Inspection on 15/07/08 for 33 Montserrat Road

This inspection was carried out on 15th July 2008.

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

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

Other inspections for this house

33 Montserrat Road 15/08/06

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 33 Montserrat Road Lee-on-Solent Hampshire PO13 9NE Lead Inspector Jan Everitt Key Unannounced Inspection 15th July 2008 10:30 33 Montserrat Road DS0000067405.V366938.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 33 Montserrat Road DS0000067405.V366938.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. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 33 Montserrat Road Address Lee-on-Solent Hampshire PO13 9NE 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) 01905 338626 Sanctuary Care Ltd Mrs Lesley Joy Senior Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: 33 Montserrat Road is registered to provide care and accommodation for up to four younger adults who have a learning disability. This is a four bedroomed detached house situated in a quiet residential area of Lee on Solent. The home is a short distance from the seafront at Lee on Solent and is close to local shops and amenities. A frequent local bus service operates from the nearby town centres of Gosport and Fareham. The home is owned by Sanctuary Care Limited and managed by Mrs Lesley Joy Senior. The current weekly fee is £435.09 plus a client contribution of £62.35. The fees do not include chiropody, holidays, outside entertainment and personal items. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 star. This means that people who use this service experience GOOD quality outcomes. The site inspection visit to 33 Montserrat Road, Lee-on-Solent, took place on the 15th July 2008. We gave the manager minimum notice of our visit to ensure that a member of staff and some residents would be at the property to assist us. The manager, Mrs. Lesley Senior and two residents assisted the inspector throughout the visit. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The home sent us their Annual Quality Assurance Assessment (AQAA) in December 2007 and from this an Annual Service Review (ASR) report was sent to the home. The focus of this visit to the home was to support the information stated in the AQAA and the ASR and other information received by the CSCI since the last inspection visit of 15th August 2006. Documents and records were examined and staff working practices was observed where this was possible. The inspector looked around the home and spoke with two of the four residents, who were at home that day. The other two residents being out at work. Those spoken to expressed satisfaction about their home and were very satisfied and complimentary about the lives they live and were happy to show us around their home. Surveys had been distributed to service users, relatives, staff, care managers, GP and other visiting professionals. Fifteen staff surveys were returned to the CSCI. The surveys returned from staff also indicated that they have good training opportunities, are listened to and feel very supported by the management. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 6 What the service does well: The home has effective systems for assessing residents’ needs and for planning ongoing care and support with their involvement. All information about the service and care plans are produced in a pictorial format and residents are able to participate fully in all monthly and annual reviews. Residents have opportunities to exercise choice and to take part in the daily routines of the home and are able to contribute to the decisions made about the home. Independence in all areas of their lives is risk assessed and managed accordingly to enable residents to reach their anticipated goals. Residents are supported to access the local community, maintain relationships, undertake activities of their choice and attend the local day service. The home ensures that service users’ have access to specialist healthcare support as required. The home offers a good standard of accommodation for residents and the house has an ongoing maintenance programme in place. Staff recruitment procedures, induction, training and supervision are in place to protect and support service users and the home encourages and supports all staff to undertake care related qualifications. The home listens to residents’ views and concerns and are responded to appropriately. The home has reviewed policies and procedures in place to ensure safe working practices for residents and staff. Residents spoken with at the time of this visit said they were very happy with their home and they were able to make decisions and choices and are able to live their lives as they wish. Residents said they knew how to complain and who to, and the complaints procedure was in pictorial format for them to understand. Staff surveys returned said: ‘We are well supported with training and by the manager’. ‘I feel we have the right support and knowledge to meet the needs of the people who live in this service. ‘Care plans are updated regularly ‘We have regular training which is helpful’. ‘The residents live individual life styles and are appropriately occupied’. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 7 ‘Residents mix well in the community and all service users are offered outings and a holiday’. ‘We put residents first and give them choices and control over their own lives’. What has improved since the last inspection? What they could do better: 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. 33 Montserrat Road DS0000067405.V366938.