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Inspection on 18/03/08 for 34 Ceely Road

Also see our care home review for 34 Ceely Road for more information

This inspection was carried out on 18th March 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users are assessed prior to admission to ensure that the home can meet their needs. Prospective service users are given the opportunity to spend time at the home to see how they relate with other service users. Service users plans are in place, which are informative and allows for staff to provide continuity of care. Service users have access to a weekly programme of day centre activities. Service users are supported to maintain contact with family and friends. Varied balanced meals are provided. Service users health and personal care needs are identified and met.Systems are in place to deal with complaints and the protection of service users from abuse. This must be supported with safeguarding of vulnerable adults training. The home is clean, nicely decorated and well maintained with individual bedrooms personalised and homely. Safe recruitment practices are in place Staff are supervised and supported in their roles. Systems are in place to ensure health and safety is monitored and to promote service users safety and well being.

What has improved since the last inspection?

There were no requirements at the last inspection. Two recommendations of good practice were made and as a result two staff signatures are in place for service users financial transactions. Service users essential lifestyle plans continue to be developed.

What the care home could do better:

Some aspects of equality and diversity is identified in care plans but not evidenced if addressed. Service user plans should be further developed to include dates, evidence of review and an indication if the service users are involved in their development. The home must work with service users in promoting choices and decisions in aspects of their daily lives and records to be maintained to support this. Risk assessments must be kept up to date, reviewed and signed. Service users records must be kept secure and confidential. Service user health records should outline the frequency of weighing if required, indicate why required and whether the aim is to gain or lose weight. Staffing levels must be reviewed to ensure that there is enough staff to meet service users needs including opportunities for leisure activities. Some areas of practice in relation to daily routines around access to the home, managing post and use of service users preferred form of address should be reviewed to further promote service users rights.Menus must be developed to outline the meals available to all service users, to include all special diets and to indicate if alternatives choices are available and provided. Some improvements are required to medication practices to safeguard service users. Exposed copper piping in one bedroom must be covered to prevent risk of injury. Staff must have up to date mandatory training and other specialist training including challenging behaviour and medication administration training to support them in their roles to meet service users needs safely. Effective monitoring systems should be put in place to ensure that records required for regulations are organised, accessible and kept up to date and reviewed.

CARE HOME ADULTS 18-65 Ceely Road (34) Aylesbury Bucks HP21 8JA Lead Inspector Maureen Richards Unannounced Inspection 18 March 2008 09:15 th Ceely Road (34) DS0000023048.V359210.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 Ceely Road (34) DS0000023048.V359210.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. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ceely Road (34) Address Aylesbury Bucks HP21 8JA 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) 01296 485756 N/A N/A www.macintyrecharity.org MacIntyre Care Mrs Penny Cummings Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: 34 Ceely Road is a large, two storey, detached modern house located within a residential area of the market town of Aylesbury and is close to Stoke Mandeville Hospital. It is home to six younger adults with learning disabilities. The home has six single bedrooms on the upper floor and has a secure maintained garden, which is accessible to all service users. The home is situated close to Aylesbury and local amenities that include shops, cinema, pubs and restaurants. Public transport is available and accessible to service users living in the home. The fees range from £58,475.93 to £63,001.64 per annum. Additional costs exist for such things as personal activities including holidays, hairdressing, clothes and personal toiletries. Information to support potential Service Users and their families to make a decision for admission to the home is provided in the homes Statement of Purpose and the Service Users Guide, which are provided to potential Service Users, with additional copies held in the home. Ceely Road (34) DS0000023048.V359210.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 people who use this service experience adequate quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a self-assessment questionnaire was sent to the manager for completion. Comment cards were distributed to service users, relatives, visiting professionals and staff prior to the inspection. Replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of examination of some of the homes required records, observation of practice, discussions with the registered manager, staff on duty and a tour of the premises. Feedback on the inspection findings and areas needing improvement was given to the manager during the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. This inspection has resulted in a number of requirements and good practice recommendations to improve outcomes for service users. What the service does well: Service users are assessed prior to admission to ensure that the home can meet their needs. Prospective service users are given the opportunity to spend time at the home to see how they relate with other service users. Service users plans are in place, which are informative and allows for staff to provide continuity of care. Service users have access to a weekly programme of day centre activities. Service users are supported to maintain contact with family and friends. Varied balanced meals are provided. Service users health and personal care needs are identified and met. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 6 Systems are in place to deal with complaints and the protection of service users from abuse. This must be supported with safeguarding of vulnerable adults training. The home is clean, nicely decorated and well maintained with individual bedrooms personalised and homely. Safe recruitment practices are in place Staff are supervised and supported in their roles. Systems are in place to ensure health and safety is monitored and to promote service users safety and well being. What has improved since the last inspection? What they could do better: Some aspects of equality and diversity is identified in care plans but not evidenced if addressed. Service user plans should be further developed to include dates, evidence of review and an indication if the service users are involved in their development. The home must work with service users in promoting choices and decisions in aspects of their daily lives and records to be maintained to support this. Risk assessments must be kept up to date, reviewed and signed. Service users records must be kept secure and confidential. Service user health records should outline the frequency of weighing if required, indicate why required and whether the aim is to gain or lose weight. Staffing levels must be reviewed to ensure that there is enough staff to meet service users needs including opportunities for leisure activities. Some areas of practice in relation to daily routines around access to the home, managing post and use of service users preferred form of address should be reviewed to further promote service users rights. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 7 Menus must be developed to outline the meals available to all service users, to include all special diets and to indicate if alternatives choices are available and provided. Some improvements are required to medication practices to safeguard service users. Exposed copper piping in one bedroom must be covered to prevent risk of injury. Staff must have up to date mandatory training and other specialist training including challenging behaviour and medication administration training to support them in their roles to meet service users needs safely. Effective monitoring systems should be put in place to ensure that records required for regulations are organised, accessible and kept up to date and reviewed. 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. Ceely Road (34) DS0000023048.V359210.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 Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Service users are assessed prior to admission to ensure compatibility with other service users and to ensure the home can meet identified needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has had an admission in the period under review. The manager confirmed that prior to the admission a referral was received from the care manager, followed by a visit from the care manager, family and prospective service user. The assessment was carried out at the home and a completed assessment form was available to evidence this, including a copy of the most recent assessment by social services. The assessment documentation covered personal and health needs, specific disability, communication, family contact, interests and an assessment of life skills. Prior to admission the prospective service user spent time at the home including over night and weekend stays. Other service users were made aware Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 10 of the visits and staff observed interactions and group dynamics during this time to ensure compatibility. The assessment documentation had not been signed off by the manager and was filed loosely in the box file. Ceely Road (34) DS0000023048.V359210.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): 6,7,9,10 Quality in this outcome area is adequate. Service user plans are in place which outlines service users needs, however support with choices and management of risks need to be further developed to promote continuity of care and service users well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service users plans were viewed. Care plans include an outline of personal details including details of next of kin and a photograph of the individual. Service user plans outlined the date of birth, gender, specific disability and religion. However it did not indicate if the individual was being supported or choose to pursue their identified religion. Each service user has an individual support plan which outlines the morning, afternoon and evening routine in relation to getting up, going to bed, oral and personal hygiene care, support with meals, and support with going out. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 12 Service users files contained separate behaviour support plans and individual communication profiles. These were found to be detailed and informative on the care and support to be given and on the management and response to behaviours. One service user had a lifestyle plan in place. These are being developed for all service users to make the plan of care more accessible and understood by service users. The service user files seen contained the required information but they were disorganised and were not filed in any particular order. This made the information difficult to access. The plans seen did not include a date of implementation, evidence of a written review and there was no indication of service users involvement in their development or an indication as to how the plan was developed. A recommendation was made at the previous inspection that emphasis be placed on completing the proposed development of person centred plans to further support Service Users. This is still being developed with essential lifestyle plans being introduced and being put in place for individuals. The majority of service users at the home are unable to verbalise their choices and decisions regarding aspects of their lives. Service user plans made some reference to supporting choice in relation to clothes and meals but this was brief and service user plans and records did not evidence how staff do this. Service users have a monthly meeting and minutes of meetings are developed in picture format to make them accessible to some service users. The manager confirmed this is not understood by all service users. One of the staff at the home is working with a speech and language therapist in developing other prompts and aids to enable service users to make choices and the progress with this will be established at the next key inspection. None of the service users are able to manage their finances and risk assessments are in place to indicate this and the support required to prevent risk of abuse. The home does not have advocacy involvement but is currently looking into accessing advocates to support service users. Service user plans included individual and environmental risk assessments. Some of the risk assessments on files were not dated or signed, and some were dated 11.01.07 and were due for review. During the inspection it was noted that rubber gloves were accessible to service users. Individual risk assessments need to be put in place to support this practice. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 13 Service users files are stored in an unlocked box in the computer room, which is accessible to all service users and visitors to the home. The manager advised this was to allow service users access to their files. However the majority of information in the files is not developed in a user friendly format and this in fact makes it in accessible to service users. The storage of service users records is not in line with the rules on storing service users records securely and confidentially and may not be in line with the Organisations policy on confidentiality. This must be addressed. Ceely Road (34) DS0000023048.V359210.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): 12,13,15,16,17 Quality in this outcome area is adequate. Service users are supported to have a balanced meal, maintain contact with family but have limited opportunity for leisure activities, which meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users attend a day centre at least four days a week with all of the service users having a home day to do activities of their choice or to be supported with life skills. The essential lifestyle plan seen outlines the individuals interests and activities that they have been known to enjoy however there is no evidence to support how individuals make the choice of an activity on the day. The daily record does not provide sufficient evidence to indicate if activities of choice have taken place and if so what was the outcome of that activity for the individual. This needs to be developed on. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 15 The home has experienced recent staffing difficulties and this will be referred to under standard 35. Some service user plans indicate that they require two staff for activities out of the home therefore with two staff per day time shift this has resulted in few leisure activities taking place particularly at the weekends. Feedback from service users and staff indicate that activities do not take place due to staff shortages and the use of agency staff who do not know the service users well enough to assist with an activity. On the day of the inspection one service user who was having a home day had to go on the trip to the day centre to drop off the other service users as there was not sufficient permanent staff at the home to enable her to be able to stay. This is unacceptable and must be addressed. Service users are supported to maintain family links and friendships and the service user plans seen evidence family involvement. The manager confirmed that service users next of kin are invited to reviews and are consulted on aspects of the service users care if they wish to be. No feedback was received from relatives as part of this inspection. Service users are supported to develop independent skills in relation to tasks around the home. None of the service users have a key to the front door and some of the service users have a key to their bedroom. A risk assessment should be put in place to support the decision for service users not to have a key to their home and bedroom. The manager confirmed that staff support service users with their post, including opening it for some individuals. Care plans should make reference to the amount of support required in managing post. Staff were observed engaging with service users and in understanding their needs. Service users can choose when to be alone or in company and this was evident during the inspection. Service users have three meals a day with drinks and snacks available when required. Service users have a choice of cereal, fruit and toast for breakfast with sandwiches provided for lunch on the days that service users go to the day centre. Service users have a cooked meal in the evening. The menu seen was found to be healthy, balanced and nutritious. The weekly menu is put together by staff taking into account specific diets at the home and an awareness of individuals likes and dislikes. There is no record to confirm likes and dislikes. The service user plans seen did make reference to specialist diets and outlined the support required by individuals at meal times. The menu plan seen was very specific for two individuals at the home and did not indicate that it took into account the other service users living at the home, including other special diets. The menu did not indicate if alternatives were Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 16 available or had been provided and service users were not being supported to make meal choices using a range of prompts to assist if necessary. It is hoped that the work with the speech and language therapist may promote service users choices in relation to aspects of their lives including meals. Ceely Road (34) DS0000023048.V359210.