s care plans described daily exercises as recommended by a physiotherapist. The manager and staff reported that these were not taking place. This should be looked into to check whether the advice is still current. Medication storage appeared to be in order, although cash tins were still stored with medication in the absence of any alternative secure storage. Some eye drops found to be out of date in the last visit had been replaced. Medication records were checked for two of the people living in the home for December 2007. These appeared to be in order, although there remained no information about people’s allergies as recommended by the pharmacist inspector. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 20 A recommendation had also been made that medicine charts be signed and dated each month by the member of staff preparing these, with a second signed check that the details correspond to the doctor’s prescriptions. A further recommendation that quantities of medicines supplied and returned during periods of leave be recorded in order to maintain a complete audit trail had not been acted upon. A system of double-checking administration records was in place. During the inspection this check picked up that some medications had not been signed for, highlighting the importance of this system (although staff said that when they were extremely busy this check sometimes did not take place until the following day). Protocols were in place for ‘as-required’ medication. Staff reported that the local pharmacy regularly visited and provided guidance/undertook checks on the systems in place. A meeting was taking place in the week following the inspection between the manager and the pharmacist about some possible changes to the system. During 2007 several medication errors had been reported to us. The pharmacist inspector had visited the home in May 2007 and made a requirement to review and provide additional staff training and supervision to make sure that staff were competent to administer medicines correctly. Although some newer staff were reported to be undertaking a distance learning course about the safe handling of medication, existing staff had not undergone retraining. Some staff commented on the need for this. A training matrix indicated that many staff had last had medication training in 2004. One person had no date recorded against medication training. A suggestion was also made that a system of periodic competency assessment be introduced. A new medication policy had been issued by the Trust in October 2007. This referred to consent being obtained from people using the service for their medication to be handled by staff. This was not documented in the files seen at Macarthur Road. The list of staff authorised to administer medication was out of date, as was the list of people who were self-administering medication (at the time of the visits nobody was). Clearly the ideal is for people to be supported to selfadminister safely. The AQAA described plans to revisit this area. Positive feedback was given by healthcare professionals involved with the home, although there was acknowledgement that short staffing needed to be addressed. There was also come concern about the use of bank and agency workers impacting on continuity of care. Staffing issues are considered later in the report. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to take forward concerns and complaints, helping to make them feel valued and listened to. However, more could be done to further safeguard the people living in the home. EVIDENCE: The service has a complaints procedure and there was reference to concerns and complaints in the Statement of Purpose and Service Users Guide. The manager stated that there had been no formal complaints since the last key inspection. He said there was no complaints log as such, but that one would be set up if a formal complaint was received. There was a discussion about the threshold for treating an issue as a ‘complaint’, with particular reference to recent concerns expressed by one person living in the home. The manager reported that he had asked the person if they wished to make a formal complaint but that they had not (although this was not recorded). Discussion with some of the people living in the home provided evidence that they felt able to say if they were unhappy about something, and that they generally felt listened to by the manager and staff. Written surveys also indicated that the people living in the home knew who to speak to if they were unhappy about something. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 22 In the last key inspection report a requirement had been made to do an audit of service users’ finances. This was because the records were found to be in a state of disorder, with discrepancies apparent. CSCI was copied into the outcome of the audit, which took place in May 2007, and the manager supplied an action plan addressing the points. Some people who had apparently lost out financially were refunded and some changes to procedures took place. Some records of people’s finances were checked during this inspection. Whilst there were clear improvements the following was noted on one person’s record: • • • A store loyalty card had been used for a transaction on 12/12/07. The manager agreed to check whether this belonged to the person living in the home. A receipt for the same person on the same date indicated that £50 of store coupons had been used, although the running record showed this figure to be £49 of vouchers. The financial audit had stated that vouchers needed to be treated as cash. July and August 2007 records for above person noted that they had some store vouchers but did not include these in the running total as if cash. They were only added to the total in October 2007. The person’s record for December 2007 contained a significant number of crossings out and overwritten figures, compromising clarity. The manager said that a calculator was available but that not all staff used this. • It was reported that the person who had conducted the original audit was returning before Christmas to follow-up the findings. The manager was able to comment on all of the findings apart from the final one (point 19), and said that he would look into this recommendation (which related to some giros sent to one of the people living in the home). The service has policies covering adult protection and whistle blowing. The manager and his line manager were at the time of the visits looking into some allegations about practices resulting from concerns expressed by a person living in the home and by staff. Staff reported that they did not receive specific training about adult protection, and there was no reference to this training on a matrix seen in the home. It is strongly recommended that appropriate training in this area be provided, as general good practice but also in the light of recent concerns about practices in the home. This is a repeated recommendation. The manager described how links with the local police had been built up. This had included them becoming involved in specific incidents in the home with a view to helping people to understand their responsibilities and the possible consequences of their actions. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A homely, comfortable and clean environment is generally maintained, although there is potential for further improving the overall quality of accommodation. EVIDENCE: All of the communal areas were checked along with some people’s bedrooms. The people living in the home expressed satisfaction with their rooms, and said that they were warm and comfortable. Bedrooms were seen to be personalised. The home has a number of bathrooms and toilets, some with aids and adaptations. These were clean and reasonably decorated, although some of the bathrooms and toilets would benefit from a freshening up of décor. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 24 One had a rusting cabinet. Some taps were very furred with limescale and should be replaced. In the last report a requirement was made to ensure that the kitchen was in a good state of repair, safe for use by people living in the home and hygienic. This was because it was in a very poor state, with some unit fronts missing altogether. Although this had not been done, plans had been drawn up and the work was due to being in January 2008. Following the inspection the manager reported that the work had been completed during January 2008. As noted in the last report, some carpets were worn and marked/stained. These should be replaced. The AQAA noted that efforts had been made to recruit a cleaner but that this had not been achieved. The home was seen to be clean. Staff described infection control measures and reported that protective equipment was available. An infection control policy dated October 2007 was seen. More fundamental questions were being asked about the suitability of the building (in terms of configuration and capacity to accommodate seven people comfortably) and with regard to location. As noted, options for relocation to Cirencester were being looked into. The service development manager was contacted and confirmed that options for reprovision were being considered. An interim plan was also being considered involving greater separation between the two adjoining properties. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst staff are caring and skilled, some improvements to practice are needed such that all of the people living in the home feel consistently valued and respected. Higher staffing levels would also benefit the people living in the home in areas such as morning routine and activity provision. Recruitment procedures help to protect the people living in the home and also give them a say about who supports them. Improvements are needed both to provision of training and associated recordkeeping in order to ensure that staff have the training they require to meet the needs of the people living in the home. EVIDENCE: The manager reported that three out of the seven permanent staff (excluding himself) had attained a relevant NVQ (National Vocational Qualification). Another staff member was hoping to take an NVQ, which would bring the total to over 50 . 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 26 The people living in the home were generally positive about the staff team and the support they received. Comments (written and verbal) included, “I’m happy here”, “really like it”, and that the staff were ‘pretty good’, ‘alright’ and ‘lovely and caring’. However, as indicated earlier some concern was expressed about the attitudes of some staff, with people saying that at times they did not feel respected, and that sanctions were applied at times. Staff also gave examples of incidents which had concerned them and of some practices appearing confrontational and punitive. As noted, some investigations were taking place into this and there had been discussion on a one to one basis and at a recent team-building day. Staff were seen responding to people’s needs and requests in a friendly and professional manner. However, some interaction was observed which was discussed with the manager, as it may have gone beyond humorous banter and become disrespectful. Another interaction was also discussed with the manager, where staff comments may have been perceived as abrupt and discourteous. As noted, a health profile referred to one person as ‘a faddy eater’. Staff were heard to describe one person living in the home as ‘lazy’. It was agreed that the above may represent a training issue. It may be that staff are not be conscious of how some comments and actions are perceived, and of the inappropriateness of certain tones and terminology. As described earlier in the report, there was evidence that the people living in the home would benefit from higher staffing ratios. Comments were made about how personal care in the mornings could be rushed, and how the team was not providing as many one to one activities as people would like. Particular issues with dynamics between the residents were also said to result in significant demands on staff time. As such it is recommended that staffing levels be raised such there are more times when three staff are on shift, particularly in respect of personal care in the mornings and to expand activity provision. The service development manager confirmed that there had been agreement to raise staffing levels in the project which would now be subject to final approval. The manager said that he had been requesting higher staffing levels and that this was being considered, although recruitment difficulties were likely to impact on this even if approved. It was reported that the home was struggling to find applicants for vacant posts, related to its rural location. The difficulties were likely to increase early in 2008, with some staff going on special leave. The manager described how he planned to ensure that cover was maintained during this time. Staff reported that regular bank staff were generally being used, helping to promote consistency, though adding that this had not always been achieved. Some staff felt that the need to use bank and agency staff had impacted on the wellbeing of the people living in the home, for example, contributing to unsettled behaviour. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 27 Discussion with the manager provided evidence that huge efforts were being made to recruit new staff. Some interviews for a senior post were due to take place shortly after the inspection. Policies were seen relating to employment law (dated July 2007), and the recruitment of ex-offenders (March 2002). There was also a recruitment flowchart from December 2006, with a new overall recruitment policy due out in April 2008. The manager described the recruitment process. This included involving the people living in the home, either directly on the interview panel or indirectly through meeting candidates and being invited to give feedback. This is good practice. A staffing file for a person who had been recruited since the last key inspection was checked and found to be in order, although the start date was not clearly identified. A training matrix was supplied by the manager. This indicated that there were significant gaps in mandatory training for staff. However, it was found to be out of date as staffing files, discussion with staff and checking the house diary provided evidence of further training taking place which was not recorded on the summary. A clear picture of the training which staff had undertaken was not obtained in view of the information being recorded in different places/formats or not at all. However, it was identified that some staff still required training in particular areas such as moving & handling and fire safety. As noted earlier, it is also recommended that all staff have refresher training about the safe handling of medication and access training about adult protection. There was discussion with staff about potential benefits of training in other areas related to people’s needs, such as around epilepsy and autism. Some staff reported that this kind of training was not generally being accessed due to short staffing and other pressures on the team at the time. The AQAA noted that staff had received training in signing, particularly in relation to one person’s needs, though noted that further improvements around total communication including use of signing were planned. Staff confirmed that they had received training in signing and there was also evidence on staffing files of this input being provided. Some handover meetings were seen, providing evidence of good communication between team members. This was further evidenced by checking the communication book and a shift summary file. Records provided evidence of regular staff meetings being held and of wideranging discussion. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 28 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Further improvements are needed to the running of the home in order to optimise the safety and wellbeing of the people living there. Systems are in place which help with monitoring and improving the quality of the service. Some aspects of health and safety in the home need attention in order that service users are as safe as possible. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 29 EVIDENCE: At the time of the inspection the manager had been in post for about a year. He reported that the short staffing was impacting on the management role since more time had to be devoted to hands-on care than anticipated. The manager had become registered with us since the previous inspection. As part of this process it was verified that he had achieved an appropriate NVQ qualification to level 4 and the Registered Managers Award in February 2006. In terms of the overall running of the home, as noted in other sections of the report, certain areas such as training continue to require attention, although some progress has been made with addressing shortfalls identified during the previous key inspection. The manager said that his style differed from that of the previous manager and that this had caused some issues within the team. He said that his line manager had been involved, and that initiatives such as team-building days were also helping to address issues around team cohesion and dynamics. Staff were generally positive about the running of the service, pointing out that the manager was very client-focussed, flexible and approachable. There were some comments about short staffing impacting on his ability to effectively manage the service and make changes. The Trust has its own standards for quality assurance. An audit had been done in October 2006. The manager said that he had completed his own audit against these standards. It was agreed that a copy would be forwarded. Reports made under regulation 26 are being sent to us. The most recent regulation 26 report found on file in the home was for 31/07/07. Regulations require that copies of these reports be kept in the home, as these form part of quality monitoring. The manager said that there were regular meetings for the people living in the home. This was also noted in the AQAA. Topics for discussion included the menus, activities and décor/facilities in the building. This was confirmed by discussion with staff and residents. A new health and safety file, including general principles and specific policies and procedures was seen in the home, dated October 2007. Records and checks around the home provided evidence of routine health and safety checks taking place. A health and safety checklist had been in place in the home, though the last entry was for June 2007. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 30 Hot water temperatures were high in some parts of the home, including in communal areas accessed by the people living there and in bedrooms. Recorded temperatures in the second half of 2007 included 48°C, 50°C and 55°C. Guidance at the top of the recording sheet stated that anything up to 50°C was acceptable. The National Minimum Standards indicate that temperatures should be around 43°C. Risk assessments will need to be done about this. If there are areas of the home accessed by residents where it is proposed that the temperature should exceed this figure then a specific risk assessment will need to be done along with a clear rationale. The manager agreed that there were some people living in the home who could potentially be highly vulnerable to scalding, in which case steps will need to be taken to regulate the temperature. Staff who were asked generally felt satisfied with health and arrangements. However, some pointed out that the layout of the building sometimes resulted in overcrowding in some areas, as well as making it difficult to keep an eye on what was happening throughout the home. It was also reported that a door had recently fallen off a kitchen unit narrowly missing a staff member. The manager said that the home’s fire doors had been checked, although there was some uncertainty about whether the door between the two adjoining properties was a fire door. It was agreed that the Local Authority Fire Officer could be asked for advice about this. Following the inspection a Fire Officer confirmed that this was not a fire door. The manager said that he had conducted a fire risk assessment, although this was not checked during the visit. 