Inspection on 30/08/07 for 33 Abbotswood

This inspection was carried out on 30th August 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

33 Abbotswood 16/02/07

33 Abbotswood 12/12/05

33 Abbotswood 25/08/05

33 Abbotswood 21/12/04

33 Abbotswood 01/07/04

33 Abbotswood 12/02/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Abbotswood (33) 33 Abbotswood Guildford Surrey GU1 1UZ Lead Inspector Christine Bowman Unannounced Inspection 30th August 2007 10:30 Abbotswood (33) DS0000040846.V344666.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 Abbotswood (33) DS0000040846.V344666.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. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotswood (33) Address 33 Abbotswood Guildford Surrey GU1 1UZ 01483 440352 01483 566056 fourseasonstrust@yahoo.co.uk 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) The Four Seasons Trust Limited Mr Paul Joseph Fitzroy Bennett Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2007 Brief Description of the Service: 33 Abbotswood, The Four Seasons Trust, is a large detached house developed to provide a good standard of accommodation for 4 adults with learning disabilities and epilepsy. It is set in a pleasant residential area of similar homes and situated close to Guilford town centre. All the service users bedrooms are on the 1st floor are single occupancy and have en-suite facilities. A sleeping-in room is provided for the staff also on the first floor. The ground floor has a dining room, sitting room, utility room, kitchen and toilet. Redevelopment has provided an office leading from the sitting room to accommodate a computer, safe storage for documents and a place for administration tasks to be completed. There is a garden to the rear and side of the property and some off road parking. There is a multi-person vehicle to ensure residents have easy access to local community. The average fees for the service are £915 per week. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over seven hours commencing at 10.30 am and ending at 17.30 pm and was undertaken by Ms Christine Bowman, regulation inspector. The registered manager, Mr Paul Bennett was in the process of interviewing a prospective new staff member when the site visit began and only one client was at home. Two staff members arrived for duty in the morning and one prepared a light lunch. The key standards for Younger Adults were assessed and two client files were viewed, including their care plans, risk assessments, medical information, and daily records. The recruitment process of two staff members was inspected and the staff training and development logs viewed. Menus, policies and procedures, health and safety certificates and the complaints and compliments log were sampled. A partial tour of the shared accommodation was also undertaken. Four surveys were completed and retuned by health and social care professionals, relatives/carers returned three and all the clients also completed surveys with support from the staff. Comments from these sources have been used throughout the report. The Annual Quality Assurance Assessment completed by the home and other information received and recorded on the inspection record since the previous site visit were used in compiling this report in addition to information gathered at the site visit. Thanks are offered to the management, the staff and the clients of 33 Abbotswood for their assistance and hospitality on the day of the site visit and to all those who completed comment cards for their contribution to this report. What the service does well: Comprehensive care management assessments, recorded on client’s files had been undertaken prior to clients being offered a placement at the home four years ago and the four friends had been specially selected as a friendship group with similar interests and abilities to share the home. Information with respect to equality and diversity, including ethnic origin, and religious and cultural needs had been included to inform the home of any special requirements they might need to provide for. A parent commented, ‘they cater for my relative’s very special needs very well. They are very aware of his vulnerability in the community, that when left on his own he wanders off easily – sees a bus or a train and talks to strangers. They are aware of the things he enjoys, such as his hobbies and they make sure he attends Adult Education twice a week, which he enjoys.’ In addition to the attendance at Adult Education sessions, many opportunities were provided for the clients to engage in peer and culturally appropriate Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 6 activities in the community, to access work experience and enjoy holidays abroad and at the home’s caravan by the sea. A healthcare professional commented, ‘this is a very caring home with stable senior staff, who provide holistic and loving care. The ‘boys’ look better every time I see them.’ The clients benefit from living in a home, which is homely, comfortable, clean and hygienic and meets their individual and collective needs very well. The home is spacious, airy, well-furnished and well-maintained. The borders in the garden had been planted with colourful plants and the lawn was well-kept. The manager and a client had been trimming the hedge on the day of the site visit and a greenhouse had been purchased recently to support the clients in their horticultural interests. A parent commented, ‘my son is very happy at ‘The Four Seasons Trust’ and has adjusted very well and made friends. We have been lucky to have retained the manager and deputy manager, who are both dedicated, since it opened four years ago,’ and a care professional stated, ‘This service is quite unusual in that it brought together a group of friends with a shared history. The manager is also part of that happy past. I am glad my client has been enabled to keep up old friendships and develop new ones. This service ‘produces’ four very