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. Service users healthcare needs are monitored to promote service users well being, however some medication practices are unsafe which could potentially puts service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users plans outline the support required with personal care and includes specific details on individuals’ morning and night time routines. Service users have a named link worker at the home who is responsible for updating care plans and completing a monthly summary report. Service users have a separate health record. This outlines key professionals involved with individuals and the support required in meeting healthcare needs. It includes a record and outcome of appointments with health care professionals and evidences that service users have access to a wide range of health care professionals. One service user health record outlined the service users weight and evidence of staff weighing and recording the weight but on an ad hoc basis. The health record should outline the frequency of weighing and what the expected Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 18 outcome is. Two other service users health records made reference to specialist diets, their ideal weight and their weights being monitored weekly by external agencies. None of the service users at the home are able to self-administer their medication. Service user have an individual support plan, which outlines medical needs including support with medication. Staff are responsible for the administration of medication. The medication is stored in a locked cabinet situated in a locked cupboard in the hallway. The home uses a monitored dosage system with some medication in blisters and some left in their original containers. The home has printed medication records. Records of drug administration were found to be in good order with no gaps evident alongside prescribed dose times and no incidences of drug errors. The home has a record of receipt of medication into the home and a record of disposal of medication back to the pharmacy. At the time of this inspection the home had no controlled drugs being administered. The home uses homely remedies for example lemsip. The manager confirmed that this was checked with the supplying pharmacist prior to administration. There is no written evidence to support this. The manager should devise a list of all homely remedies used and obtain written confirmation from the General Practitioner or Pharmacist that the homely remedies used do not interact with individuals prescribed medication. The home has service users on prescribed rectal Diazepam. Staff have received training on epilepsy and rectal diazepam however for the majority of staff this training is now overdue. Staff have not been assessed and deemed competent to administer rectal diazepam and individual guidelines are in place, which makes it clear that staff are not to administer this medication and in the event of an epileptic fit lasting more than four minutes then an ambulance is to be called. Records evidence that this has happened. The manager confirmed that all service users on prescribed rectal diazepam are being reviewed with a view to being prescribed a less intrusive effective emergency medication. The home has some service users on as required medication. For one individual the as required medication has not been required for a period of time. Written guidelines are not in place to indicate the use of this as required medication. The manager confirmed that this was only given following an assessment by a senior or head of service and in view of the fact it had not Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 19 been used for some time she would make arrangements for this to be taken off the medication administration record. The manager must ensure that written guidelines are put in place if as required medication is prescribed in the future. The training records indicate that five staff have had medication awareness training, and were all overdue for a refresher and update training in safe administration of medication. Three staff have not had any medication training including the manager. All of those staff are involved in medication administration. The manager confirmed she was due to commence a distance learning medication training the day following the inspection and intended to get more staff enrolled on this training. The medication cupboard was disorganised with medication bottles sticky, some medication loose and out of packets and excess stock of lactulose left on the floor within the locked cupboard. A prescribed food supplement was stored in a box where something had leaked, was sticky and looked unhygienic. These issues need to be addressed and monitored. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 20 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. Systems are in place to ensure service users views are listened to and acted on and to safeguard service users, however safeguarding of vulnerable adults training need to be put in place to support this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality assurance document indicates that the home has had no complaints in the last twelve months. The complaints log seen supports this. No complaints have been received by the Commission in respect of this service. Service user plans include a copy of the complaints procedure and feedback from service users indicate that they know who to go to if they are unhappy. The Annual Quality Assurance document indicates that there has been no safeguarding of vulnerable adults referrals in the last twelve months. The training records indicate that two staff have not had safeguarding of vulnerable adults training and this training was overdue for six staff members including agency staff. The manager confirmed that safeguarding of vulnerable adults training was booked and scheduled to take place at the home at the end of April 2008 and she planned for all staff members to attend. This must happen as a priority. The home has policies in place on the management and prevention of physical and verbal aggression. Service user plans outline guidelines on the management of challenging behaviours but as outlined under the staffing Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 21 section staff have not got up to date training in challenging behaviour to support them in this. The Annual Quality assurance document confirms that weekly and monthly financial checks are completed. A recommendation was made at the previous inspection for two staff signatures to be included on service users finance records. This has been put in place. Ceely Road (34) DS0000023048.V359210.