Inspection on 22/07/08 for 33a Forest Road

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 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 17/04/07

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 27/09/2008.

CARE HOME ADULTS 18-65 33a Forest Road Kingswood South Glos BS15 8EW Lead Inspector Paula Cordell Key Unannounced Inspection 22nd July 2008 09:00 33a Forest Road DS0000037337.V366395.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 33a Forest Road DS0000037337.V366395.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. 33a Forest Road DS0000037337.V366395.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 forestroad.manager@shaw.co.uk Shaw Healthcare (Specialist Services) Ltd Manager post vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 people who use the service using a variety of approaches determined by a detailed assessment of individual need. Individuals 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. Presently the home is managed by Ms A Trainer who is planning to submit an application to become the registered manager. The fees for the home are in the region of £2512 per week at the time of publishing this report. 33a Forest Road DS0000037337.V366395.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit as part of a key inspection process. The inspection was brought forward due to concerns about the changes of management and a high staff turnover. This had been identified through the annual service review, which was recently completed by the Commission for Social Care Inspection. In addition the Commission had received an anonymous complaint. The provider was asked to investigate the concerns. A response was received with the findings. The purpose of the inspection was to follow up these concerns and to follow up the requirements and recommendations from the last visit, which was conducted in April 2007. In addition to monitoring the quality of the care provided to the individuals living at 33a Forest Road. The visit consisted of gathering documentary evidence from care files and records, discussing the service with the staff who were on duty, and observing and chatting to the individuals living in the home. Further evidence was obtained from surveys sent to individuals receiving a service, relatives, professionals and the staff team prior to the visit. This information along with notifications in respect of incidents that effect the wellbeing of individuals living in the home and the annual quality assurance audit assisted in the planning of the visit ensuring the visit focused on the outcomes for people living in the home. The visit was conducted over 10 hours and ended with structured feedback being delivered to the manager. What the service does well: The people living at 33a Forest Road receive a good standard of individualised care. Each person has an allocated member of staff to support them enabling them to access the community. 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. 33a Forest Road DS0000037337.V366395.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 rolling programme of renewal and maintenance to the property. What has improved since the last inspection? What they could do better: Individuals should have a contract of care with Shaw Health care detailing the terms and conditions and a breakdown of the fees of what is included ensuring an open and transparent service. Individuals would benefit from a review on the effectiveness of the care planning processes that are in place. Information should be relevant to the person’s needs and information archived if no longer relevant. Individuals must be protected by the home’s medication systems with a clear audit trail of medication entering the home. Individuals and their relatives must be assured that all complaints are taken seriously with a record maintained of the nature of the complaint and the outcome. Individuals must be assured that their personal finances are protected with good accounting systems in place. Staff should benefit from good support systems being in place, which will assist with the communication in the home. The organisation must investigate the high staff turnover of staff at all levels and develop an action plan to address the issues. Individuals must be assured that staff have appropriate training in supporting them with their challenging behaviour. Where restraint is used this must be clearly defined in the person’s plan of care and only in agreement with the individual, their representatives and other professionals. This would ensure an open and transparent approach. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 7 Individuals would benefit from a review of the menus to ensure that they are healthy and balanced. Individuals would benefit from the ground floor communal area being made more homely within a risk assessment framework. 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. 33a Forest Road DS0000037337.V366395.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 33a Forest Road DS0000037337.V366395.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): 1,2,3,4,5, Quality in this outcome area is adequate. 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. However, the home is failing to ensure that a Shaw Healthcare contract is in place. EVIDENCE: There is a comprehensive statement of purpose and resident guide detailing the facilities and services provided. The individual’s rights and choices and aims and objectives of the home, the philosophy of care are also contained in the documents. A minor amendment is required to acknowledge the change in management and ensure that the details are correct in respect of the Commission for Social Inspection as these could be misleading as it states the National Care Standards Commission. Questionnaires returned from people who use the service stated that they did not have a choice whether to move to the home. 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 up of nine individual flatlets where individuals can chose to live separate from the 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 10 others or when stable can interact with the other people in the home. There are intense staffing packages, which enable individuals to have their own allocated staff member during a shift and in one person’s case two staff. A professional stated in a survey “individuals do not appear to have positive outcomes or progress in respect of independence and they consider the service to have poor results considering the cost of the placement”. This was discussed with the manager on whether there were plans to enable individuals to move from 33a Forest Road as part of long term goals to more independent living. The manager was unable to fully respond to this as she has only been in post for three weeks. 