happy young men’. ‘They provide a safe environment in which our son can live with support and encouragement in a homely atmosphere,’ another parent commented. What has improved since the last inspection? The statement of purpose and the service user guide had both been reviewed and contained more up-to-date information to inform current and prospective clients and their relatives and representative. Review meetings had been held in order to assess the client’s current needs and goals and to inform the individual client’s care plans and up-date them. A statement of risks with respect to the client’s achieving their goals was recorded. A local medication policy and procedure had been developed to inform the staff on the safe receipt, recording, storage, handling, administration and disposal of medication to protect the clients. An up-dated copy of the local authority multi-agency Safeguarding Adults policy and procedures had been downloaded from the website to inform the staff and a flowchart of the referral procedure was available to them. The home had produced a local policy based on the local authority policy, which was very brief. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 7 The situation with respect to the subsidence problem had been clarified and the manager had confirmed that a letter from a structural engineer would be sent to the Commission for Social Care Inspection to verify this. The recruitment process had improved since the previous site visit. The manager stated that a new umbrella body had been used and in respect of the most recently recruited staff member, a Protection of Vulnerable Adults First check had been received prior to the commencement of employment and the Criminal Record Bureau check had been received soon afterwards. Two references had also been received to verify the suitability of the applicant for the caring role. Individual training logs had been compiled to record the training received and planned for individual staff and in which to retain certificates gained. One staff member had completed the common induction standards as a sound introduction to care practise. Quality assurance monitoring had been introduced to ascertain the views of relatives and care and healthcare professionals as a tool for further improvement of the service. Policies and procedures had been reviewed and up-dated to inform the staff and clients. What they could do better: The Service User Guide did not include terms and conditions and information with respect to the arrangements for charging and the paying of fees to inform clients, prospective clients and their relatives and representatives. The client’s care plans did not include their aspirations as well as their goals. The goals were not sufficiently specific to be attainable, were not timebonded and did not include sufficient information to inform the staff of the actions to be taken to support the clients to achieve their goals and develop according to their individual potential. The client’s skills in achieving an independent lifestyle had not been risk assessed to promote continuous development and kept under review. Risk assessments were not detailed enough to show the potential hazards, actions in place to reduce hazards, the level of risk posed to the client and the positive outcomes to the client of taking the risk. The local policy and procedure, which reflects the local authority multi-agency adult protection procedures was very brief and needed to be expanded to inform the staff and protect the clients. A recruitment and employment policy specific to the home was not in place to ensure systems were safe and fair. One of the references received in respect of Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 8 a prospective employee was not from the referee indicated on the application form and no explanation was recorded. Despite an improvement plan, sent after the previous site visit, specifically highlighting the details required for the applicant to complete on the application form to confirm safe recruitment to protect the clients from the risk of potential abuse, a full employment history, an explanation of gaps in employment, a full statement of ‘no criminal convictions’ and reasons for leaving posts, which involved the care of vulnerable adults or children, had not been required for the applicant to complete. No person specification, job description or equal opportunities monitoring forms were held on the personnel files inspected to confirm informed and fair recruitment. The staffs’ individual training plans and records did not contain sufficient information to confirm that mandatory and specialist training has been accessed in a timely fashion and to ensure the clients are supported by appropriately trained staff. Dangerous substances were not stored safely to prevent the risk of harm to the clients. A social care professional stated, ‘I am not aware of any problems. I think this is a great placement for my client because he is so happy and has lots of opportunities that other young men of his age often miss out on. The Four Seasons is his second ‘home’’. 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. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 9 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 Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 10 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): Standards 1,2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the information supplied to current and prospective residents and the lack of an appropriate format leaves them dependent on others for information and not fully informed about the service. The needs of the current clients had been assessed prior to the offer of a placement to ensure their needs would be met and the home had developed an assessment form for prospective clients but there was no admissions policy. EVIDENCE: The statement of purpose and the service user guide had both been reviewed and contained more up-to-date information, but no review date was recorded on the documents and there was no indication of a future review date. Details of terms and conditions and information with respect to the arrangements for charging and the paying of fees had not been included. The manager had ordered an up-to-date copy of the regulations from the Department of Health, but the most recent amendments had not been included to inform him. The service user guide had not been produced in a format, which is more accessible to people with learning disabilities to ensure prospective service users are in receipt of sufficient information to make an informed choice about the suitability of the service to meet their needs, and to ensure current service users have up-to-date information with respect to the service they are Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 11 receiving. The manager was clear in his intention not to produce any documentation in accepted formats, which facilitate service users with learning disabilities to decipher information for themselves. The preferred method of supporting the residents to understand documentation, the manager stated, was one-to-one discussion. Comprehensive care management assessments, recorded on client’s files had been undertaken prior to clients being offered a placement at the home four years ago and the four friends had been specially selected as a friendship group with similar interests and abilities to share the home. Information with respect to equality and diversity, including ethnic origin, and religious and cultural needs had been included to inform the home of any special requirements they might need to provide for. The manager had known all the clients, when he worked with them at a previous placement. The manager stated, ‘clients are still residing with us and are very happy to continue with their placements here. We have received positive feedback from families, social services and other involved outside agencies. Through past knowledge and reviews, all parties involved in the care and well being of the clients agree that this should be seen as a very long term placement’. A form produced by the home for the assessment of prospective clients was viewed and required sufficient information for a decision to be made about the eligibility of the prospective client for the placement and included a visiting plan. The risk assessment, however, was more suitable for admission to a mental health faciliy than a learning disability home and there was no admissions policy to support the documentation. The manager stated in the Annual Quality Assurance Assessment returned to the commission for social care inspection that in this area there was ‘nothing the service could do better at present’. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 12 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): Standards 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements had been made in that care plan reviews had taken place to assess the changing needs of the clients, but care plans and risk assessments required more detail in order to provide the care staff with essential information to support the clients in shorter-term personal goals. Plans were not in a person-centred format to empower and enable clients to take some control of their own lives and to gain independence skills according to their individual abilities. EVIDENCE: The files of two clients were viewed and records confirmed that review meetings had been held within the last six months. The home had recorded the minutes of the review meetings, which did not include those present. The manager stated that the care managers had yet to send the official minutes of the meetings with signatures of the clients and/or representatives to confirm they agreed with the contents. The resulting care plans included up to four long term goals with respect to personal hygiene, peer relationships, community activities and appropriate behaviour, family contact, education and completing tasks with respect to self-help and domestic skills. However, Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 13 the goals were very general and not specific enough be achievable. There was also no information to instruct the staff of actions to be taken to support the clients to achieve the goals. Risk assessments were included as a statement after each goal, but were not detailed enough to show the potential hazards, actions in place to reduce hazards, the level of risk posed to the client and the positive outcomes to the client of taking the risk. The client’s future aspirations had not been recorded and the plans were not in a format normally accepted as supporting people with learning disabilities to understand, be involved and take some control over their own lives. A parent commented, ‘they cater for my relative’s very special needs very well. They are very aware of his vulnerability in the community, that when left on his own he wanders off easily – sees a bus or a train and talks to strangers. They are aware of the things he enjoys, such as his hobbies and they make sure he attends Adult Education twice a week, which he enjoys.’ Clients had been allocated key workers to ensure continuity of support and to assist them with decision-making. Client meetings, the minutes of which were recorded offered clients the opportunity to give their views on important issues about the running of the home and plans such as where to go on holiday. The Annual Quality Assurance Assessment completed by the manager confirmed that, as a result of discussions with the clients, a football goal had been erected in the garden, the arrangements for the two annual holidays had been made and plans had been considered and were in place for a games/activity room to be added to the structure of the home. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 14 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): Standards 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. Many opportunities are provided for the clients to engage in peer and culturally appropriate activities in the community. Relationships are promoted and clients benefit from a wholesome, balanced diet. EVIDENCE: Records of review meetings confirmed that clients continued to attend further education courses. The Merrist Wood course had been completed and the clients had attained certificates in ‘Skills for Life’. Twilight classes at Guildford College had been booked for all four clients from the beginning of the new educational year. On Tuesday evenings from 4.30 to 8.30 a cooking session was planned and ‘the students will provide the ingredients and cook their own evening meal’, the manager stated. The Thursday session scheduled at the same time was for work related skills. The clients continued to do voluntary work at the Edwardian Steam fair at Hollycombe and the manager was looking into the possibility of a change of location for work experience placements from Hatchlands to Polsdon Lacy, another National Trust property. The clients had spent the past three years working at Hatchlands. A Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 15 relative commented, ‘They try to provide suitable activities and a variety of experiences for example work, social and educational.’ Daily records confirmed the clients had busy social lives and were supported to maintain contact with their families. Some of the regular clubs attended by clients included a music club, a social club and a church group. Discos, bar-bcues, swimming, bowling sessions and dinners out were amongst the activities clients engaged in. The home has its own vehicle for shopping trips and days out. The manager stated that the relatives of one of the clients’ lives by the sea and some weekends they all take him to visit his relatives and everyone else enjoys a day at the seaside. Clients also enjoyed football, cricket, badminton and mowing the large lawn surrounding the home. The manager and one of the clients had been trimming the hedge on the day of the site visit. The clients had already taken two holidays to the same locations as the previous year, as they ‘had enjoyed themselves so much’. Photographs and videos had been viewed at a previous site visit. Two weeks had been spent in Tenerife and another ten days staying at the home’s caravan at Pagham. There was a possibility of a trip to the continent on Eurostar in the near future, but it was just at the planning stage, the manager stated. All the clients confirmed in the surveys they completed that they always made decisions about what they did each day. Menus continued to be well balanced and nutritious and fruit was always available. As the site visit drew to a close a staff member was preparing tea which consisted of Turkey fillets, potatoes, corn on the cob, green beans and mushrooms. The fresh vegetables were being steam cooked to retain the nutrients. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 16 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): Standards 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients receive the support they require and access specialist services to promote their health. Medication policy and procedure instruct the staff on the safe handling and administration of medication. EVIDENCE: All the clients confirmed in the surveys they completed that they could do what they wanted during the day, in the evening and at weekends. Key workers were allocated to clients to provide consistency and continuity. All the clients commented that the carers always listened to what they had to say and acted on it. The clients also made comments about the support they received from the staff in completing the surveys, ‘I filled this form in with help. The staff helped me to understand some of the questions,’ and ‘I filled the form in with help from a member of staff, who helped with the reading.’ A relative commented, ‘As our son is unable to live without the full support of the Four Seasons Trust, we are very happy the staff are able to support and encourage him as much as possible.’ The clients continued to require only prompts from the staff to complete personal care tasks. A record of appointments with healthcare specialists continued to be kept in daily logs and future appointment dates were in the Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 17 diary. All the clients were registered with a General Practitioner and records confirmed they kept appointments for annual medical checks and dental checkups. There was evidence that the manager had booked a staff member on a health action-planning course and was given the wrong venue. The manager stated that this method of recording would be completed for clients when the staff had accessed the training. A local medication policy and procedure had been developed to inform the staff on the safe receipt, recording, storage, handling, administration and disposal of medication. A certificate with respect to medication administration in care homes was viewed on one of the staff files inspected and the manager confirmed that only trained staff administered medication. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Clients are supported to make their views known and feel they are listened to. The homes’ own safeguarding policy needs to be expanded to provide more information to the staff to safeguard the clients. EVIDENCE: All the clients stated in the surveys they completed that the carers always listened to what they had to say and acted on it. Client meetings were arranged with minutes taken and client participation recorded. All the clients confirmed they knew who to speak to if they were not happy and knew how to make a complaint. The client’s version of the complaints procedure included symbols of unhappy and happy faces to indicate worries and problems solved. All the relatives who completed surveys confirmed they knew how to make a complaint should they need to do so. Two confirmed the care service responded appropriately if the person using the service had raised concerns about their care and one stated ‘it had not been applicable to date’. A care manager commented, ‘my client’s parents have a good rapport with the service and they are happy with the way things are dealt with.’ A complaints folder was available for inspection but there were no entries. The manager stated, ‘No complaints have ever been made.’ The compliments folder contained a compliment from some visitors from another home, ‘Thank you for the lovely visit. What a lovely house you live in and thank you for making us so welcome.’ An up-dated copy of the local authority multi-agency Safeguarding Adults policy and procedures had been downloaded from the website to inform the staff and a flowchart of the referral procedure was available to them. The Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 19 home’s policy based on the local authority policy and procedure was very brief and needed to be expanded to provide more information to the staff. Training logs viewed did not contain certificates for training in the Protection of Vulnerable Adults, but the manager stated the training had taken place on 17/07/07 and the certificates had not yet arrived. ‘They provide a safe environment in which our son can live with support and encouragement in a homely atmosphere,’ a parent commented. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 20 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): Standards 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients benefit from living in a home, which is homely, comfortable, clean and hygienic and meets their individual and collective needs. EVIDENCE: The home was suitable for its stated purpose, well-maintained and met the client’s needs in a comfortable and homely way. The borders in the garden had been planted with colourful plants and the lawn was well-kept. The manager and a client had been trimming the hedge on the day of the site visit and a greenhouse had been purchased recently. It was not yet ready for use, but the manager stated that the clients would be growing plants from seed in the future. There were tomato plants growing in the garden and garden furniture for the clients to enjoy. The home was attrative externally and internally and was located on a quiet road on a private estate of similar large detached houses. Internally the home had benefited from complete redecoation over the last twelve months and was bright, cheerful and fresh. Improvements to the facilities over the last twelve months included the incorporation of an office on the ground floor facilitating the administrative processes and providing a more convenient place to store confidential information. The manager stated in the Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 21 Annual Quality Assurance Assessment that the clients had suggested they would like a games/activity room to be added to the structure of the home and this proposal was under consideration. The home was spacious, having a large, well-equipped sitting room containing a television, DVD player and comfortable seating, a separate dining room, containing good quality domestic furniture and appropriate lighting. Shared accommodation also included a large kitchen with a breakfast bar and a utility room. The clients’ bedrooms were large, wellfurnished, comfortable and personalised and each had their own en-suite facilities. Possible evidence of recent subsidence had been noticed at the previous site visit in that new cracks had appeared in the stairwell, since the structural reinforcement had been carried out and the home had been redecorated. Written confirmation from someone qualified to make a judgement to verify that the premises were of sound construction and safe for the clients to live in had not been sent to the Commission for Social Care Inspection local office. The manger stated in the Annual Quality Assurance Assessment that when purchased, the home had an ongoing subsidence claim with their insurers. In 2005 the home was banded and this had cured the subsidence problem. Due to the hot summers we had been experiencing, some settlement cracks had appeared around the landing, which the insurance company were still liable for. ‘We are in regular contact with the insurance company and structural engineer and have been assured that these matters will be resolved quickly’, he stated. This issue was discussed with the manager, who gave assurances that that a letter would be sent from a structural engineer to confirm the safety of the building. The home was clean and fresh on the day of the site visit and all the clients confirmed in their comment cards, that this was always the case. The manager stated, an infection control policy was in place, that the Department of Health guide ‘Essential Steps’ had been used to assess the home’s current infection control management and that an action plan was in place with respect to work still to do. There was no evidence of infection control training in the staff training logs. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures, though improved, were not sufficiently robust to ensure the right people are recruited for the posts and could put the residents at risk of harm, poor practice or abuse. Shortfalls in the staff training records meant that it was impossible to confirm that mandatory and specialist training has been accessed in a timely fashion. EVIDENCE: Of the three surveys completed by social care professionals, one thought the staff always have the right skills and experience to support the client’s social and healthcare needs and two thought they usually did. One social care professional commented, ‘ A staff member supported my client at his review and was skilled in supporting him to speak and answer my questions put to him.’ Two of the three relatives, who completed surveys, thought the care staff always had the right skills and experience to look after the clients properly and one thought they usually did. A parent commented, ‘We have not met anyone who works at the Four Seasons Trust, who does not seem to be the ‘right’ type of person’ with the skills necessary to look after the young adults in their care.’ All the clients thought the staff always treated them well that they always listened to what they had to say and acted on it. They also commented that the staff had helped them to read and understand the Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 23 questionnaire. The manager confirmed that at least 50 of the staff had achieved a National Vocational Qualification at level 2 or above or already held an equivalent qualification. The two staff members on duty on the day of the site visit confirmed they had access to training and that they were encouraged to participate. The home had not developed a recruitment policy and procedure specific to the home to ensure systems were safe and fair. There was no evidence that qualities, experience and qualifications of potential care staff were considered in the process. Interview notes had been retained on file but contained no record of the applicant’s skills, experience, attitudes or questions with respect to their caring abilities or knowledge. Despite an improvement plan, sent after the previous site visit, specifically highlighting the details required for the applicant to complete on the application form to confirm safe recruitment, a full employment history, an explanation of gaps in employment, a full statement of ‘no criminal convictions’ and reasons for leaving posts, which involved the care of vulnerable adults or children, had not been required for the applicant to complete. No person specification, job description or equal opportunities monitoring forms were held on the personnel files inspected to confirm informed and fair recruitment. Two personnel files were inspected, however only one staff member had been recruited since the previous site visit and a Protection of Vulnerable Adults First check had been received prior to the commencement of employment and the Criminal Record Bureau check had been received soon afterwards. One of the references received was not from the referee identified on the application form and no explanation was recorded. Staff, who are not recruited through a robust procedure could put residents at risk of harm, poor practice or abuse. The training records of two staff members were inspected and the overview of all the staff training. Both files contained evidence of an induction. One was the home’s own induction but the second also contained completed records showing that the staff member had completed the Common Induction Standards to show they were well prepared for the caring role, however, the two Learning Disability Framework Award standards had not been included to ensure the new staff member had an initial understanding of the needs of the clients. Individual training logs consisted of a folder with certificates received and showed training planned for the forthcoming year. Certificates covering mandatory training included moving and handling, First Aid, food hygiene and health and safety (including fire safety). Infection control training was not included. Other training included medication for care homes, epilepsy (including the administration of rectal diazepam) and autism awareness. There were no certificates to confirm the staff had received training with respect to the Protection of Vulnerable Adults, but the manager stated this training had taken place on 19/07/07 and the certificates had not arrived. Individual training logs did not give a chronological list of training the staff had received or the date they commenced employment. The overview of the staff training did not clarify when the staff member had received the training previously, but Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 24 it did record planned training dates. It was difficult to judge if all the staff had received mandatory training in a timely fashion, in that food hygiene training had been completed prior to handling the client’s food, or that all the staff that administer medication, had been trained by an independent organisation. A social care professional commented, ‘Following open conversation with the staff it is clear they are very receptive to actively improving their service for users and carers etc.’ Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 25 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): Standards 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite improvements made and the positive and supportive comments of those who know the service well, shortfalls in record keeping, the compiling of policy and procedure, health and safety and lack of evidence of the commitment to support the clients to achieve their full potential with respect to self-sufficiency means the clients do not benefit from a well run home, have their best interests safeguarded or their health, safety and welfare protected and promoted. EVIDENCE: From observations made, comments recorded in surveys and from speaking with staff members, it was evident that the manager had a charismatic leadership style and was thought of highly by the clients, the client’s parents and other professionals. The manager’s relationships with the clients, observed on the day of the site visit and on a previous site visit, confirmed he knew them very well, could predict their wishes, cared for them as a group of Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 26 friends and wanted to protect and preserve the lifestyle the home had created for them. He had an excellent rapport with them, which was observed in the gentle banter between them and the smiles on the client’s faces when engaging in conversation with him. A parent commented, ‘my son is very happy at ‘The Four Seasons Trust’ and has adjusted very well and made friends. We have been lucky to have retained the manager and deputy manager, who are both dedicated, since it opened four years ago.’ A care manager wrote in the survey he completed, ‘ I have never had cause for concern about this service. I have always found the manager open, caring and enthusiastic.’ The manager had completed the Registered Managers’ Award within the past twelve months and stated that the deputy manager is in the process of undertaking the National Vocational Qualifications at level 4 in management and care. Although a great deal of work had been completed since the previous site visit to improve the quality of the home’s record keeping and written policies and procedures, more work is required to bring them up to the excellence of the day-to-day practice recognised by those who know the service well. Since the previous site visit relatives had completed quality assurance questionnaires, and the manager stated that a report had been compiled for the trustees. Some of the comments taken from the home’s surveys included, ‘Our son has made good relationships with both the clients and the staff and in addition other social contacts have been made through activities supported by the Trust,’ and, ‘We would like to thank the staff for the help and support in providing an extended family and an extended family environment.’ The Annual Quality Assurance Assessment completed by the home confirmed that the equipment had been maintained in a timely fashion and certificates sampled including the Control of Substances Hazardous to Health (COSHH) risk assessments were found to be in order. However, the manager stated, the COSHH cupboard was never locked even though bleach and other hazardous substances were stored there. He was advised to ensure this omission was rectified as soon as possible to safeguard the clients. The records of staff training and retention of certificates to confirm training received were not sufficient to confirm that all the mandatory training was up-to-date. There was evidence, however, to confirm that the home had initiated the common induction standards for new staff, but the Learning Disability Framework Awards had not been accessed to support new staff to gain an understanding of the needs of the clients. The home did not have fire safety exit signs, but the manager explained that the fire service recognised that due to the small number of clients, the number of exits and regular fire drills they were not required. Care professionals commented, ‘I believe the manager has full respect for the clients, as a professional going into Four Seasons I find the communication open,’ and, ‘This service is quite unusual in that it brought together a group of friends with a shared history. The manager is also part of that happy past. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 27 I am glad my client has been enabled to keep up old friendships and develop new ones. This service ‘produces’ four very happy young men’. Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 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 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation Requirement Timescale for action 26/10/07 2. YA6 5(1)(ba)(bb)(bc)(bd) The Service User Guide must include terms and conditions and information with respect to the arrangements for charging and the paying of fees. 14(2)(a)(b) The client’s care plans 15(1)(2)(a)(b)(c)(d) should include their aspirations as well as their goals, which should be specific, attainable, time-bonded and include enough information to inform the staff of the actions to be taken to support the clients to achieve their goals and develop according to their individual potential. 13(4)(b)14(2) 26/10/07 3. YA9 The client’s skills in 26/10/07 achieving an independent lifestyle should be risk assessed to promote continuous development and kept under review. The local policy and procedure, which reflects DS0000040846.V344666.R01.S.doc 4. YA23 13(6) 28/09/07 Abbotswood (33) Version 5.2 Page 30 the local authority multiagency adult protection procedures, must be expanded to inform the staff and protect the clients. 5. YA34 19 Schedule 2 A recruitment and employment policy and procedure must be in place and all necessary checks and documentation completed in respect of staff in order to protect the clients from the risk of potential abuse. The staffs’ individual training plans and records must contain sufficient information to confirm that mandatory and specialist training has been accessed to ensure the clients are supported by appropriately trained staff. Dangerous substances should be stored safely to prevent the risk of harm to the clients. 26/10/07 6. YA35 19 26/10/07 7. YA42 4(a)(c) 01/09/07 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 YA1 Good Practice Recommendations All the documentation produced for the clients including The Service User Guide, the care plan and the minutes of client meetings should be produced in a format, which is DS0000040846.V344666.R01.S.doc Version 5.2 Page 31 Abbotswood (33) more accessible to the clients to aid their communication, facilitate their participation and empower them. 2. YA34 It is recommended that the Criminal Record Bureau website is accessed to obtain current information with respect to CRB checks and their recording, storage and retention to protect this sensitive information. It is recommended that the staff training include the Learning Disability Framework Awards as a sound introduction to care practise for those with learning disabilities. The staff training overview should include the dates the staff commenced employment, the date of the most recent training and the planned dates for future training so that it is possible to ascertain if training has been accessed in a timely fashion and that the staff are suitably trained for the work they undertake. 3. YA35 4. YA35 Abbotswood (33) DS0000040846.V344666.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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