Inspection on 06/11/08 for 35 Lowther Road

This inspection was carried out on 6th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

35 Lowther Road 29/10/07

35 Lowther Road 14/05/07

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 06/02/2009.

CARE HOME ADULTS 18-65 35 Lowther Road 35 Lowther Road Charminster Bournemouth Dorset BH8 8NG Lead Inspector Heidi Banks Key Unannounced Inspection 6th November 2008 11:45 35 Lowther Road DS0000068520.V373386.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 35 Lowther Road DS0000068520.V373386.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. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 35 Lowther Road Address 35 Lowther Road Charminster Bournemouth Dorset BH8 8NG 01202 391610 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) www.robinia.co.uk Robinia Care South Ltd Mrs Claudie Thornewill Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning Disability (Code LD) The maximum number of service users who can be accommodated is 4 Date of last inspection 29th October 2007 Brief Description of the Service: 35 Lowther Road was registered as a care home in October 2006. It is a detached house situated in a residential area of Bournemouth and is registered to provide accommodation and personal care to up to four adults with a learning disability. The registered provider is Robinia Care South Limited. The regional office of the organisation is in Hindhead, Surrey. Accommodation at 35 Lowther Road is on two floors. There is one bedroom with en-suite facilities on the ground floor and three en-suite bedrooms on the first floor. There is a communal lounge, spacious kitchen / dining area, conservatory and large garden at the rear of the house. The home is staffed on a 24-hour basis. The home is within walking distance of a bus stop from which the shopping and commercial centres of Bournemouth, Charminster and Winton are easily reached. Bournemouth’s main railway station is also within reasonable walking distance to enable access to places that are further afield. The home has a paved area at the front of the property for parking and additional parking is available on the road. From information provided to us by the service in December 2008 the weekly fees charged by the service, based on individual assessment of needs, ranged from £1507-£1640. General guidance on fees and fair terms of contracts can be obtained from the Office of Fair Trading at www.oft.gov.uk. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection of the service. The inspection took place over approximately 12 hours on 6th and 13th November 2008. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the requirements made at the last key inspection in October 2007 and random inspection in June 2008. At the time of the inspection there were three people living in the home aged between 21 and 30. This inspection was carried out by one inspector but throughout the report the term ‘we’ is used to show that the report is the view of the Commission for Social Care Inspection. During the inspection we were able to meet all of the people who use the service and observe interaction between them and staff. Discussion took place with the Registered Manager of the home, Claudie Thornewill, and some members of staff on duty. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were sent to the home before the inspection for distribution among people who live in the home and those who have contact with the service. We received two surveys from people who use the service who were supported to complete them by members of their family; two surveys from care workers and one survey from a health care professional. We received the home’s Annual Quality Assurance Assessment before the inspection, which gave us some written information and numerical data about the service. A total of 23 standards were assessed at this inspection. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 6 What the service does well: The home strives to have a person-centred approach in the care they deliver. A system is in place to assess people’s needs before they are admitted to the home to ensure that it is the right place for them. People have care plans which contain detailed information about their needs and wishes. This means that care workers have the information they require to provide support in a way that is both respectful to individuals’ needs and that promotes consistency. The home aims to encourage people’s independence in their home and community and offers them opportunities to access a range of activities and amenities in the local area. This enables people who live in the home to lead an ordinary lifestyle. The home is clean, warm, well-decorated and homely thus providing a comfortable environment for people to live in. Attention has been given to personalising individuals’ bedrooms so that they meet their preferences. Systems are in place for people who have contact with the service to raise concerns and complaints and know that these will be responded to. Procedures to keep people safe from abuse are also in place and permanent staff have received training on abuse awareness to help them respond appropriately if they have concerns. The home now has a manager, Mrs Claudie Thornewill, who is registered with the Commission and who has made significant efforts to familiarise herself with the regulations and national minimum standards since coming into post in June 2008. Mrs Thornewill has fully addressed most of the requirements made at the last inspection of the service and demonstrates a sound awareness of where further development is needed to continue to improve outcomes for people who live in the home. Comments we received in surveys included; ‘I am very happy living at Lowther Road. I have an active life but also plenty of time to relax’ (service user survey); ‘It is a lovely place to work and the residents are quite happy and well looked after’ (staff survey); ‘The new manager has made lots of good changes and my parents believe things can only get better for me’ (service user survey). 