Inspection on 17/04/07 for 33a Forest Road

This inspection was carried out on 17th April 2007.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

33a Forest Road 23/06/09

33a Forest Road 22/07/08

33a Forest Road 08/08/06

33a Forest Road 30/11/05

33a Forest Road 04/07/05

33a Forest Road 26/02/05

33a Forest Road 20/05/04

33a Forest Road 06/02/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 33a Forest Road Kingswood South Glos BS15 8EW Lead Inspector Paula Cordell Key Unannounced Inspection 17th April 2007 09:30 DS0000037337.V334612.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 DS0000037337.V334612.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. DS0000037337.V334612.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 33a Forest Road Address Kingswood South Glos BS15 8EW 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) 0117 9677447 0117 9677239 Shaw Healthcare (Specialist Services ) Ltd To be Appointed Care Home 9 Category(ies) of Learning disability (9) registration, with number of places DS0000037337.V334612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2006 Brief Description of the Service: 33a Forest Road is a purpose built home providing personal care with nursing for 9 adults with a learning disability. The home is owned and operated by Shaw Healthcare (Specialist Services) Ltd, an organisation that specialises in providing accommodation and support that promotes independence. The accommodation is set over two floors and a lift is available. Individual rooms are spacious with en-suite facilities; some rooms have small private garden areas. Communal space includes lounge, relaxation room, kitchen/diner, therapy room and a large Jacuzzi tub. The home provides individual support to service users using a variety of approaches determined by a detailed assessment of individual need. Service users are encouraged to be involved in the everyday running of the home, and activities in the local community are organised on a regular basis. The home opened on the 6th January 2003. The registered manager is Mrs Deborah OShea who is on maternity leave; in her absence an acting manager Mrs C Booth has been in post. Mrs Booth has been in post since April 2006 she is a registered manager for another care home owned by Shaw Trust. The fees for the home are in the region of £2512 per week at the time of publishing this report. DS0000037337.V334612.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The purpose of the site visit was to review the progress to the requirements and recommendations made at the last visit in February 2006 and review the quality of the care provided for the people who use the service at 33a Forest Road. The focus of the site visit was on the general care of a sample group of individuals living at 33a Forest Road, including an extensive tour of the premises. This provided a good opportunity to observe people who use the service as well as allowing for informal conversations with individuals and the staff supporting them. Seven members of staff were spoken with during the site visit, which included a registered nurse in charge of the morning shift, the cook, the domestic and the deputy manager. The inspector met with four of the seven people living at 33a Forest Road, many of the individuals use non-verbal communication and/or refused to discuss matters relating to the home or their care, so on this occasion it was difficult to gain their views on the service. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the individuals living at 33a Forest Road and these were used as a focus for the site visit along with questionnaires completed by the relatives (2) and people who use the service (1). The home has yet to submit the pre-inspection questionnaire. The site visit was conducted over a period of 5.5 hours. What the service does well: The people living at 33a Forest Road receive a very good standard of individualised care based on assessed need, some of which are complex. They are well supported on a one to one basis, by a key team of staff allocated for each individual. Staffing levels are appropriate so that this can be accomplished. Individuals at Forest Road benefit from comprehensive plans developed through a multi-disciplinary approach and staff members are provided with detailed guidance on how to meet each person’s individual needs. The rights and choices and independence of the people is promoted by clear policies and procedures in conjunction with a comprehensive staff training programme, ensuring staff are aware of their role and responsibilities with in the home. DS0000037337.V334612.R01.S.doc Version 5.2 Page 6 The individuals benefit from an environment that is homely which meets their challenging needs. There is a good rolling programme of renewal and maintenance to the property. 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. DS0000037337.V334612.R01.S.doc Version 5.2 Page 7 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 DS0000037337.V334612.