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 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that service users’ aspirations and needs are assessed before they move into the home EVIDENCE: There had been no new admissions to the home since December 2005, this resident being transferred from the sister home in the locality. The care plans viewed evidenced that initial assessments had been undertaken in consultation with the prospective resident, care managers and relatives/advocate. The manager told us that following this assessment, it would be decided if the home could meet the person’s needs and whether they would fit in with the other service users. If so, the resident would then be invited to come to the home to stay for extending periods of time, to enable them to integrate into the home gradually. A trail period would then be planned for the resident and following this a review meeting would be set for the resident, relatives/advocate, care manager, to discuss the outcome of the this trial period and for a decision to be made about the resident moving into the home permanently and being issued with a contract of terms and conditions of residency. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 10 From the initial assessment, care plans and risk assessments start to be developed. These are initially reviewed monthly and then six monthly. There was evidence of these reviews in the care plans viewed. The previous report identified that the Statement of Purpose needed to be reviewed to reflect the organisation that had taken over the ownership of the home. This has now been developed and is available. The AQAA states that this information is to be transferred a graphic format to ensure residents fully understand its content. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are clear and effective care planning and risk assessment systems in place to promote service users’ independence and provide staff with the information they need to meet service users’ needs. Service users are enabled to make decisions and the staff provide them with appropriate support. EVIDENCE: . A sample of two resident’s care plans was viewed. The care plans are very comprehensive and contained information and guidance for meeting each resident’s individual needs. Care plans are reviewed monthly and this is undertaken by the key worker in consultation with the resident who has the one-to-one meetings with their key worker, at which time residents are encouraged to discuss any changing needs they have and agree plans to meet their needs and choices. The records of these monthly meetings and the 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 12 issues discussed are documented in detail and are maintained in the care plans, we saw these. The organisation, that own the home, are currently piloting a new care planning system which is more person centred and consists of a personal planning book for residents to go through with their key worker. The book is in a pictorial format and identifies all aspects of the resident’s life and their perception of how they wish to live their lives and records their goals and aspirations. The residents feel more ownership of their care plans now they are keeping a copy in their rooms and are more involved with all reviews. Daily notes are recorded by key workers describing the activities of the day and how the resident has spent their day. There was evidence in the care plans that care plans are reviewed monthly, six monthly and annually. The yearly review reports include a summary of notable events over the past year, significant progress and areas for development. Service users’ relatives are invited to attend the six-monthly and annual reviews. We viewed evidence of a letter of invite to one parent, who declined to attend the review but who wrote very complimentary comments in the letter about the service and her son’s care. There was information on each specific identified risk, action needed to manage the risk and the people responsible for this. Risk assessments included, for example, activities such as making hot drinks and accessing the community and for one specific resident there was detailed risk assessments around his sexual orientation. The risk assessments were clearly linked to promoting service user’s independence, participation and choice. Staff comments on surveys returned to CSCI say that ‘Care plans are updated regularly’. ‘We look after residents in a person centred way all the time’ ‘We staff promote the resident’s independence’. ‘We put residents first and give them choices and support them to have control over their own lives’. The two residents that were at home at the time of this visit told us that they make decisions about their lives and make choices and are able to live their lives as they wish. One resident was observed to go out to the bank independently and the manager said he does this every week as part of his routine. Records that documented the service user’s daily activities were seen and evidenced that residents have a varied and daily choice of activities and are supported and encouraged to make their own decisions and choices. The home provides appropriate assistance to service users with managing their finances and this is well documented. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit through opportunities to take part in appropriate activities, access the community, maintain relationships and participate in the planning of meals. Resident’s rights and responsibilities are recognised in the daily routines of the home. EVIDENCE: The home accommodates four residents. They are all of a similar age and the two residents spoken to say they mix well get along alright. The residents also enjoy going to visit the other home along the road and have friends who live there. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 14 The care plans viewed, evidenced that the residents have excellent social and educational programmes in place. The residents are supported to attend college courses of their choice and two of the residents have jobs, one having worked for a number of years at a Gardening Centre and another at a voluntary work placement in the community for four days of the week. The two residents at home were spoken with and one said he had had various jobs over the years but he did not work now, another said she goes to day centre during the week and has attended various college courses and hopes to return after the summer. The residents at home on the day of this visit confirmed that they enjoy going to the local shops, shopping, pubs for lunch, cafes, and visiting the sister home down the road. Outings are arranged on an individual basis with the key worker or as a group. A resident told us that he and his support worker plan an outing of his choice for a day each week. He was keen to show us the records in the care plans that demonstrated the various outings he had been on in the past and the photographs of the events. Another resident told us that she was a member of an advocacy group and she was also was the home’s representative at the Sanctuary Help to Involve Residents Equally, (SHIRE) monthly meetings. These meetings are held at a venue and are attended by representative from each service in the group, and are chaired by a resident. It is at these meetings that issues can be aired and suggestions can be discussed, which are then taken back to the management team for the organisation, who take the comments seriously and take action if indicated. Family links and friendships are important to the residents and are supported and documented in the care plans. Residents go out into the community freely and this is risk assessed and documented. The manager said that the residents are involved with fund raising to buy a ‘people carrier’ for the homes and they had recently had a stall at the local church fete at which they sold the goods they have been involved in making, and this had proved very successful. A resident told us that he and other residents had attended the church fete and had enjoyed it. The manager said that residents from the home and neighbouring home enjoy a good relationship with the neighbouring community. The home and staff do support the residents to go on holiday. We looked at photographs with a resident who described her recent holiday to a holiday camp. Most of the residents from both houses had chosen to go on this holiday with the staff to support them. The resident told us that they had had a great time and that she was eagerly awaiting the dates of the next holiday to the same place, which the deputy manager was booking for next year. The manager told us that the residents really enjoy their holidays and had integrated well with other holidaymakers. The AQAA identifies that the home has provided more outings, celebrations and house parties in the previous year and house activities have increased. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 15 Service users have responsibilities for helping with the daily routines of the home with the support of the care worker, and these were well documented. The AQAA stated that residents are supported to do their own laundry, clean their rooms and help clean the communal areas. A resident spoken to told us that it was her day for cleaning her room and changing the bed and that the home was waiting for a new washing machine to be delivered so she was going down the road to the other house to use their machine. The other resident was observed to be cleaning the kitchen. The support worker on duty confirmed that he would give support and guidance, if necessary. The home was observed to be neat and tidy at the time of this visit. A resident confirmed that they have their own house and room keys. The staff member on duty at the time of this visit was observed to be interacting with the residents in a friendly and respectful manner. Service users were seen to be able to move about the communal areas freely and could choose whether or not to be alone or in company, one preferring to sit and talk to the staff. Food menus are devised on a week-by-week basis with service users taking turns to help plan and prepare the main meals whilst acknowledging the resident’s likes and dislikes. Drinks and snacks are freely available. Residents are supported to make their own breakfast and lunch and packed lunch if they attend day services. 33 Montserrat Road DS0000067405.V366938.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): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal and healthcare support to meet their individual needs and are protected by the home’s medication policies and procedures. EVIDENCE: The AQAA stated that personal hygiene support preferences are established and respected. Cross gender care does not take place where this has been specified and where not specified is only provided in an emergency. The home has a good mix of both male and female staff and there is a written policy on staff members giving cross-gender personal care. A resident spoken with confirmed that they were well supported by the staff team and that they choose their own clothes and go to the hairdressers when they wish. The care plans identify the individual support needs that each resident needs. The residents living in the home currently are independent with their personal care. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 17 The residents do choose when they get up and go to bed, but are encouraged to have set times for this if they are attending their chosen activity the next morning. This was confirmed when speaking to a resident who stated her times for getting up and said she got up earlier on the days she was going out to day centre. Residents are registered with the local GPs and are able to attend surgery, with support, if they should need to do so. Residents are encouraged to discuss their own health issues when ever possible. All residents attend the GP surgery for a yearly health check. Optician, dentist and chiropody are available to residents in the community and home. The care plans evidenced that health care records are maintained and health care needs are monitored and met. The key worker accompanies residents to any outpatient’s appointments. The residents do have support from the learning disability community team Resident’s support needs, with regards to medication, is detailed in their personal care plans. There were no service users able to manage their own medication appropriately, except for one resident who was self-administering topical cream to their skin. There are written procedures for the receipt, recording, storage, handling, administration and disposal of medicines. At the time of the visit there was only a small amount of medicines kept in the home and these were stored appropriately in a secure environment. We observed the support worker administering a resident’s medication. The procedure for this home is that the resident attends the office and the support worker administers medication to them. A sample of the administration records was checked, these were appropriately recorded. The home also keeps a record of medication taken out and returned for when service users go away. Medication training is provided for all staff and this is being reassessed by Boots pharmacist that supplies the medication. The manager said that the home is striving to communicate better to residents in words they understand, any information resulting from a medical visit and for staff to communicate faster when they observe any changes in a resident’s health status. 33 Montserrat Road DS0000067405.V366938.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): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems for ensuring that residents’ views are listened to and responding to any complaints. Residents are protected by the home’s policies and procedures for responding to any form of abuse. EVIDENCE: The service has a complaints procedure that is available to residents and relatives in the Statement of Purpose. This procedure is also produced in a pictorial format, which is kept in resident’s care plans held in their rooms. This enables residents to better understand how and to whom any complaints or issues should be dealt with. The complaints procedure is regularly discussed with residents at their monthly one-to-one meeting with their key worker at which time they are asked if they have any complaints or issues they wish to talk about. This was evidenced in the monthly meeting records. The complaints log was viewed and the home has not received any complaints. The manager told us that if there are issues they are discussed at an early stage and resolved. The AQAA states that the home distributes surveys to service users and relatives, who are encouraged to air their views, which the manager said, are received by she and the staff with a positive attitude. The 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 19 outcome of any complaints/issues highlighted, are discussed at the team meetings where any actions required are planned and discussed. The two residents spoken with said they would talk to their key worker if there were any problems. The service has a copy of the Hampshire ‘Safeguarding’ procedures. Residents are made aware of abuse using pictorial format to enable them to know what is acceptable behaviour from others and what is not. This procedure is also kept in resident’s care plans in their room. Staff are provided with training on safeguarding and abuse during their induction programme and further training is provided through NVQ training and in-house mandatory training by viewing a DVT and completing a questionnaire to test knowledge. The AQAA states, the service wishes to update on abuse and safeguarding training more frequently for staff to achieve greater awareness. The manager told us that the staff is shared between the two homes in the same locality, and there had recently been an incident with a resident from this home, which had been reported following the agreed procedures. This incident was currently being investigated and dealt with within the organisations disciplinary protocols and the home would inform the CSCI of the outcome and conclusion from this investigation. All staff undergo a Criminal Record Bureau check (CRB) and a Protection of Vulnerable Adults (POVA) clearance before they commence employment. The management of the resident’s finances was discussed with the manager. We viewed the financial files. All residents have bank accounts. One resident was going to his bank independently during this visit. There was evidence that residents had signed an agreement for some of their monies to be in the home’s safe. There are procedures and finance routines to follow for the collection of client’s contribution and all transactions are recorded and signed by the resident and the support worker dealing with the money, these were seen by us. 33 Montserrat Road DS0000067405.V366938.