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: As a result of this inspection we have made five requirements, one of which is repeated from the last inspection of the service. The outstanding requirement is in relation to ensuring that there are enough permanent staff employed within the service. There is still a high reliance on agency workers which the home needs to address so that people who use the service always benefit from care workers who know them well and have the 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 8 necessary skills and knowledge to understand and meet their needs in a consistent way. In addition certificates for training undertaken by staff are not always on file in the home which means that there is not always enough evidence to show that people have completed the training they need. These issues were inherited by Mrs Thornewill when she became the manager of the service in June 2008. Mrs Thornewill demonstrated awareness of where shortfalls exist and was able to tell us the actions she is taking to address these. While some progress has been made it is not yet sufficient to fully meet the regulations and national minimum standards in these areas. Quality assurance frameworks are in place within the organisation although these have not always been fully implemented in the home. The home must now look at making this process an integral part of what they do to ensure that the care that is delivered is firmly based on the needs and wishes of the people who live there. The home must review their procedures to ensure that the Commission, and other relevant authorities, are always notified of events in the care home where people may have been put at risk. This ensures that people who live in the home remain protected through multi-agency working. At the time of the inspection a lock on the door of a kitchen cupboard containing chemical products was broken. This had already been identified by the service but the repair had not taken place. The manager has informed us that since the inspection the lock has been repaired to ensure the secure storage of hazardous substances. We have also made six recommendations as a result of this inspection. Recommendations made are based on good practice and should be given serious consideration by the provider to improve outcomes for people who use the service. 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. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 9 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 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 10 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: People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that people’s needs are assessed before they come to live in the home so that there is a smooth transition and to ensure their requirements and wishes can be met. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) supplied by the home told us that there have been no new admissions to the home in the last twelve months. This was confirmed with the manager at the time of the inspection. At the last key inspection of the home in October 2007 the judgement we made was that people had their needs assessed before they came to live in the home, which helped promote a smooth transition. The manager has stated in the AQAA that any prospective service user would have an assessment of needs carried out before admission to involve the person themselves as well as other relevant parties including their families, friends, representatives and placing authorities. In addition, both surveys we received from people who use the service told us that they and their families had been involved in making a choice to come and live in the home. The home has also told us that they are looking to promote the involvement of the prospective service user in the assessment process, which will mean reviewing current documentation and the accessibility of existing information. 35 Lowther Road DS0000068520.V373386.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 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is working hard to identify people’s needs and choices and to respond to this appropriately. This will help ensure that people have the opportunity to fulfil their goals and participate in a full and meaningful life. EVIDENCE: We looked at the care plans in place for one person who uses the service. We saw some very detailed information available to care workers on how the person should be supported with their care including how to communicate with them. Information about the person’s preferences was also included in the plan as well as guidance about what they can do for themselves and what they require support with. The plans were written in a person-centred style focusing on what is important to the individual concerned. The plans showed evidence of being updated to reflect the individual’s changing needs. We also noted that an annual review meeting had taken place in May 2008 regarding 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 12 the person’s needs to ensure that care was being delivered that matched their requirements and wishes. The manager told us that she is looking to develop the current system of care planning to include ‘pen pictures’ of people and to ensure that the care plan promotes the involvement of the person it concerns. The home’s Annual Quality Assurance Assessment tells us that all three people who use the service have specific communication needs and therefore more work is needed to ensure that care plans are as accessible as possible to the people they belong to. The manager acknowledged that accessibility of information is an area for further development and will give this consideration when care plans are reviewed. Both care workers who responded to surveys told us that they are always given up-to-date information about the needs of the people they support. The manager demonstrated commitment