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have sufficient information to enable them to make a choice on whether to move to the home and their assessed care needs are being met. EVIDENCE: There is a comprehensive statement of purpose and resident guide detailing the facilities and services provided. The service users’ rights and choices and aims and objectives of the home, the philosophy of care are also contained in the documents. This was viewed at the last key inspection. A minor amendment is required to acknowledge the return of Mrs O’Shea from her period of absence. Questionnaires returned from people who use the service stated that they did not have a choice whether to move to the home or have information available to them. It has to be acknowledged that this is a specialist service for individuals that challenge and that for some of the people who use the service this is the only option available to them to enable them to succeed at living in the community. The provision is made of nine individual flatlets where individuals can chose to live separate from the others or when stable can interact with the other people in the home. There are intense staffing DS0000037337.V334612.R01.S.doc Version 5.2 Page 9 packages, which enable individuals to have their own allocated staff member during a shift and in one persons case two staff. Admission to the home is through the care management approach and each admission is on a planned basis. There are presently two vacancies. Copies of placing authorities assessments and care plans were seen on files for the individuals and it was evident that these inform the home’s assessment and care planning processes. Of the seven people who use the service, two have additional funding for staffing when accessing the community due to the behaviours that are exhibited. One requires three staff when accessing the community and the other two. It was evident that this was incorporated into the plan of the care for the individuals and the planning of staff. Another individual required two staff at all times and this was part of the individual’s package of care. Again this was made very clear in the plan of care and sufficient staff were working in the home to meet the needs of the individual. It was evident that all the individuals had a package of care tailored to their individual needs with appropriate staff allocated to them as evidenced via discussions with staff, the people who use the service and care planning documentation. As reported at the last key inspection people who use the service are offered an opportunity to visit the home prior to making a decision to move and are offered a trial period of three months. This is then formally reviewed with the individual, the placing authority, relatives and other professionals where appropriate to ensure all parties are happy with the service provision. The deputy manager stated that the registered manager is actively marketing the two vacancies. DS0000037337.V334612.R01.S.doc Version 5.2 Page 10 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. People who use the service benefit from a comprehensive care planning process ensuring that all aspects of personal, social and health care needs are being met. People who use the service are assured that their package of care is individualised and a core group of staff support them. People who use the service are safeguarded by comprehensive risk assessments that do not curtail their independence. EVIDENCE: At the last inspection a recommendation was made for the home to review the term “off baseline” a term that is used to describe behaviours that challenge which are part of the norm for the individual. It is a term that has apparently been adopted across Shaw Health Care. This term fails to capture what is actually happened and would hinder a full review taken place on the individuals DS0000037337.V334612.R01.S.doc Version 5.2 Page 11 challenging behaviour. In addition the term does not blend to person centred planning. It was evident that this has been discussed at a recent staff meeting. Staff stated that they were revising the term to give more clear information about the behaviours that had been exhibited in daily records. However, it was acknowledged by staff that this was a slow process as this has been in use for some time. Staff used the term when in discussion with the inspector and it was noted that some of the care documentation including risk assessments contains the wording “off baseline”. This will continue to be a recommendation and followed up at the next site visit and via reports sent to the Commission for Social Care Inspection of incidents that affect the wellbeing of people who use the service in accordance with Regulation 37. Each person has a comprehensive care plan that is person centred. Those viewed demonstrated that the provision of care was individualised to a high standard. The care plans were reviewed at regular intervals to ensure that they met individual needs and aspirations. The majority of the care documentation was reviewed at three monthly intervals this is good practice in view of the complex and changing needs of the individuals. The daily observation records contained good detail of daily interactions, outings and meals provided. Behaviour was described in daily records and cross-referenced to the behaviour monitoring records. Risk assessments were in place and described how staff minimised risks, ensuring the safety of the individual and the staff whilst encouraging independence. Risk assessments covered a wide spectrum of activities including detailing strategies for staff to follow when supporting individuals who at times exhibit challenging behaviour. Staff described positive interventions for supporting people who use the service with their challenging behaviours including gentle teaching a technique to divert challenging incidents to more appropriate activities and interactions. Where physical intervention is used as part of a behaviour management strategy, a detailed protocol was in place providing adequate guidance to staff. Staff stated that restraint is only used as a last resort and usually to ensure the safety of the other people living in the home. All staff spoken with during the site visit conveyed a good understanding of the care needs of the individuals and the commitment to providing an individualised package of care. A new member of staff stated that during the induction it was made clear what their role was, the expectations and that 33a DS0000037337.V334612.R01.S.doc Version 5.2 Page 12 Forest Road is the “service user’s home”. It was evident