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): 24,30 Quality in this outcome area is good. The home is clean and homely which provides a comfortable environment for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home consists of a two-storey building. The communal areas are on the ground floor with six bedrooms, toilets and bathrooms on the first floor. The home has a large sitting room / dining room with a separate modern kitchen and a separate computer / quiet room accessible to service users and staff. The home has a separate laundry, two bathrooms and two toilets. The manager confirmed that the flooring in one of toilets was scheduled to be replaced and the walls in the toilets had recently been decorated. All of the service users’ bedrooms were viewed. The bedrooms are nicely decorated, furnished and very individual and personalised. In one of the Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 23 bedrooms viewed exposed copper piping was visible. This must be covered as it looks unsightly and to reduce any potential risk of injury to the service user. The manager confirmed that a programme of redecoration is in place with a request for money to replace the carpet in the hallway, stairs and landing and to redecorate the walls in this area during the next financial year. The home has an enclosed garden with a patio area and a small grassed area. The manager confirmed that plans are in place for staff to develop the garden to include a sensory area. Staff are responsible for the cleaning at the home and cleaning schedules and records are in place to support this. On the day of the inspection the home was clean, homely and nicely presented. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 24 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): 32,33,34,35,36 Quality in this outcome area is poor. Staff are not appropriately trained and staffing levels are not appropriate to meet service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to be comfortable and accessible to service users. The agency staff member on duty at the start of the inspection was found to be unreceptive and this should be addressed. The Annual Quality assurance document indicates that there are nine permanent staff. Four staff have achieved a National Vocational Qualification and a further two staff are working towards an National Vocational qualification. Five staff have attended autism training in 2005/2006. Three staff have attended communication training in 2004 and 2005. The manager confirmed that all staff have attended infection control training, certificates were available to evidence this but the training records were not updated to indicate this. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 25 Three staff have attended physical intervention training in 2004 and 2006. One staff member has attended challenging behaviour training in 2006. Service users plans indicate that some service users can present with behaviours that challenge and up to date challenging behaviour training must be available to staff to support them in their roles and to promote service users safety. As outlined above all specialist training is overdue for updating for the majority of the staff team. Staff confirmed that they have built good working relationships with other professionals. No feedback was received from professionals as part of this inspection. The home has an established staff team with low rates of turnover. However at the time of the inspection the home had two staff on maternity leave, two staff on annual leave and a full time vacancy, which had been filled but was waiting clearance prior to commencing work. The manager is using agency staff to cover vacancies but this has limited activities for service users who require staff who know them to take them out on activities. The rota indicates that there are two staff on each day time shift with a third staff member for part of some morning shifts. However some service users require two staff for specific activities and the current staffing levels do not allow for this. This must be addressed. There is one sleep in staff at night with back up on call available if required. The records indicate that staff have had recent disturbed sleep in’s but the rota does not allow for staff to be able to take time back the following day. Staffing levels must be reviewed to ensure that sufficient staff are provided to meet service users needs. Regular team meetings take place and records are maintained to support this. Three recruitment files were viewed. The staff files were disorganised, inaccessible and not in any particular order. The files contained an application form, confirmation of criminal records bureau checks and two references. Some files contained a photograph and some proof of identity. The home has confirmation of a criminal record bureau check and two references for agency staff working at the home. A training matrix is in place to indicate what training staff have had and indicates when updates are due. However during the course of the inspection it was established that the training matrix was not kept up to date. The training records indicate that six of the nine staff have up to date first aid training, only two staff have up to date fire training, five staff have had manual handling training with updates due in April but not yet scheduled. Two staff have not got this training. Three staff have up to date food hygiene training, one staff member have not got this training, whilst four staff are overdue for updates in food hygiene training. Staff are responsible for preparing and cooking meals and must have up to date training to support them in this role. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 26 As outlined above mandatory training is not been provided for some staff and updates are not been scheduled and taking place when due. This must be addressed as a priority. Information supplied by the agency indicates that some mandatory training is due for review. The manager must address this with the agency. The manager confirmed that new staff are inducted into roles however the home has not had new staff in post for some time to assess and evidence this. The manager confirmed that performance reviews have taken place for all staff and that staff receive formal supervision to support them in their roles. Records are maintained to evidence this. Feedback from staff confirm that training is provided but not regularly updated. They confirm that they receive supervision and feel supported in their roles and that recent staffing levels has resulted in a reduction in community activities for service users. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 27 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): 37,39,41,42 Quality in this outcome area is adequate. The home has a committed manager however some aspects of management are not being addressed and monitored which potentially puts service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that she has completed the National Vocational Qualification level 4 and has been put forward to enrol on the Registered Managers award training. Due to the staff shortages the manager has been working on shifts on a regular basis and this has impacted on administration tasks. The manager is committed to ensuring that service users day to day needs are met, however the lack of staff and insufficient training does not allow this. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 28 Staff confirms that the manager is approachable, supportive and hands on and this was evident during the inspection. This inspection has resulted in a number of requirements and good practice recommendations to improve outcomes for service users. The manager confirmed that monthly monitoring visits take place, although at present they are announced and on the day of her supervision. The manager confirmed that this was scheduled to change with the Regulation 26 visits becoming unannounced. This needs to happen in line with the Regulation. Copies of Regulation 26 reports up until December 2007 were available but not filed appropriately. The manager confirmed that the Regulation 26 reports for January and February 2008 were on the computer but had not been printed out and made accessible. The organisation carries out an annual audit referred to as the “Big Respect” Audit and this is scheduled to take place on the 15th and 16th April 2008. The manager confirmed that questionnaires had been sent to families as part of that audit. The results of this will be reviewed at the next key inspection. The Annual Quality Assurance document outlines changes they have made and areas where improvements are required. However the information within the Annual Quality Assurance document was brief and lacked supporting evidence. Some of the records required for Regulation as outlined within the report are disorganised and inaccessible and this must be addressed. Training and development of staff is not promoted and addressed. A sample of health and safety records were viewed. The home carries out a series of weekly and monthly health and safety checks, including water temperature checks, fridge and freezer temperature checks and daily food temperature checks. The home has records in place to confirm that fire exits, emergency lighting, fire extinguishers checks are carried out and fire drills take place on a regular basis. Last recorded fire drill took place on the 18th January 2008. The home has records in place to confirm that the fire equipment, fire alarm, boiler and electrical appliances had been serviced. Five staff have attended health and safety training in 2006.Health and safety records are organised, accessible and kept up to date. Staff have not got the required up to date mandatory training as outlined under standard 35. Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 1 33 2 34 3 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 2 2 LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x 2 3 x Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 30 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 YA7 Standard Regulation 12 Requirement The manager must evidence how service users are supported to make individual choices and decisions in relation to all aspects of their lives. Service user plans must include up to date and signed risk assessments including a risk assessment on whether access to rubber gloves poses any risks to individuals. Service users records must be kept secure and stored confidentially. The organisation must ensure that staffing levels are reviewed to ensure that sufficient staff are provided to meet service users needs, to allow individuals to pursue leisure activities and trips out or to allow service users to be able to stay at home on their home days if they choose to. Menus must outline meals available to all service users, including all special diets, alternative choices and develop service users involvement in menu planning. The manager must ensure that DS0000023048.V359210.R01.S.doc Timescale for action 31/05/08 2 YA9 13 15/04/08 3 4 YA10 17 18 15/04/08 30/04/08 YA13 YA33 5 YA17 16 15/04/08 6 YA20 13 30/04/08 Page 31 Ceely Road (34) Version 5.2 7 YA20 13 8 9 10 YA20 YA24 YA32 YA23 13 & 18 23 13 & 18 11 YA35 18 confirmation have been obtained from the prescribing General Practitioner or Pharmacist that homely remedies administered by staff do not interact with individuals prescribed medication. The manager must ensure that written guidelines are put in place if any as required medication is prescribed in the future. Staff involved in medication administration must have up to date medication training. The exposed copper piping in one bedroom must be covered. The manager must ensure that staff have up to date specialist training and challenging behaviour training. All staff must have up to date mandatory training including agency staff who work at the home on a regular basis. 30/04/08 31/05/08 30/04/08 31/05/08 31/05/08 Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA6 Good Practice Recommendations Service users plans should be reorganised with the required information in a standard format and made accessible. Service user plans should include a date of implementation, evidence of a written review and an indication of service users involvement or how the plan was developed. A risk assessment should be put in place to support the decision for service users not to have a key to their home Service user plans should outline support required with post. The health record should outline the frequency of weighing and what the expected outcome is for individuals. The medication cupboard should be kept clean, organised and all medication stored appropriately. This should be maintained and monitored. Staff recruitment files should be reorganised and the required information put in order and made accessible. Training records should be reorganised, made more accessible and regularly updated. 3 4 5 6 7 8 YA16 YA16 YA19 YA20 YA34 YA35 Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ceely Road (34) DS0000023048.V359210.R01.S.doc Version 5.2 Page 34 - 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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