to promoting people’s involvement in making decisions about their care. We noted in the care plan for one person that they should be encouraged to sign at all times as this is their ‘best communication (and understanding) skill’. The plan stated ‘I am very good at using and understanding Makaton signs but need lots of encouragement to use them’. A short period of observation in the home indicated that some staff were more confident in using Makaton than others. Training is available within Robinia to permanent care workers on total communication approaches but the manager acknowledged that total communication is an area that needs to be consistently implemented in the home in such a way that it becomes integral to the service and used by all staff. The manager reported that she has made contact with a local Speech and Language Therapist regarding provision of training to all staff. The manager told us that she liaises closely with relatives of people who live in the home to obtain their views about the service. She gave an example of how this had led to her investigating ways to create a more ‘sensory’ environment for people who use the service, of particular benefit for a person who has a visual impairment. Although these plans are still in their infancy the manager has a clear vision of what she wants to achieve in this area and has identified potential sources of advice to support her in developing the service in this way. We looked at a sample of risk assessments in place for one person. These focused on promoting the person’s independence including access to activities, public transport and involvement in activities of daily living. Observation of life in the home indicated that permanent staff are keen to promote people’s independence through appropriate risk-taking, for example, enabling people to have space and privacy in their bedrooms as they wish and promoting people’s access to the kitchen where they can be involved in food and drink preparation. In addition, discussion with staff indicated that they are positive about offering a range of opportunities for the people they support, including access to a gym, swimming and trampolining, putting appropriate support in place to overcome possible barriers and maintain people’s safety. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service generally ensures that individuals have access to a wide range of places and amenities and offers them opportunities to take part in activities of daily living. This enables them to live an ordinary life in their home and community. EVIDENCE: The manager has told us in the home’s Annual Quality Assurance Assessment that the home actively promotes ‘interaction with the local community for the people living at Lowther. We use local amenities on a regular basis’. We looked at a sample of daily records to see what activities people participate in outside of the home. These showed that people go for walks in the neighbourhood, to local pubs and cafes, to the leisure centre for swimming and the gym, college, sailing and drumming sessions. Each person who uses the service has a photographic timetable in the kitchen of the home. This is 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 14 supplemented by photograph albums of people accessing a wide range of activities and visiting local places of interest which were on display in the lounge. The manager told us that one person who did not previously access a day service now attends twice a week and that this is going well. The entries in daily records we looked at for this person demonstrated that they were supported to attend the day service. Both people who use the service told us in surveys that they can do what they want to do during the day, in the evening and at weekends. One person added that access to activities ‘sometimes depends on how many staff are working and if they can drive etc.’ Discussion with the manager indicated that there are some staffing factors that may sometimes inhibit people accessing the community although the home tries to plan ahead to ensure that scheduled activities take place at the appropriate time. Some entries in daily records about activities people engage in at home were rather repetitive – for example, many entries for one person stated that they did puzzles and listened to music. Although these are known to be enjoyed by the person concerned the home should ensure that there are a range of activities on offer to the individual so that they can evidence the person is making a real choice and their choice is not limited by staffing levels or the availability of a driver. Care workers we spoke with during the inspection showed a good awareness of ordinary life principles and the need for them to support people with all aspects of their daily life. We observed this being put into practice with people being encouraged to help with meal preparation and making a cup of tea for themselves. We also observed one person actively choosing to spend some time alone in their bedroom following their return from day service. This was fully respected by staff on duty. The manager told us that all three people who use the service have contact with their relatives either by making visits to their family’s home or by visits to 35 Lowther Road. This was reflected in individuals’ daily records. People’s dietary intake is recorded, records showing evidence of times when individuals had chosen to eat different meals. Inspection of kitchen cupboards showed availability of a range of foods including a large selection of cereals for people to choose from. The menu for the week was on display on the refrigerator, evidencing a range of meals on offer, for example, pasta, beef casserole, sweet and sour chicken, pizza and roast dinners. A bowl of fresh fruit is located in the kitchen for people to help themselves to. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 15 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 and 20: People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from personal and health care that meets their needs and preferences. Medication procedures in the home are generally robust and ensure that people who use the service get the medication they need. EVIDENCE: The care plan we looked at for one person who uses the service was very detailed in respect of the individual’s personal care needs, what they can do for themselves and where support is required. The care plan gave attention to the person’s preferences, for example, how they like they hair to be washed and how to support them effectively with cleaning their teeth. Both people who responded to the survey indicated that staff always treat them well; ‘They are sensitive to my needs and feelings’. Care workers who are permanently employed in the home showed a sound knowledge of individuals’ needs and were observed to interact with people positively and respectfully during the inspection. In addition, care workers told us that where preferences have been expressed regarding the gender of people providing care to individuals this has been respected by the service. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 16 Records we looked at for one person who uses the service showed evidence of input from various health care professionals with documentation in place to record appointments attended. There was a monthly weight chart on file, which was up-to-date. Epilepsy guidelines were in place for the person giving staff information on the action they must take in the event of a seizure and records were in place documenting seizures that had occurred. A health care professional who has contact with the home indicated in a survey that the health care needs of the people who live there are always met and that the home seeks advice as appropriate. Medication is supplied to the home by a local pharmacy. Medication administration record (MAR) charts are also supplied by the pharmacy for completion in the home. Medication is stored securely in a metal cabinet attached to the wall of the office. The home did not have a suitable cupboard for the storage of controlled drugs at the time of the inspection. This is now a legal requirement to ensure that, in the event of a person being prescribed a controlled drug, it can be stored safely. Since the inspection the manager has arranged for a controlled drugs cupboard to be installed in the home. We have been notified of two medication errors occurring in the home in the last twelve months. The manager has responded to this by reviewing practices in the home and implementing an audit trail. There was evidence at the inspection that the error had been followed up appropriately with staff concerned. The manager reported that she has sought advice from the pharmacist from the Primary Care Trust who has visited the home recently to undertake a medication audit. At the time of the inspection the manager was awaiting a report from the visit. For the person we case-tracked at this inspection we saw evidence of a medication profile including a list of medication and indication that the person has no known allergies. There was detailed information on file about how the person should be supported with taking their medication. We observed these guidelines being followed to good effect by a care worker. Inspection of a sample of MAR charts indicated that medication has been signed for by staff suggesting that the medication had been given as prescribed. Handwritten instructions regarding the administration of ear drops were evident on the MAR chart for one person but these had not been doublesigned to ensure their accuracy. There was evidence of liaison with a community nurse about one person’s PRN (as required) medication for which guidelines are being developed before the prescription is commenced. Training records showed that permanent staff have received training in the administration of medicines. Medication is only administered by permanent staff in the home. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 17 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 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from staff who are responsive to their wishes. Systems are in place to protect people from harm. EVIDENCE: The home has told us in their Annual Quality Assurance Assessment that they have a concerns and complaints procedure and a policy on the disclosure of abuse and bad practice. Information about how to make a complaint was seen in the home, this giving the contact details for the Commission. Both care workers who responded to the survey told us that they knew what to do if a person using the service or their relative had concerns about the home. Both of the people who use the service told us in surveys that carers always listened to them and acted on what they say; ‘The staff are sympathetic to my needs when I make it known that I am not happy’. Both surveys also indicated that relatives of the service users were aware how to complain. We looked at the complaints record for the home. There have been no entries in the past twelve months. The Commission has not received any complaints about the service. The manager told us that she is making efforts to communicate with families of people who use the service on a regular basis to obtain their feedback and ensure the home is responding to their needs and ideas for improvement. The manager also told us that she is looking to make 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 18 the complaints process easier to understand for people who use the service so that their feedback can be obtained in a meaningful way. There has been one safeguarding investigation in the home in the last twelve months. The training records of permanent staff working at the home showed evidence of attendance at abuse awareness training. We asked an agency worker if they had covered abuse awareness during their induction programme with the agency. They replied that they had not covered this in their induction although had received this training in a previous post of employment. Their profile from the agency indicated attendance at the ‘company induction’ but did not refer specifically to training in abuse. The home has implemented an orientation programme for agency workers which introduces them to the policies and procedures of the organisation but this does not specifically refer to safeguarding procedures. We have recommended that the home clarifies with the agency whether abuse awareness is covered in the agency’s induction programme and ensures this is clearly documented on profiles obtained from the agency. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 19 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is decorated and furnished to a high standard offering people a homely, attractive and clean environment to live in that promotes an ordinary lifestyle. EVIDENCE: A tour of the home’s premises indicated that it provides a clean and homely place for people to live in. Bedrooms are highly personalised and reflect the tastes and interests of the people they belong to. All bedrooms have en-suite facilities, which promote people’s privacy and dignity in the home. There is a lounge, conservatory and kitchen / dining room on the ground floor. The manager has told us in the home’s AQAA that they will be updating the décor and furnishings in communal areas of the home in the next twelve months. It is anticipated that this will be based on the needs and preferences of the people who live in the home and will focus on people’s sensory needs. The manager informed us during the inspection that it is planned the conservatory 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 20 will be adapted into a sensory area including lights, soft furnishings and music. It is hoped that this will benefit all three people who currently live in the home, as they will be able to use the area as a place to relax as well as for sensory stimulation. The relative of a person who lives in the home commented in a survey that the home offers an environment like a ‘flat / house share’ appropriate for the young adults who live there. Both of the people who use the service indicated in their surveys that the home is always fresh and clean. The home presented as clean on both days of the inspection and there were no offensive odours. The home’s AQAA tells us that they have a policy on communicable diseases and infection control. They have also indicated that staff have received training in prevention and control of infection, this being confirmed in the training records that we looked at. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There have been improvements in systems to safely recruit and train care workers within the home. Further development is needed to ensure that all care workers have the specialist training they need to provide effective support to people who use the service and there are enough permanent staff appointed to provide consistency of care. EVIDENCE: We looked at the recruitment records for two people who had recently come to work in the home. For the first person there were two written references, proof of identity and evidence of registration with the Accession State Worker Scheme. Gaps in employment on their application form had been explored at interview and documented. For the second care worker there were appropriate references and proof of identity on file. From documentation on file it was evident that the person required a visa to work in the United Kingdom. However, although there was a copy of a visa on file, it appeared to be past its 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 22 expiry date. There was no evidence of renewal of the visa on the person’s file in the home. The manager has since liaised with Robinia’s Head Office and has been informed that the visa has been renewed and there is appropriate documentary evidence to support this. Evidence of both care workers having had a check undertaken with the Criminal Records Bureau was seen in a spreadsheet provided to the home by Robinia’s Head Office. This did not state whether disclosures received were clear. We have recommended that the home reviews the information they receive to ensure that it meets the criteria of current guidance as available on our website; www.csci.org.uk/professional. Discussion with the manager and inspection of the home’s rota between the period of 4th and 31st October indicated that on most days an agency worker was employed to ensure the home is fully staffed. The manager has told us in the AQAA that in the three months before the AQAA was submitted a total of 103 shifts involved use of temporary staff or staff from an agency. One member of agency staff works alongside a permanent member of staff at these times. The manager has also told us that approximately 50 of the time she is also on the premises in a supernumerary capacity providing support to staff on duty. The manager reported that the home aims to employ the same agency workers to promote a consistent approach although acknowledged that this was not always possible. We discussed issues around the regular use of agency staff including the fact that they do not have the same training as staff employed by Robinia, they do not have the same knowledge and understanding of people’s specialist needs and that at times when agency workers are employed the responsibility for running the shift naturally falls on the permanent care worker. The two care workers who responded to the survey indicated that there were usually enough staff to meet the needs of people who use the service, one adding that reducing the use of agency staff and having a solid team was an area that the home could improve on. The manager told us at the inspection that the home is currently one member of staff short. The vacancy had been filled in September 2008 but this had not worked out and therefore they had needed to re-advertise. We were advised that they have recently appointed again and are awaiting the return of checks to confirm the