that staff were encouraged to read all care documentation prior to supporting individuals. Evidence was provided that people who use the service and where appropriate relatives were involved in the planning of their care. In addition to the individual care reviews, key worker meetings were organised to review progress and discuss changes to the plans of care. Service user were organised every three months. The subject matter lacked detail and attendance was limited to three or four of the people who use the service with others refusing. At the random inspection in February a team leader told the inspector that the near-future plan is to involve the people who use the service on an individual basis. This is due to the people who use the service’ complex needs and ability to participate in-group meetings. The team leader also informed the inspector that the team are developing a ‘read easy questionnaire’ for the people who use the service, staff and family members to gain their views. The questionnaires were viewed but less apparent was evidence of the individual meetings. This will be followed up at the next inspection. People who use the service can be confident that information about them is handled appropriately ensuring confidentiality is maintained. The home has a policy on confidentiality. This is discussed during staff induction and observations on the day confirmed that staff were aware of the need to maintain confidentiality. Records were kept secure. DS0000037337.V334612.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. People who use the service are supported within a risk assessment framework ensuring the safety all working and living in the home. Activities are service user led and individuals are not discriminated against due to their complex needs. EVIDENCE: Care documentation included information about the interests and hobbies of each individual. A member of staff stated that each day is led by the person receiving the service from the time their get up to going to bed. This included when to take their meal where and with whom. This level of control is commendable. DS0000037337.V334612.R01.S.doc Version 5.2 Page 14 One person receiving a service stated that they had spent much of the morning in bed and would be going out later with their allocated member of staff. Other people were being supported to attend college, or for a walk around the local area or a trip to the local shops or being supported in their flatlet. Clear guidance was contained in care documentation on contact with relatives. Staff stated that people who receive a service are supported to visit their relatives, as are relatives are welcome to visit the home. Staff conveyed that this was seen as an important role. Relatives were visiting on the day of the inspection. People who use the service had an “opportunity plan” aimed at fostering new interests in the community, the home, and maintaining relationships with relatives and friends. Plans indicated that people who use the service could choose what and where to go. Activities included walking, going to the shops, cinema, swimming, trips to the seaside and meals out. It was evident that the levels of behaviour that challenge were not discriminated against and people who use the service are encouraged to lead full lifestyles, which was based on choice. Holidays were being planned with individuals based on their preferences. One person had recently been away with three support staff. From conversations with staff this was viewed as a positive experience. Positive relationships were seen between people who use the service and staff. Communication was inclusive of the person. Staff clearly described how people who use the service are supported with their communication and this was seen as an important area in reducing episodes of challenging behaviour. The deputy stated that three staff have recently attended a workshop on intensive interaction a communication system for individuals who have limited or no verbal communication and described how this was being used for one individual. This is good practice. Further staff training was being organised in makaton (a sign language for people with a learning disability). Aids were available in bedrooms to assist with communication including a list of common makaton signs. This again is good practice. Visiting professionals provide access to aromatherapy, music therapy and Indian head massage. Menus were viewed during the tour of the home and demonstrated that people who use the service had access to a nutritious and balanced diet based on their preferences. People who use the service were observed being supported to make drinks in the training kitchen. Staff were observed responding to requests from people for drinks and snacks appropriately. People were observed taken meals at different times, which evidently suited them or their activities that they were undertaken. DS0000037337.V334612.R01.S.doc Version 5.2 Page 15 A person confirmed that they enjoyed the food and alternatives were available. It was evident that people who use the service had a high degree of choice in relation to meals and when they were taken. DS0000037337.V334612.