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 manager was unable to locate the Shaw Healthcare contracts. These must be made available for inspection demonstrating an open and transparent service detailing the fees and what is and not included. Placing authority contracts were seen and kept in a central file. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals needs are being met, however the documentation in place does not lend to person centred planning and that of a service that supports people with a learning disability. Individuals are supported to be as independent as possible within a risk assessment framework. EVIDENCE: Three care plans were looked at as a means of determining the processes the home goes through to support the individuals living at 33a Forest Road. Each person had a comprehensive care plan based on the model of activities of daily living. This blends to an assessment rather than a care-planning tool. Concerns are raised in that individuals had pressure sore risk assessments (where it was evident that the person was not at risk of pressure sores), fluid monitoring charts (where there was no risk of dehydration or link to the plan of care) and other assessments that were not relevant to the individual and did 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 12 not blend to person centred planning. The manager stated that Shaw Healthcare as part of the audit tool measures the service and if these are not in place then the home does not score well. The planning model does not blend to a service for people with a learning disability to allow for individuals aspirations to be met or addressed. The majority of the care documentation was reviewed at monthly intervals this is good practice in view of the complex and changing needs of the individuals. Each person had three large lever arch folders containing a person care plan, health care action plans and a behaviour-monitoring file. There was a further file containing day-to-day records and monitoring sheets. The information was difficult to navigate and contained information that was no longer relevant. All staff spoken with during the site visit conveyed a good understanding of the care needs of the individuals and a 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 Forest Road is the “individual’s home”. It was evident that staff were encouraged to read all care documentation prior to supporting individuals. However a member of staff stated that once they have completed their induction it would be rare to pick up care files unless the care plan had been amended. Staff stated that the files were difficult to navigate due to the amount of documentation they contained. Behaviour was described in daily records and cross-referenced to the behaviour monitoring records. The home still uses the term “baseline”. It has been recommended on past visits that this not be used to describe people’s behaviour when they are being particularly challenging, as this will not capture what the person was actually doing at the time. The manager said that this is the term that is used in the positive response training. It was noted that care plans and risk assessments still state “off baseline” whilst this term is better than some terms it still sounds derogative and again does not capture the behaviours pertinent to the individual. 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. Concerns were raised in relation to one person’s risk assessment, which made reference to bedsides being in situ however from talking with staff these had not been used in excess of six months. This had not been picked up during the monthly review completed by a registered nurse. 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. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 13 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. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals evidently lead very active lifestyles both in the home and the local community. Individuals are supported to maintain friendships and keep in contact with family. Menu planning lacked evidence that a healthy diet was promoted or that individuals were involved in the planning of the main meal of the day. 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. Staff stated that there has been an increase in activities since the new manager has been in post and there has been less reliance on agency staff. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 15 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. People who use the service had an “opportunity plan” aimed at promoting 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, arts and crafts, use of the sensory room, the Jacuzzi tub and going out to places of interest. 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. Records included details of the how the person enjoyed the activity or where they had declined to participate. Risk assessments were in place for activities completed both in the home and the local community detailing the staff support and triggers for behaviour. One person said they go to work in a café it was evident that they enjoyed this experience. From the conversations with the individual it was evident that they were regularly supported to access the local community. The Annual Quality Assurance assessment and opportunity plans provided evidence that individuals have access to college courses, hydrotherapy and music therapy. In addition an aromatherapist and a reflexologist visits the home on a regular basis. Other areas of improvement have been noted, in that the home has employed an activity co-ordinator. The manager stated that this has been a real positive step towards ensuring activities regularly take place both in the home and the local community. Holidays were being planned with individuals based on their preferences and staffed in accordance with their care plans. It was evident that the home was pro-active in ensuring that holidays were geared to the individual taking into consideration behaviours that challenge but again this did not restrict them. Menus were viewed during the tour of the home. These lacked evidence that individuals were given a choice on the main meal of the day and information to fully demonstrate that individuals had