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): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a clean and comfortable environment. However there are areas of the home that are in need of refurbishment and redecoration. EVIDENCE: The home is a spacious four bed roomed property situated in a quiet residential area close to the sea front. A resident accompanied us and showed us around the building and we visited the communal areas of the lounge/dinner, kitchen, bathroom, downstairs shower room and the two bedrooms of the two residents at home at the time of this visit. The home was seen to offer a comfortable, environment that was reasonably clean but because the home needed to be redecorated that paintwork looked dirty. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 21 A resident told us that he had painted his room the colour he chose with the help of the staff. Another resident said she was in the process of painting her room. Both said they were very happy with their rooms. One overlooked the sea and the other room being very large. The other two rooms were locked at this time, the residents being at work. The house is in need of redecoration and refurbishment in all communal areas. The manager agreed that this is acknowledged by the organisation and that the refurbishment of the downstairs shower room and the redecoration throughout the whole house is high on the agenda for the next cyclical maintenance year when a budget will be set in October 2008. She told us that this year’s budget had been spent on the other house in Victoria Square, which had been refurbished throughout. The staff have made a good job of making the front garden low maintenance and this looks attractive. The back garden is a good size and is mainly laid to grass. The garden area at the back was in need of some attention, to prevent areas becoming overgrown. Through discussion with the registered manager it appeared that the home’s staff currently maintained the garden. This is outside of the care role and will have an impact on staff support for service users. It is therefore recommended that the organisation increase its support in this area. The washing machine at the home is situated in the kitchen as part of normal domestic arrangements and service users have a routine for their weekly laundry. The washing machine was out of order on the day of this visit and the manager was awaiting the arrival of a new machine within the following two days. Alternative arrangements had been made for the residents to do their washing at the sister home. The home has an infection control procedure and personal protective clothing is available for staff. At the time of the visit an adequate standard of cleanliness was observed throughout the home. 33 Montserrat Road DS0000067405.V366938.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): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s staff recruitment procedure and are supported by appropriately trained and supervised staff. The home supports and encourages staff to undertake relevant care qualifications EVIDENCE: The AQAA states that the home has a stable consistent staff team with the shortest length of time in post being one year. The AQAA records that staff have developed good relationships with the service users and are aware of their needs. Residents are able to trust and rely on each staff member and are able to discuss more delicate matters with them. This was evidenced in the daily records and care plans that contain records of staff interactions with residents and also records the monthly meetings. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 23 The relationship between staff member on duty and the residents at home was observed to be good and residents said they were supported and were able to talk to staff at anytime The AQAA records that all staff are encouraged and supported to undertake NVQ training. 7 of the 8 support staff have now achieved their NVQ level 2 or 3. Five staff are to commence their NVQ level 3 training in October 2008. The AQAA told us that four staff have been inducted to pilot the Learning Disability Qualification and it is anticipated that they would have achieved this qualification imminently. All staff will have achieved a minimum care qualifications of NVQ level 2. There was evidence that this has been achieved. The inspection report of July 2006 stated that in addition to the registered manager, who also manages the other nearby home, there is one member of staff on duty at any time during the day. There is no sleep-in carer in this house. It is shared with the other house and there is an on call system in place that goes directly through to Victoria Square, should a resident need a carer in the night. There is a good mix of both male and female staff at the home. The staff surveys returned to CSCI, two of the fifteen indicated that cover could be better to cover sickness and annual leave, however, there was no indication that people are being put at risk and the manager said that existing staff are willing to cover absences. The remaining survey comments say that: ‘The staff put residents first and give them choices. Support them to have control over their own lives’. ‘The service meets the needs and wishes of the service users’. ‘The service and organisation are a very friendly environment to work within and if ever I am unsure about anything the correct information is available’. ‘ Lovely atmosphere’. ‘We support the service user to go to college and clubs and visiting friends’. A sample of three recruitment files was viewed and contained CRB, POVA checks and two references. All staff have a job description and the manager told us that at the present time staff are being profiled and performance assessed against their appraisal and supervision record. There was evidence in the recruitment files of an induction