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. People who receive a service can be assured that their personal and health care needs are being met in the preferred manner of the individual. People who receive a service are protected by the home’s procedures in the administration of medication. EVIDENCE: Each person receiving a serviced has a designated health care file and a review of the information provided evidence of clear guidance to staff on the provision of personal care for each individual. Records reviewed indicated that the people who use the service had access to relevant health care professionals and the home is aware of preventative health care. People who use the service are supported to attend health appointments and screening and a consultation report is completed after each visit. This ensures a consistent approach to meeting individual needs. Appropriate action was noted to be taken where a concern had been raised. DS0000037337.V334612.R01.S.doc Version 5.2 Page 17 33a Forest Road is a registered care home with nursing. Registered Nurses known as team leaders manage each shift and support the people who use the service and the care staff. This was confirmed on the duty rota. However, there was no evidence that the registered nurses were confirmed to having renewed their registration with the Nursing Midwifery Council and was only evidenced via their initial application. The home has robust medication policies and procedures to guide staff. The registered nurses complete the administration of medication. Training certificates were seen demonstrating that they had received medication training from the local pharmacist on the system that was in place in the home. Records were in place to demonstrating that people receiving a service were administered medication safely, including records of disposal. The storage of medication met with regulations. However, again concerns were raised that this was in a hallway with no protection for the member of staff dispensing the medication and where they could easily be distracted and potential for an error occurring. The home has developed a risk assessment on the present place of storage in response to a previous requirement. On the day of the inspection an individual was agitated and had already attacked a member of staff, this had caused a delay on the inspection of the medication. As this person’s bedroom was in close proximity to the medication storage area. Again it was noted that whilst dispensing medication staff have their backs to any passing person and is in a potentially vulnerable situation. The deputy did state that they could move the medication trolley to the office, which could reduce the risk to staff. It is strongly recommended that the storage be moved to a place that is free from distractions ensuring the protection of staff. DS0000037337.V334612.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. People who use the service can be assured that their concerns would be listened to and that they are protected from harm. EVIDENCE: Policies relating to complaints and protection are in place and were seen at the last inspection. These met with the National Minimum Standards. The home maintains a record of complaints. There have been no complaints since the last inspection. Care files viewed indicated that key team members have a sound knowledge and understanding of the complex communication methods of people who use the service, and changes in behaviour, body language and facial expressions are observed closely. People who use the service would be offered support in a sensitive manner to determine whether a problem existed, and appropriate action taken to rectify it. All staff spoken with conveyed a good understanding of abuse and what action must be taken following an allegation. Staff receive training as part of their induction on abuse and protection, evidenced in conversations with staff and training records. The deputy manager stated that one of the registered nurses has attended “train the trainer in abuse”, and this is being cascaded to all staff. Seven staff were attending the training on the day of the inspection with further dates for the remaining staff were being organised. DS0000037337.V334612.R01.S.doc Version 5.2 Page 19 Policies and procedures were in place relating to restraint and the management of aggression as seen at a previous inspection. Where restraint had been used there were clear records in place detailing the time, the reason, the well being of the person and a review of the incident to ensure that the restraint was used appropriately. Three staff stated that they have not had any need to use restraint and this is only used as a last resort to ensure the safety of the individual or others living in the home. It was evident that the high staffing levels and the individualised care was having a significant impact on the reduction of challenging incidents. Body charts were maintained for any injury either caused by self injurious behaviour or that from an incident involving another person receiving a care service, these linked with other care documentation including accident records enabling the home to fully review accident and injuries in the home. A random check of finances was conducted. The records corresponded with the amounts held in the home, supported by two signatures the manager’s and the administrators. There were good auditing procedures in place. DS0000037337.V334612.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): 24,25,26,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a clean, comfortable and wellmaintained home. EVIDENCE: 33a Forest Road is a purpose built building. Each resident has a large bedroom, which exceeds the National Minimum Standards. These were furnished to suit the individual. All areas of the home were clean and free from odour. The home was in a good state of repair with a rolling programme of decoration. Areas of the home were secure with the training kitchen, activity rooms and the office being locked when not occupied, to ensure the safety of people who use the service and visiting personnel. People who use the service were observed accessing the training kitchen with staff. DS0000037337.V334612.R01.S.doc Version 5.2 Page 21 The communal spaces include lounge/dining area, therapy room, and hydro pool and as already mentioned the social skills kitchen. People who use the service were observed accessing