access to a nutritious and balanced diet. There was no description on what vegetables or fruit that individuals were having ensuring the five portions a day principle is applied. Staff stated that individuals have more choice in the evening meal, which is usually a snack as the supporting staff member usually prepares this. This was evidenced in the daily records maintained for individuals. Records included likes and dislikes. Presently the home does not cater for any specialist diet. The manager stated that a member of staff is developing pictorial menus to 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 16 assist with the individuals making choices on what to eat and there is an expectation on the cook to prepare a number of dishes to promote more choice. These were not seen on this occasion. The manager stated that a full review is being undertaken in relation to the catering in the home and the cook is working closely with a project manager to better improve the provision. 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. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health and personal care are being met. The lack of records of medication entering the home could put people at risk. EVIDENCE: Individuals’ care records included information that demonstrated that the people living in the home have access to a GP, dentist, optician and other health professionals. To support individuals with their needs the home liaises with other relevant professionals in the planning of care that is provided and to ensure the individual’s care needs are well met. Care plans included daily routines regarding their personal care needs and the way they preferred their needs to be met. Accident records were viewed and it was evident that the home was addressing incidents promptly and minimising any further risks where relevant. Staff have received health and safety training and first aid as evidenced in the training records and speaking with staff this will be discussed later in this report. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 18 The home is keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals in respect of Regulation 37. Ongoing medication is stored safely in a lockable cupboard. The home has moved the medication to a small room where there is less disruptions as previously this was in the hallway, which could of left staff vulnerable. A medication policy is in place but this was not viewed on this occasion. Medication Records were clear and signatures supported the administration process. Less apparent was a record of incoming medication from the pharmacy. The manager had identified this and a notification had been sent to the Commission for Social Care Inspection. The manager was in the process of investigating why the registered nurse had not recorded this. The manager since being in post has introduced a new audit system for all medication but it was evident that staff needed some training in this area. A disposal record was seen. Good practice would be for two staff to sign this record. Registered Nurses are responsible for administering all medication in the home and they had recently had training from the local pharmacist. Medical profiles seen identified current health needs and medication and included a current photograph. Where medication is given covertly (hidden) agreements are in place with professionals, including the pharmacist and the prescribing doctor and were seen in the person’s best interest. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of recording in respect of complaints received by the home does not fully demonstrate that the home responds appropriately to complaints. Individuals are not being protected in the management of challenging behaviour where restraint is being used. Individual’s finances could be better protected. 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. From information received, as part of the annual service review and from talking to a relative it was evident that they had made a formal complaint to the home about the staffing, management changes and care. There was no record in the complaint book of the complaints made. However, from speaking with one relative it was evident that a meeting had been arranged with the Regional Manager for Shaw Healthcare. A record must be maintained of all complaints and the outcome. The manager stated that this had gone to head office and had not been received by the home. As already mentioned a formal complaint was received by the Commission for Social Care Inspection relating to the high turnover of both qualified and unqualified staff. The complaint was from an anonymous staff member. The 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 20 provider investigated the complaint. This lacked sufficient information about the staff turnover by only stating two team leaders (qualified staff) have left. It was evident from talking with staff and the annual quality assurance assessment completed by the manager that 14 full time and 12 part time staff have left in the last twelve months. It is evident that this complaint has been substantiated. In respect of the management this shall be discussed later in this report. Some staff spoken with during the visit stated that they did not have faith in the organisation to respond to concerns at a higher level. Examples were given relating to the kitchen, staffing and the management. There has been a turnover of both senior management external to the home and management in the home, which could lead staff to feel unsettled, and a feeling that issues are not responded to and the outcome not being fed back to the individuals. A letter of concern was written to the registered provider and it was noted that a response has not been received by the individual within a reasonable timescale relating to equal opportunities and employment of staff. 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 although this in the main was reporting this to their line manager. Staff receive training as part of their induction on abuse and protection, evidenced in conversations with staff and training records. Concerns are raised in relation to training but this will be discussed further in the standards relating to staffing. 