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 31 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 2 x 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 32 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 YA20 Regulation 13 (2) Requirement Review and provide additional staff training and supervision to make sure staff are competent to administer medicines correctly. Timescale of 31/08/07 not met. Investigate the apparent discrepancy of £1 between a receipt on 12/12/07 and the entry on the person’s financial record, as cited in the text. Check whether the loyalty card used on the above date belonged to the person using the service and take appropriate action if not. Treat vouchers as cash, as per recommendation of the May 2007 financial audit. Staff must receive training appropriate to the work performed. Timescale of 31/08/07 not fully met. Some progress made. DS0000066773.V352022.R01.S.doc Version 5.2 Page 33 Timescale for action 30/04/08 2 YA23 12 (1). 17 (2). Sch. 4 (9) 01/02/08 3 YA35 13 (3), (4) & (5).18 (1) c (i). 23 (4) a. 30/04/08 32-33 Macarthur Road 4 5 6 YA35 YA39 YA42 17 (2). Sch. 4 (6) g. 17 (2). Sch. 4 (5) 12 (1) a. 13 (4) Keep appropriate records of all training undertaken by staff. Keep a copy of all reports made under Regulation 26 in the care home. Take action to address hot water temperatures which are significantly higher than 43°C. Conduct risk assessments and, where appropriate, regulate temperatures to keep them at safe levels. 31/01/08 29/02/08 31/01/08 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 Refer to Standard YA2 YA6 Good Practice Recommendations The Trust should update the referral and admissions policy to take into account the National Minimum Standards. Ensure that all documents are dated. Review all documents in people’s care planning files at suitable intervals and revise them as necessary in order that they are as up to date as possible. Continue to introduce a more person-centred approach to care planning, to help ensure that care plans reflect people’s goals and wishes as well as their support needs. Continue to take action to address possible restrictions on people’s decision-making and choices where these are not appropriate, including the alleged use of sanctions. There should be more explicit consideration given to the Mental Capacity Act and accompanying code of practice in documentation. Ensure that risk assessments are kept as up to date as possible. Consider comments made by some of the staff and people DS0000066773.V352022.R01.S.doc Version 5.2 Page 34 3 YA7 4 5 YA9 YA12 32-33 Macarthur Road 6 7 8 YA16 YA18 YA19 living in the home about there being potential for more support around activities, particularly one to one support (see also comments and recommendation about staffing levels). Staff should pay more attention to people’s preferred form of address. Note comments from some staff about personal care being rushed at times in the mornings, particularly when there is only one female member of staff on shift. Implement a system of ‘Health Action Planning’ in consultation with appropriate healthcare professionals. Ensure that dates of appointments or interventions are recorded in full (including the year). Improve monitoring of people’s weight, including acting on specific recommendations of healthcare professionals in this area. Check whether the advice for one person to have daily exercises as recommended by a physiotherapist is still current. Provide alternative secure storage for cash tins so that they do not need to be kept with medication. Ensure that the double check of the administration record happens on a daily basis so that any errors are quickly picked up. Consider introducing a competency assessment framework for the handling of medication, which staff undertake periodically. Obtain people’s consent for the service handling and administering their medication. Update lists of staff authorised to administer medication (with signatures) and the list of people self-administering. Review medication records to make sure that: • • There is somewhere to note any known allergies. The medicine charts are signed and dated each month by the member of staff preparing these with a second signed check that the details are correct with the doctor’s prescriptions. Quantities of medicines supplied and returned during periods of leave are recorded in order to maintain a DS0000066773.V352022.R01.S.doc Version 5.2 Page 35 9 YA20 • 32-33 Macarthur Road complete audit trail. 10 YA23 Ensure that records of people’s finances are as clear as possible. Staff should use a calculator to check workings out. Follow up point 19 of the internal financial audit of May 2007. It is strongly recommended that training about adult protection and prevention of abuse be provided for all members of the team as part of the overall approach to safeguarding people using the service. Consider repainting bathrooms and toilets with more tired décor, in consultation with the people living in the home. Replace the rusting cabinet in one bathroom. Replace taps which have significant limescale deposits. 13 YA32 Replace carpets which are worn and stained/marked. Continue to address concerns expressed by some staff and some people living in the home about attitudes and values, through avenues such as team building, supervision, training and more formal routes as appropriate (see also specific comments about training). Increase staffing levels, particularly with regard to supporting people with their morning routines and to pursue more individual activities of their choice. Ensure that staffing files clearly identify people’s start dates. Enable staff to access other training related to people’s needs, such as about autism or epilepsy. Consider reinstating the monthly health and safety check, reviewing and revising it if necessary to make it as useful a tool as possible. 11 YA23 12 YA24 14 15 16 17 YA33 YA34 YA35 YA42 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 32-33 Macarthur Road DS0000066773.V352022.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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