Inspection on 08/08/06 for 33a Forest Road

This inspection was carried out on 8th August 2006.

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 7 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 17/04/07

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 8th August 2006 09:30 33a Forest Road DS0000037337.V307445.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.V307445.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.V307445.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 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 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 at the time of publishing this report. 33a Forest Road DS0000037337.V307445.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 November 2005 and review the quality of the care provided for the residents living at 33a Forest Road. The focus of the site visit was on the general care of a sample group of residents and the environment, including an extensive tour of the premises. This provided a good opportunity to observe residents as well as allowing for informal conversations with individuals and the staff supporting them. Five members of staff were spoken with during the site visit, which included a registered nurse in charge of the morning shift and the acting manager. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the residents and these were used as a focus for the site visit along with the pre-inspection questionnaire completed by the home, relatives (1), professionals (2) and residents (7). The site visit was conducted over a period of 7 hours. The atmosphere in the home was relaxed and the residents indicated they were comfortable with the service being provided. What the service does well: The residents 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. Residents 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 resident’s individual needs. The rights and choices and independence of the residents 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. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 6 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. 33a Forest Road DS0000037337.V307445.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 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents have comprehensive information to make a decision to move to 33a Forest Road. Residents can be assured that the home will meet their assessed care needs. EVIDENCE: There is a comprehensive statement of purpose and resident guide detailing the facilities and services provided. The residents’ rights and choices and aims and objectives of the home, the philosophy of care are also contained in the documents. This has recently been reviewed and updated to include the acting manager Mrs Booth. Admission to the home is through the care management approach and each admission is on a planned basis. There is presently one vacancy. Residents 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. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 9 The residents benefit from comprehensive care management and health care needs assessments on file. Assessments are completed prior to the admission process. This continues during the trial period and this information along with the placing authorities care plan and assessment informs the home’s plan of care. Contracts were not viewed on this occasion but were in place at the last inspection. 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ benefit from a comprehensive care planning process ensuring that all aspects of personal, social and health care needs are met. Residents are assured that their package of care is individualised and a core group of staff support them. Residents are safeguarded by comprehensive risk assessments that do not curtail their independence. EVIDENCE: Each resident 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. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 11 The majority of the care documentation was reviewed at three monthly intervals in view of the complex and changing needs of the individuals. This is good practice. However, one resident’s care file had not been reviewed in seven months. The acting manager stated that this is due to a period of absence of the care co-ordinator, and this would be rectified with this role being delegated to another registered nurse. 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. A concern was raised that staff referred to all challenging behaviour as being “off baseline”. This did not fully describe the behaviour that was exhibited and lacks a person centred approach that is seen in all other care documentation within the home. It would be difficult to review behaviours exhibited due to the lack of description. The manager and a registered nurse explained that this is how behaviour is described within the positive response training, which is delivered to all staff. 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 residents 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 residents. It was evident from discussions with staff that where a residents needs were complex, staff had to have additional training. The home is using a high percentage of agency staff. On the day of the inspection four out of the eight staff were agency. Staff, the manager and a registered nurse confirmed that agency staff and new staff are allocated to residents with less challenging care needs. This is good practice. 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 Forest Road is the “resident’s home”. It was evident that staff were encouraged to read all care documentation prior to supporting individuals. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 12 Evidence was provided that residents 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. Resident meetings were organised every five to six months and a variety of topics were discussed demonstrating that residents were consulted on the running and the care provision at 33a Forest Road. However, residents should be consulted on the frequency to ensure that it is appropriate. Residents 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. 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. 