the communal areas with support from their designated care worker. Since the last inspection the home has installed heating to the shed, which contains relaxation/sensory equipment. This was needed as one of the people especially enjoys using this space and now can use it all year round. Bedrooms seen were personalised. All had ensuite facilities. A person confirmed that they had been consulted on the colour scheme. A wardrobe was broken but the administrator and deputy confirmed that this was being replaced. It was evident due to the nature of the people using the service that furniture where broken, was routinely being replaced or repaired. A maintenance man works in the home for a period of 15 hours per week. The home employs a domestic to assist with the cleaning of the home. From discussions with staff it was evident that safety was paramount. The domestic has attended positive response training and safe working practices are in place for both the domestic and the people using the service, which include care staff are always present when bedrooms are being cleaned. The domestic described a high level of job satisfaction and support from the care staff in completing her role. It was evident from discussions with staff and individuals that household cleaning tasks in their bedrooms were completed as part of their daily activities. The home has an industrial kitchen, which was clean and well organised. Records relating to kitchen equipment were up to date and in order. A cleaning rota was in place. Staff using the kitchen area undertook food hygiene training. The home has won a four star award from South Gloucestershire Environmental health in January 2007. The home employs presently has two catering staff working over a seven-day period. However one is due to retire. It was noted that neither have attended training in supporting individuals that challenge. DS0000037337.V334612.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. People who use the service are supported by competent, trained staff that are committed to improving the quality of life for the individuals living in the home. The home is failing to ensure that people are protected by robust recruitment practices and that the registered nurses hold an appropriate professional qualification, which could put people at risk. EVIDENCE: Staffing rotas were viewed for the last four weeks. It was evident that the home has sufficient staff to support the individuals receiving a care service. As already discussed individuals are allocated a named staff to support them for the entire day. Staffing is increased in some cases to support individuals in the community. On the day of the inspection there were nine care staff on duty, two registered nurses (the deputy manager and a team leader) and seven home support workers. In addition there was a domestic, a cook and the maintenance man working in the home. One team leader and three home support workers staff the home at night. DS0000037337.V334612.R01.S.doc Version 5.2 Page 23 The staff and the deputy stated that there has been a great reduction in the use of agency staff. Presently agency is only being used to cover a team leader post at night. From records seen it was evident that the home was using in the main one named agency staff to cover these shifts. The deputy stated that this was to ensure consistency for the people who use the service. Staff described a high level of job satisfaction and informal support within the team. There are clear aims and values in this home, which are service user focused and centre on choice, rights and self-determination. Staff spoken with were evidently informed about the home’s aims, their role and knowledgeable about the care needs of the individuals. Recruitment information was viewed for six staff. It was noted that five of these staff were from overseas. The deputy stated that the organisation had used an agency for this particular recruitment drive. It was noted that for three of the overseas staff there were no references. It was evident that the home had completed the appropriate criminal record bureau check prior to an individual taking up post. The administrator stated that the references could possibly be held at Human Resources in the Organisations headquarters. These were being chased up during the inspection. If these are not in place references must be taken up to ensure that people who use the service are protected. In the other three files it was noted that it was the organisational policy to take up three references, which exceeds the Care Home’s National Minimum Standard’s of two. Staff and the deputy stated that the overseas carers had settled into the team well and were building positive relationships with the people who use the service. A concern was raised via a relative questionnaire about the comprehension of the English language of some of the overseas carers. The staff and the deputy stated that they had settled well and were building good relationships with both the team and the people who use the service. A concern was raised that on a previous visit to the service the inspector had been shown up to an office where the door was securely locked behind until the manager could be located. However, on this occasion an overseas carer allowed the inspector to go alone. Whilst the deputy gave reassurances that this was discussed with the member of staff who happened to be an overseas carer. It could bring into question some understanding of the home’s policies and procedures which could have been detrimental to the safety in this case the inspector, but on another occasion a member of staff, visitor or a person living in the home. Regular staff meetings were taking place. Meetings were broken down into team leader meetings, key worker meetings and house meetings where all