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 in each person’s care file. The annual quality assurance assessment documented eleven incidents where restraint had been used in the last twelve months. Good practice would be that a central log was maintained of all restraint used so that this could be monitored by the home without navigating each person’s care file. Each person had a behaviour file detailing strategies in place to support the individual including the triggers. However, what was lacking was a record of the type of restraint that should be used with clear guidelines for staff to follow or evidence that this had been an agreed approach involving other professionals, their relatives and the individual. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 21 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. Discussion was held with the manager about reporting all incidents of aggression caused by another person to the adult duty desk to determine whether a safeguarding meeting is necessary. A random check of individual’s 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. A concern was raised in that a member of staff had completed a petty cash slip for two separate expenditures totalling £30, one on the 1st June and the other in July 2008, no receipts were available. This is poor practice. The manager is the appointee for six of the people living in 33a Forest Road and a relative acts as the appointee for the seventh. Each person has their own bank account, with the manager and the administrator able to withdraw from their accounts with the use of a bankcard. Bankcards are kept separate from the PIN numbers. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 22 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): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 33a Forest Road is purpose built and is meeting the needs of the people living in the home. The home was clean with a good rolling programme of redecoration. Consideration should be taking to make the communal area on the ground floor more homely within a risk assessment framework taking into consideration the behaviours that challenge. 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. Whilst 33a Forest Road is a purpose built building there are still concerns raised in relation to supporting individuals that can challenge. One person has 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 23 attacked staff on the stairs on two separate occasions both were serious and resulted in injury to the staff member. The newly appointed manager is completing risk assessments and updating those that are in place in relation to the environment. The stairs particularly put staff in a vulnerable position. The manager stated that mirrors are being put at the top of the stairs to improve the view to the top of the stairs and to the hallway. This should be undertaken promptly to protect individuals living in the home, their visitors and staff. 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. The communal spaces include two lounge/dining areas 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. Survey comments from two relatives, highlighted concerns about the communal space on the ground floor stating it is barren and lacks a homely feel. This has been addressed with the area now benefiting from being redecorated. The manager stated that new furniture has been ordered including a new television. However, further work could be undertaken to make this area more homely within a risk assessment framework taking into consideration the behaviours that challenge. There were no curtains in this area. Bedrooms seen were personalised. All had ensuite facilities. Flatlets on the lower floor had access to a private garden. From talking with the manager there is a rolling programme of decoration with individuals being consulted on the colour schemes. It was noted that one of the individuals had paid for a chest of drawers. There was no policy or contract to determine whether this was the responsibility of the individual or the organisation. The manager said that this should of come out of the home’s budget and would ensure that this was made clear to the administrator and staff. Good practice would be for the home to develop a clear protocol on breakages in the home and who is responsible for paying for the damage. The home employs a maintenance person. Maintenance records were seen. This demonstrated that repairs were responded to promptly. However, a relative had raised a complaint about the odour that was coming from the bathroom and an issue with the shower. This had been responded to. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 24 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. 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 that the individuals took some responsibility in the cleaning of their bedrooms. The home has an industrial kitchen, which was clean. There was a slight odour from the fridge, which the manager was going to respond to. All food was labelled and sealed appropriately. Records relating to good food hygiene practices were difficult to navigate. The staff were not consistently completing checks on the fridge/freezer temperatures. The manager said that a member of staff was supporting the cook to ensure that records relating to the kitchen are better maintained. It was noted that some of the baking tins were rusty. This must be addressed. 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 presently employs one cook who works five days a week. Care Staff or agency complete the catering on the other two days. Catering staff and the domestic staff have attended training in supporting individuals that challenge. The cook has completed a course in food hygiene. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staff support the individuals living in the home with individualised staffing arrangements in place. There has been a heavy reliance on agency staff to support the home due to a high staff turnover. This is having an affect on moral. Whilst there is a rolling programme of training concerns are raised in that a lot is covered during a short period and may not suit everyone’s learning style. Systems for supporting staff have not been consistently completed during the changes of management in the home. EVIDENCE: Adequate staff support the people living in the home. Six of the people living in the home have one to one support, whilst another has two staff supporting them in the home. The staff rota provided evidence that were sufficient staff with additional staff being rostered to provide opportunities that needed increased staffing when out in the community. One person has additional funding to enable them to access the community with three staff. Records 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 26 