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 the service. Residents have opportunities for personal development and links with the community are an integral part of the care provided at this home. Residents are supported to maintain contact with relatives. Residents have available to them a nutritious and varied diet, based on their preferences and choices. EVIDENCE: Residents are allocated staff based on their care needs and as described in their plan of care. A number of the residents require two staff to support them in the community and in the home and one resident requires three staff to support when out of the home. There is a high ratio of staff to residents. Residents had a designated member of staff supporting them throughout the day. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 14 Staff described how additional staff were rostered to ensure that residents have opportunities to go out in the community. Records confirmed the support and activities undertaken or where residents had been offered opportunities and this was refused. This is good practice. A resident stated that they attend college, go shopping, go to the pub and on the day of the inspection had been supported to purchase a gold fish. It was evident that this had been an enjoyable outing. Clear guidance was contained in care documentation on contact with relatives. Staff stated that recently one resident had been supported to visit a relative in London. This is commendable. Staff conveyed that this was seen as an important role. Residents had an opportunity plan aimed at fostering new interests in the community, the home, and maintaining relationships with relatives and friends. Plans indicated that residents 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 residents are encouraged to lead full lifestyles, which was based on choice. Two residents were keen to describe a recent holiday they had taken to Butlins. It was evident that this had been enjoyable and one resident wanted to return again. Positive relationships were seen between residents and staff. Communication was inclusive of the resident. Staff clearly described how residents are supported with their communication and this was seen as an important area in reducing episodes of challenging behaviour. Staff described how they had recently attended a workshop on intensive interaction a communication system for individuals who have limited or no verbal communication and how this was being used for one individual. This is good practice. Visiting professionals provide access to aromatherapy, music therapy and Indian head massage. Residents are supported to attend college during term time. Staff stated that this is usually life skills, cookery and arts and crafts based on the interests of the resident. Certificates were seen displayed in bedrooms of residents. Menus were submitted prior to the inspection visit and demonstrated that residents had access to a nutritious and balanced diet based on the preferences of the residents. Residents were observed being supported to make drinks in the training kitchen. Staff were observed responding to requests from residents for drinks and snacks appropriately. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 15 A resident stated that they only need to ask for a drink and they would be supported to make this for themselves. Two residents stated that the food was good, and one person stated that it was “alright”. It was evident that residents had a high degree of choice in relation to meals and when they were taken. One resident was observed having his breakfast late mid-morning. This is good practice and further evidenced the commitment to providing individualised packages of care. 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. 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 the service. Resident’s personal and health care needs are being met in the preferred manner of the individual. Residents should be assured that staff can account for all medication entering the home and that staff are free from distractions when dispensing medication. EVIDENCE: Each resident 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 residents had access to relevant health care professionals and the home is aware of preventative health care. Residents 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 has been raised. 33a Forest Road DS0000037337.V307445.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 residents and the care staff. This was confirmed on the duty rota. Feedback from a doctor states, “that the staff support residents to attend appointments, however it is not always clear why they visited but this was not a concern”. This may be due to the lack of verbal communication of some of the residents in expressing pain or ill health and the home was ensuring that an appropriate professional had been consulted where this was not clear. 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. There was no record of medication entering the home for the particular medication order that was being used for the month of August 2006. All other records were in place to demonstrate that residents were administered medication safely, including records of disposal. The storage of medication met with regulations. However, 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 must risk assess the present place of storage and it is strongly recommended that the storage be moved to a place that is free from distractions. 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. 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 the service. Residents can be confident that they concerns would be listened to and acted upon. Residents are protected by the homes policy on protection. All allegations of abuse are taken seriously and appropriate safeguards are put in place to offer residents protection. Residents must be assured that their finances are accounted for appropriately. EVIDENCE: There is an adequate complaints procedure in place and a review of records indicated that a recent complaint from neighbours about noise from the home had been dealt with appropriately. It was noted that the home had a previous complaint about noise, which was to do with the kitchen fan, this one relates to noise of carers at night. This is being closely monitored by the home. Care files viewed indicated that key team members have a sound knowledge understanding of the complex communication methods of residents, and changes in behaviour, body language and facial expressions are observed closely. Residents would be offered support in a sensitive manner to determine whether a problem existed, and appropriate action taken to rectify it. There have been two referrals to the local Authority in respect of protection issues. One was made directly by the home and the other by a resident who no longer lives in the home. The home has investigated both and appropriate action was taken to ensure the safety of the residents. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 19 It is evident that the home takes allegations of abuse seriously and follows the appropriate guidance ensuring residents are protected. 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 acting manager stated that one of the registered nurses had attended “train the trainer in abuse”, this person has since left and this gap needs to be filled. This will be followed up at the next inspection. Policies and procedures were in place relating to restraint and the management of aggression. Where restraint had been used there were clear records in place detailing the time, the reason, the well being of the resident and a review of the incident to ensure that the restraint was used appropriately. Two 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. A random check of finances was conducted. Two residents finances did not account with the records held in the home, both had in excess of the amount recorded. The manager stated that a new system is being piloted and the administrator did not have time to complete this prior to their holiday. The new system was introduced, as care staff were not recording all expenditure. Documentation lacked two staff signatures. A concern was raised that the bankcards and the pin numbers were held together in the safe. The safe was restricted to the administrator and the manager. 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. 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 the service. Overall a warm, comfortable environment has been created ensuring the resident’s needs are met taking into account the levels of challenging behaviours and the specialism of the service provision. 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. A requirement that has been repeated at the last two inspections has now been met, which relates to furniture in a residents bedroom. The acting manager stated that the resident had been consulted on the missing draw fronts and this is how the particular resident prefers to store their items of clothing. Documentation was in place supporting the above. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 21 All areas of the home were clean and generally free from odour. Where there was a slight odour staff were observed making that additional effort to reduce and were exploring different flooring for that particular bedroom. This is good practice. The home was in a good state of repair with a rolling programme of decoration. The large communal area has recently been redecorated and staff confirmed that pictures were still needed for the walls to make it more homely and this was in hand. 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 residents and visiting personnel. Residents were observed accessing the training kitchen with staff. The communal spaces include lounge/dining area, therapy room, and hydro pool and as already mentioned the social skills kitchen. Residents were observed accessing the communal areas with support from their designated care worker. One resident was keen to show their bedroom which was noted to be personalised and reflected the individual’s choice and preferences. Staff stated that residents are consulted prior to admission on what they would require in their bedroom to make it homely and safe including the colour scheme. 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 residents, 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. 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. 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are supported by competent, trained staff who are committed to improving the quality of life for the individuals living in the home. However there is a high percentage of agency staff. EVIDENCE: Staff described a high level of job satisfaction and informal support within the team. Staff spoke positively about the acting manager stating that there is much clearer direction for the team and the dedication of the team leaders (registered nurses that lead the shifts). There are clear aims and values in this home, which are resident, 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. There are high staffing levels and it was evident that this was tailored to the individual. On the day of the inspection there were eight staff on duty, however four of the eight staff were agency. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 23 The acting manager stated that the home has recently recruited 15 new staff and the home is taking up references and the appropriate recruitment checks. The home has 3, full time vacancies including a registered nurse (team leader). It was evident that the acting manager and the organisation were ensuring good recruitment programmes were in place to ensure that the home was fully staffed. Eight staff have left since the last inspection, with two staff having been dismissed. The manager stated that the high turnover is for a number of reasons including personal reasons, the complex needs and the intense support that is offered to residents and new employment opportunities. One member of staff stated that the acting manager has offered the home stability and direction, and some staff may have stayed. Regular staff meetings were now taking place since the acting manager has taken up post. These were less evident in the interim when the deputy manager was in post and the registered manager was on maternity leave. 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. It was evident that positive relationships had been developed between staff and residents. Staff described their key residents in a positive manner and their shared interests whether that be walking, watching old films or visiting places of interest. This evidently gave residents and a staff a baseline to build and foster positive relationships. Recruitment information was in place to demonstrate that residents were protected. 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. The home presently has 12 of the workforce having completed an NVQ in care as taken from the pre-inspection questionnaire. The NVQ assessor has recently left the employment of the home. It would be strongly recommended that a plan is developed to work towards the governments target of 50 of the workforce must 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. It was evident that the acting manager was planning training for the shortfall as this has lapsed for some staff between the registered manager and Mrs Booth taken up post. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 24 This was true of the formal supervision for staff with some not having had supervision since February 2006. In light of the complex needs of the residents this must be re-introduced to give staff an opportunity to discuss incidents of aggression, be supported in their role, offered professional guidance and to identify future training needs. Training for staff in supporting residents that challenge was in place however it was evident that this had lapsed during the interim management and was now being addressed. A registered nurse has been trained as a “Positive Response Instructor” and delivers the training to staff. No requirement was made during this visit as the home has developed a plan to address the shortfall. This will be monitored at the next inspection. There is always a registered nurse in charge in the home. The organisation routinely reviews staff registration details with the Nursing Midwifery Council. 33a Forest Road DS0000037337.V307445.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is now well managed; it was evident that the home is benefiting from the acting manager taking on this responsibility. There is a comprehensive quality audit undertaken on the care provided to the individuals living at 33a Forest Road. Resident’s health and safety could be compromised if staff do not attend fire training at the appropriate intervals. EVIDENCE: Ms Booth has been the acting manager since April 2006 prior to this period the deputy manager had taken on the role. An application was submitted for the deputy manager to become the registered manager and was withdrawn by the organisation. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 26 Staff spoken positively about the acting manager and the support and direction that she gives to staff. It was evident from conversations that she strives to achieve the home and the organisations aims and objectives and ensuring the residents have an individualised package of care. Mrs Booth is a registered learning disability nurse. She worked in the home as a team leader prior to taken up a registered managers post in another Shaw Trust home. Mrs Booth stated she will be working in the home until October 2006 until the registered manager returns to work. The home operates good auditing systems to ensure that a quality service is provided including seeking the views of service users. 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. Copies are not being sent to the Commission for Social Care Inspection. The area manager has agreed to send these from April 2005. Policies and procedures are in place to ensure the health and safety of the residents and staff members, as seen at the last inspection. These form part of the induction. A new member of staff was reading these at the time of the site visit. 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 residents. Some of the notifications lacked detail and made reference to residents being off baseline. These require more information if they are to have any meaning on the incident and for the home to fully review behaviours that challenge. A review of the fire records demonstrated some serious shortfalls in training and the attendance at fire drills for staff. Staff only attend annual training and not as per the recommendations of the fire officer which is six monthly for day staff and three monthly for night staff. At least three staff have not attended a fire drill in the last twelve months. Staff must attend a fire drill once in a sixmonth period. The fire systems have not been checked since the 13th July 2006. The manager stated that a fire representative from another Shaw Home was visiting that week to show staff the procedures. No requirement was made at this visit in relation to routine testing. Confirmation was seen in the home’s diary of the planned visit. Generally the feedback about the organisation was positive and provides comprehensive training enabling staff to deliver a high standard of individualised care. 33a Forest Road DS0000037337.V307445.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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 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 3 3 3 3 2 3 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 28 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. 3. Standard YA20 YA20 YA23 Regulation 13 (2) 13 (4) 17 (2) Sch 4.9 18 (2) 18.1(c) Requirement To maintain a record of medication entering the home. For the home to risk assess the medication storage to ensure that potential risks are reduced. To ensure that records of finances are up to date and reflect the amounts held in the home. For staff to have adequate supervision. Provide staff with training and guidance on language used when completing records. (Extended to enable the home to comply previous timescale 28/02/06) Timescale for action 08/08/06 08/10/06 15/08/06 4. 5. YA36 YA23 08/11/06 08/09/06 6. 7. YA42 YA42 23 (4) (e) 23 (4) (d) For all staff to attend a fire drill 22/08/06 once in a six month period. For all staff to attend fire training 22/08/06 in accordance with the fire officer’s recommendations – six monthly for day staff and three monthly for night staff. 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 29 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. Refer to Standard YA6 YA23 YA23 YA20 YA8 YA32 Good Practice Recommendations To review the use of the term “off baseline” when recording levels of behaviour. Bankcards to be kept separate from pin numbers. Financial transactions to be supported by two members of staff or where possible the resident. The home to consider moving the medication cupboard to reduce distraction. Consult with residents on the frequency of meetings and to ensure that these are at regular intervals. For the home to develop a plan to achieve the governments target of 50 of the workforce to have an NVQ 2 in care. Staff to receive supervision at least six times per year. YA36 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 33a Forest Road DS0000037337.V307445.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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