staff would participate. The minutes demonstrated that clear guidelines and expectations were in place in relation to the running of the home and the provision of care. DS0000037337.V334612.R01.S.doc Version 5.2 Page 24 It was evident that positive relationships had been developed between staff and people who use the service. Staff described their key people in a positive manner and their shared interests whether that be walking, watching old films or visiting places of interest. This evidently gave the people using the service and a staff a baseline to build and foster positive relationships. Inductions of staff were in place, which included attendance at a four-day training session. Staff complete the Learning Disability Award Framework and progress onto an NVQ 2 in care. Since the last inspection the manager has encouraged seven staff to enrol to complete an NVQ in care. This was in response to a recommendation from the previous inspection as only two staff have an NVQ 2 in care. It was evident that the home was committed to meet the government’s target of 50 of the workforce to have an NVQ in care. A rolling programme of health and safety training was in place as demonstrated through the home’s computer, which highlighted deficits in training. The deputy stated that this was his designated responsibility and was addressing the shortfall. Supervision was not viewed on this occasion as it was evidenced at the random inspection that staff were being supervised at regular intervals. Training for staff in supporting people who challenge was in place. Further up dates were being arranged for staff that required an annual update. There is always a registered nurse in charge in the home. However, as mentioned previously it was not apparent whether the home was completing checks to ensure that the nurses had renewed their registration annually with the Nursing Midwifery Council ensuring that they can continue to practice as a nurse. DS0000037337.V334612.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): 37,38,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a well-managed service that has good auditing systems that drive the quality of the care provision. People who use the service are assured that their safety is paramount. EVIDENCE: Mrs O’Shea is the registered manager. She returned to post in January 2007 from a period of extended leave. She is a registered nurse and has completed a Registered Managers Award. Staff spoke highly about the management style of Mrs O’Shea. It was evident that she offered her staff clear direction and was motivational. Staff stated that she operates an open door policy. DS0000037337.V334612.R01.S.doc Version 5.2 Page 26 The home operates good auditing systems to ensure that a quality service is provided including seeking the views of people who use the service. In addition a representative of the organisation completes an external audit annually. The home is audited on a monthly basis in respect of regulation 26 provider visits. Regulation 37 notifications are being received on a regular basis in the event of any incident occurring in the home that might adversely affect the people who use the service. Some of the notifications lack detail and still make reference to people being off baseline as discussed in the report of the visit in August 2006. These require more information if they are to have any meaning on the incident and for the home to fully review behaviours that challenge. There were good systems in place to ensure the safety of people who use the service and staff. Information was accessible to staff and included policies and procedures and risk assessments. Routine checks on the premises were being completed including the testing of the gas and electrical appliances as evidenced at previous inspections. These systems also included checks on water temperatures, food temperatures, fridge temperatures and the home’s vehicles. Logs were maintained of the checks. This is good practice. An opportunity was taken to view the fire logbook. It was noted that these were up to date in relation to the checks on the fire equipment and staff participating in fire drills every six months. However less apparent was staff training in fire. The deputy stated that staff watch a fire video and complete a questionnaire and participate in a fire drill. However, this was not fully captured in the fire logbook and was difficult to evidence for all staff. It is recommended that the home ensures that a log is maintained to ensure that all night staff attend fire training three monthly and day staff six monthly. DS0000037337.V334612.R01.S.doc Version 5.2 Page 27 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 3 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 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 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 3 3 3 X X 3 X DS0000037337.V334612.R01.S.doc Version 5.2 Page 28 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. 1. 2. Standard YA34 YA34 Regulation 17 (2) Schedule 4.6 18 (3) (b) Requirement To ensure that references are obtained prior to staff taking up post. To ensure that the registered nurses are registered with the Nursing Midwifery Council. Timescale for action 17/04/07 17/05/07 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. 2. Refer to Standard YA6 YA42 Good Practice Recommendations To review the use of the term off baseline when recording levels of behaviour. (Outstanding since August 2006) Provide documented evidence that staff are attending fire training – six monthly for day staff and three monthly for night staff. DS0000037337.V334612.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 DS0000037337.V334612.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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