person’s employment. We looked at a sample of records for agency workers employed to work in the home to ensure the home had obtained sufficient evidence in relation to their recruitment and training. Records we looked at showed a significant improvement from previous inspections. The manager has ensured that there is appropriate evidence in relation to all agency workers including a photograph and evidence of a satisfactory disclosure, references and training courses undertaken. During the inspection, however, an agency worker was supplied to the home for whom they had not received relevant information. The manager responded appropriately to this situation contacting the agency immediately to request that the necessary information was sent through before the agency worker commenced work. The manager has told us that she is 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 23 liaising with the agency to ensure that this does not happen again. The manager was advised to ensure that there is a clear protocol for staff to follow in the event of an agency care worker for whom there is no information available being supplied to cover a shift. Induction checklists are in place for all agency workers who are new to the home. This covers an orientation to the home, its procedures and policies, an introduction to people who use the service and record-keeping. Induction checklists are carried out with the agency worker by the permanent member of staff on duty. We looked at a sample of training records in place for staff. The manager showed us the system in place for monitoring training undertaken by staff and to identify gaps where they exist. The manager informed us that she is communicating with the organisation’s training department to ensure that staff access training and updates as necessary. The manager told us that positive progress has been made in this area but acknowledged that there were some shortfalls in maintaining documentary evidence of training on people’s files. There was evidence in the form of certificates that the majority of care workers had completed training in epilepsy. For two people there were no certificates but both are believed to have completed the training. Four out of six care workers are recorded as having undertaken training in disability awareness and five out of six care workers were recorded as having attended training in communication. The manager recognised that communication skills and training in total communication approaches are key to the role of the support worker at 35 Lowther Road and reported that she is investigating further training in this area. The manager has told us in the home’s AQAA that more than 50 of staff in the home are qualified with a National Vocational Qualification (NVQ) at Level 2. We also saw evidence in training records of two care workers having attained their NVQ Level 3 Award. Given the regular use of agency care workers in the home we looked at a sample of six profiles for agency workers to see if they had received training in epilepsy awareness. The profiles for three of the workers showed no evidence of them having received training in epilepsy. The remaining three showed evidence that they had undertaken training in epilepsy from a previous employer but not from the agency themselves. The manager showed us an email she has sent to the agency emphasising the need for workers supplied to the home to have training in epilepsy. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 24 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 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although there are some areas that need further development, the home is demonstrating the capacity to meet these by establishing systems to promote people’s welfare in the home. EVIDENCE: At the time of the inspection Claudie Thornewill had recently completed the process to register with the Commission as the manager of the home. This met a requirement made at the random inspection of the service in June 2008. Mrs Thornewill has stated her commitment to her personal development in the role and is liaising with her employer regarding commencement of her Leadership and Management for Care Services Award and NVQ Level 4 in Care. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 25 Staff employed at the home who we spoke with at the inspection commented on Mrs Thornewill’s commitment and enthusiasm for the job; ‘Cannot fault the way she does her job’; ‘She is definitely what we need’. Discussion with Mrs Thornewill indicated that progress has been made in relation to requirements made at previous inspections and she is working through an action plan in conjunction with her line manager in order to make the necessary improvements to the service. Mrs Thornewill told us that the quality assurance process in the home, to be based on the views of people who use the service, has not been fully implemented to date although it will commence in January 2009. She showed us a folder of paperwork relating to quality frameworks in the organisation, which she is familiarising herself with and plans to implement in the home. Various audits take place in the home on an annual basis including a financial audit and health and safety audit by the organisation’s Head Office, documentation on which we were able to see at the inspection. Inspection of records indicated that there had been a gap in monthly visits taking place by the provider in accordance with Regulation 26 between January 2008 and August 2008. The visits taking place in September and October 2008 had been completed by a manager of another home owned by Robinia Care South. Mrs Thornewill told us that Operations Managers will be undertaking this function in future. We looked through a sample of incident reports for one person who uses the service. One report indicated that people using the service were potentially put at risk by an incident occurring in the care home. This had not been referred as a safeguarding issue and we had not been