were seen confirming that this was happening. There is always a registered nurse on duty. A relative had requested to take a person out on the Saturday after this visit. It was evident that the manager was trying to roster additional staff to enable this to happen even though it was short notice. This is good practice. One relative stated in a telephone call that the home is always loosing staff and this is detrimental to the people living in the home, there is a lot of agency and bank staff. This was echoed in two of the surveys completed by relatives and in two returned by staff. Recruitment information was seen for three new staff. Records seen confirmed that a robust recruitment process had been completed. The home has demonstrated compliance to a requirement from the last visit to ensure that two references are obtained prior to confirming employment. Concerns have been raised via an anonymous complaint about the high staff turnover. The annual quality assurance assessment provided evidence that 14 full time and 12 part time staff have left in the last twelve months. This is a concern in that the individuals living in the home should benefit from a stable workforce in light of the complex needs of the individuals and the levels of challenging behaviour. It was evident from talking with staff that there has been a heavy reliance on agency staff to support the team. This has meant someone they know or has had appropriate training does not always support individuals. Reasons for the high turnover of staff was discussed but there was no one reason. The manager gave reassurances that the home has completed a recruitment initiative and there is now only three Home support worker and two registered nurse vacancies. As the home is not fully occupied it has not hit a crisis in staffing but evidently the heavy reliance on agency staff has affected the morale of the staff team. Computer records evidenced that staff were completing an induction within a reasonable timeframe. A member of staff stated that they had a period of two weeks of being supernumerary as part of their induction enabling them to shadow more experienced staff and allowing them the time to read care records and policies and procedures. From the conversation it was evident they had felt supported by the staff team and the newly appointed manager. However, staff were not completing the Learning Disability Qualification. The manager was not sure of the reason, but felt this has not been in place for the last six months some staff are still waiting for their files to be verified. Good practice would be for staff to complete this as recommended in the National Minimum Standards. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 27 There was an ongoing rolling programme of annual training. This included protection of vulnerable adults, fire, health and safety, first aid, manual handling, infection control and food hygiene. It was noted that at least six of these course were on one day last for a one-hour duration. Concerns are raised whether this is sufficient time to ensure that the content is covered and to allow staff to ask questions or explore what it means for 33a Forest Road. Staff attend training in supporting individuals that challenge. This is updated annually. One member of staff has been working in the home for five weeks but has not attended this training although is running the shifts as a registered nurse. The manager stated that there is always staff on duty who have attended the training and they would support the individuals where it specifies in the care plan that staff have to have this training. From conversations with the manager at least three of the people living in the home have to be supported by staff that have had the positive response training. A concern was raised in that the staff member without this training was the qualified and who was the second person for someone who could potentially be aggressive and requires staff that have had the training. Evidence was provided that staff have attended other training including supporting individuals with epilepsy, makaton (a sign language for people with a learning disability), health action planning and person centred planning and more recently training on the mental capacity act. Less evident was mental health training. An opportunity was taken to review the supervision and the appraisal system. The manager stated that this is an area that she was trying to re-establish as many staff have not had an appraisal or been given regular one to one supervision. It is evident that since she has been in post this has been reestablished with the help of the project manager and everyone has had at least one supervision session. It was evident that in the last two years some staff have only had three supervisions and not many of the staff have had a staff appraisal. This would bring into question the role of the previous area manager (who has recently left) who completes monthly quality assurance visits. The manager has organised a monthly meeting for all the care staff and a separate meeting for the registered nurses. It was evident that she was looking at the staff roles in the home ensuring that each person was aware of their role and specific responsibilities. Registered nurses manage each shift as demonstrated through the home’s duty roster. In addition the home now maintains a record of each registered nurse’s registration PIN number with the Nursing Midwifery Council. Thus ensuring they can continue to practice as a registered nurse. The home has demonstrated compliance to a requirement from the last visit. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has been through a period of change in all levels of management. It is evident this has had an impact on the moral in the home. During the changes of management areas have slipped and not been picked up by senior management who visit the home. Health and safety of the people living in the home is paramount, however, risk assessments could benefit from a review. EVIDENCE: The home has been through a period of management change with the registered manager leaving in December 2007. Since that period the home has had two managers, one manager leaving in May 2008 with a new manager commencing in post in July 2008. Ms Trainer has recently been successfully 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 29 appointed as the manager of 33a Forest Road. Ms Trainer has completed the Registered Managers Award and is a registered nurse supporting individuals with a learning disability. She has worked for Shaw Healthcare for three years in one of their other homes as the deputy. Ms Trainer is planning to submit an application to the Commission for Social Care Inspection to become the registered manager for 33a Forest Road. A project manager from another home has supported Ms Trainer and has worked in the home since May 2008 but has recently returned to her substantive post. It is evident from talking with staff, the manager and the administrator that during the management changes many of the systems that should have been in place have slipped. Ms Trainer has borrowed two administrators for a couple of days per week from other homes to review all the administrative tasks and set up systems that should have been in place. The home has an administrator who started just before the manager. From conversations with both the administrator and the manager it is evident that the local homes are supporting both of them in their new roles. The manager has devised a plan of action to address the areas that need to be improved. This was included in the annual quality assurance assessment. The manager stated whilst the administrative tasks may have slipped she commended the staff team on their dedication to continue to provide a good level of care to the individuals during all the management changes. Staff spoke positively about Ms Trainer and her open door approach. In addition to the management changes in the home there have been changes at a more senior level. Staff stated that in the last three years there has been three area managers and more recently there has been a change at a regional management level. It is advised that the organisation completes a study on why staff are leaving at all levels with an action plan developed to address the issues so that this does not impact on the care delivery. Quality Assurance systems are in place with the manager being measured by a clear criteria in relation to care planning, complaints, staff support mechanisms, environments, finances etc. 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. However, there are concerns relating to the external monitoring of the home in relation to addressing the concerns about staffing or whether the organisation had fully ensured the home was continuing to be managed appropriately including ensuring staff have regular supervisions and appraisals. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 30 As discussed in the section relating to care planning the information is recorded using a format that the organisation expects the home to follow. A review should be undertaken to determine whether this is the best format for people with a learning disability addressing all areas of need including aspirations. The care-planning format in place is more a medical model of planning care or an assessment and maybe more suited to an older person’s care home to that of a home supporting people with a learning disability. 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. 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 and through the annual quality assurance assessment (AQAA). These systems also included checks on water temperatures, food temperatures, fridge temperatures and the home’s vehicles. Logs were maintained of the checks. There were gaps in the record of fridge/freezer temperatures. 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 and routine fire training. Generic risk assessments were viewed in relation to health and safety and general activities undertaken by the staff. These would benefit from a review. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 32 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. Standard YA5 Regulation 5A Requirement For each person to have a contract of care with Shaw Health care that details terms and conditions a break down of the fees and a list of what is and not included. Care plans to be reviewed to ensure current and relevant to the individual. To ensure that the documentation that staff maintain is relevant and tailored to the individual. To maintain a record of all medication entering the home. Maintain a record of all complaints entering the home including the outcome. Where restraint is used this must be recorded in the plan of care on the type of restraint used giving clear guidance to staff. This must be agreed within a multi-disciplinary framework and with the consent of the individual. A central log of restraint must be maintained so that this can be kept under review for all individuals living in the home. DS0000037337.V366395.R01.S.doc Timescale for action 22/10/08 2. 3. YA6 YA6 15 (1) (a) 15 (1)(a) 22/10/08 22/10/08 4. 5. 6. YA20 YA22 YA23 13 (2) 22 Schedule 4.11 Schedule 3.3 (p) 22/07/08 22/08/08 22/08/08 33a Forest Road Version 5.2 Page 33 7. YA23 17 (2) Schedule 4.9 18 (2) (a) 8. YA36 Maintain a record of all expenditure with a receipt within a reasonable timescale of the expenditure (daily). Ensure staff are supervised. 22/07/08 22/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Refer to Standard YA6 YA6 YA6 YA24 YA36 YA42 YA17 YA24 YA40 YA24 YA33 Good Practice Recommendations Review present care documentation to ensure that it reflects current good practice in relation to supporting individuals with a learning disability. To review the use of charts such as fluid charts and risk assessments relating to pressure sores etc to ensure relevant to the individual. Care documentation to be archived and consider how information can be more accessible. Consider how the communal area on the ground floor can be made more homely within a risk assessment framework. Staff to receive at least six supervisions every year and an annual appraisal in accordance with the National Minimum Standards and the organisation’s policies. Maintain a record of fridge and freezer temperatures in accordance with the guidance from Environmental Health. Ensure that individuals have available to them a well balanced diet with better evidence that at least 5 portions of vegetables and fruit is being offered. Ensure that all kitchen equipment is fit for purpose, including baking tins. For the organisation to develop a policy/guidelines on breakages in the home covering furniture. Where person has purchased furniture for this to be reimbursed due to breakages. For the organisation to review and develop an action plan to address the high staff turnover. 33a Forest Road DS0000037337.V366395.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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