programme. The manager told us that the service has introduced a new induction programme over a three-month period using a DVD method of training and uses the induction foundation workbook to test the candidate’s knowledge, which is supervised and signed off by a senior person. There was evidence of a completed induction workbook in the latest recruit’s personal file. Staff have individual training files. Each file has a matrix of the training staff have undertaken and the date this has taken place. The certificates are stored 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 24 in this file. The files viewed, demonstrated that staff do receive regular and appropriate training, which is funded. Other training such as Challenging Behaviours and Medication training was evidenced in the staff training files. The manager told us that the organisation has adopted a DVD training method for all mandatory training, which is delivered in house and is followed by discussion and staff completing a work sheet to test the level of knowledge they have gained. The staff gave back positive feedback about this method of training. The staff undertake a practical moving and handling update yearly. Service specific training is accessed if it is requested. The manager is able to access the budget for this training. Staff comments on surveys returned to CSCI were: ’Good induction and we have the right support and knowledge to meet the needs of the people who live in the service’. ‘We have regular house training and I am doing the LDQ3’ ‘We have on going training, which is very helpful’’ The organisation has introduced a more structured supervision programme. This is now an agreement between the staff member and the supervisor, who equally prepares and contributes to the supervision meetings. The manager said as a result of this staff have more input into the meetings and now think of them as a two way information and idea sharing time. Records of the supervision meetings and annual appraisals were evidenced in the staff personal files. 33 Montserrat Road DS0000067405.V366938.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): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home that seeks their views and promotes the health, safety and welfare of service users and staff. EVIDENCE: The registered manager has completed the NVQ level 4 Registered Managers Award (RMA) and has managed the home for four years. She also manages the sister home in the close proximity of Montserrat Road. The manager told us that her development within her management role is through the training courses provided by the organisation and she and her team leaders have attended an in depth management development course throughout the previous twelve months, which she considers has resulted in a stronger more confident management team. The manager told us that a deputy manager has 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 26 recently been appointed to support her role of managing the two houses and she see that as positive but this has resulted in her loosing a senior support worker to another home. The Sanctuary Group has a quality assurance system in place for measuring outcomes for residents. The organisation has distributed questionnaires to service users and relatives in the past twelve months. The results from this have been represented in a graph like format, which was observed to be displayed on the notice board in the kitchen. The results are also posted on the organisations website. One of the outcomes from this survey was that the questionnaire is not designed specifically for learning disabilities and some questions are not applicable and have distorted the results of the survey. This issue has been addressed at the SHIRE (Sanctuary Help to Involve Residents Equally), which is a group, that meets once a month, and is represented by residents from all the Sanctuary homes and is chaired by a resident from another area. It is at this meeting that issues can be aired and discussed, and it is at this forum that appropriate questions are being put together to formulate a new questionnaire, which will be presented in a graphic format to be distributed to residents. Regular staff meetings are held and the minutes for these are recorded and maintained in the home. The manager said these are well attended and are an open forum for discussion on any issues. The operational manager visits the home once a month and reports on the findings of this visit. The monthly audits that take place are care plans, medication charts, the environment, health and safety and training and development. We observed that the company policies were reviewed in 2007. A sample of the servicing certificates for systems and equipment were viewed and found to be up to date. Staff have received training in safe working practices and risk assessments are in place. The fire log was examined and records of the fire alarm checks are recorded appropriately. The fire log demonstrated that staff have had fire drills and training, which has been recorded as taking place in March 2008. We asked a resident if he would do if the fire alarm went off. He was very aware of the procedures to be taken and told me ‘I would go out to the front of the house’. Accidents to staff and residents are recorded and maintained in personal files. The accident recording book was viewed. No accidents had been recorded recently. 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 27 33 Montserrat Road DS0000067405.V366938.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 29 NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 33 Montserrat Road DS0000067405.V366938.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!