notified of the incident in accordance with Regulation 37. The manager told us that she had given this consideration at the time but as prompt action had been taken in relation to the incident to minimise the risk of reoccurrence and there was no evidence that people using the service had been adversely affected it had not been reported. We have made a requirement for the registered persons to review their procedures to ensure that incidents where people’s welfare is put at risk are reported promptly to the relevant authorities. Mrs Thornewill has confirmed her commitment to ensuring notifications are made to the relevant authorities as appropriate. We looked for evidence of health and safety checks taking place in the home. There were records in place to monitor the temperature of the refrigerator and freezer facilities in the home, which were seen to be up-to-date. The temperatures were checked at the time of the inspection and were within a safe range. Checklists are also in place to assess lighting and ventilation, 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 26 cleanliness, food storage, floor coverings, window restrictors, storage of chemicals, fire safety and security. These had been completed on a monthly basis and were up-to-date. We noted on the checklist completed on 4th November 2008 that a lock on the door of the cupboard used to store chemicals products needed repair. We looked at this on both days of the inspection and found that the lock had not been repaired which meant that the products were not being stored securely. We also noted on the first day of the inspection that a cleaning fluid had been put in an unlocked cupboard in the communal toilet on the ground floor presenting a potential risk to people. We note from the home’s AQAA that response times for maintenance requests in the home has been identified as an area for improvement. Since the inspection the manager has informed us that the lock on the cupboard has been repaired to ensure the safe storage of chemical products. We saw evidence that safety testing of portable electrical appliances has been completed in the home with a certificate valid until April 2009 being on file. Radiator covers are in place in the home and we noted that window restrictors are in place in the two occupied bedrooms on the first floor to promote people’s safety. We looked at training records for six permanent care workers for evidence that they have undertaken training in areas of health and safety including moving and handling, food safety, infection control and first aid. All staff were recorded as having received training in moving and handling and infection control. All but one care worker (night staff) had undertaken training in food hygiene. Three out of six care workers had documentary evidence of completing training in first aid, two people had been booked in for a training date later that month and the third had no certificate on file but was believed to have completed the training. 35 Lowther Road DS0000068520.V373386.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 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 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 3 12 2 13 X 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA33 Regulation 18(1)(a) Requirement The provider must evidence that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This requirement is repeated from the last inspection of the service, as the timescale of 15/08/08 has not been fully met. 2. YA35 17(2) Documentary evidence of all training undertaken must be kept on care workers’ records. This provides evidence that people are suitably qualified for their role and able to meet the needs of people who use the service. 31/01/09 Timescale for action 28/02/09 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 29 3. YA39 24 A quality assurance system must be fully implemented in the home which is based on the needs and wishes of people who use the service. This will help ensure that the development of the service is based on outcomes for people who live there and is evaluated against these outcomes. 30/04/09 4. YA42 13(4)(c) The registered person must ensure that chemicals that are hazardous to health are stored securely in the home. This is to safeguard the welfare of people who live there and ensure they are protected from harm. The registered person must review their procedures to ensure that any incident occurring in the home where people are placed at risk of harm is reported to the Commission and to the relevant authorities. 31/12/08 5. YA42 37 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations The manager should look at ways they can promote a total communication environment in the home to ensure that all individuals are fully involved in making choices and decisions about their lives. The manager should ensure that staffing in the home promotes people’s access to activities in the community and real choice about the activities they want to do. 2. YA12 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 30 3. 4. YA20 YA23 5. YA32 6. YA34 Handwritten instructions on medication administration record (MAR) charts should be double-signed to confirm their accuracy. The home should clarify with the agency they use whether abuse awareness training is covered in their induction programme and ensure that this is clearly documented on people’s profiles. All care workers employed in the home should have the necessary skills in total communication approaches and Makaton to be able to communicate effectively with people who use the service. The home should review the information they receive from the organisation’s Head Office regarding disclosures from the Criminal Records Bureau to ensure it meets the specifications of current guidance. 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 35 Lowther Road DS0000068520.V373386.R01.S.doc Version 5.2 Page 32 - 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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