CARE HOME ADULTS 18-65
35 Valley Road Clevedon North Somerset BS21 6AQ Lead Inspector
Paul Grey Announced Inspection 09:30 15 December 2005
th 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 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 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 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 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 35 Valley Road Address Clevedon North Somerset BS21 6AQ 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) 01275 879634 0117 9699000 The Brandon Trust Mrs Linda Purnell Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. May accommodate up to 4 persons aged between 18-64 years. One named Service User with dementia to reside. This condition will lapse when the resident leaves the home. 27th April 2005 Date of last inspection Brief Description of the Service: Valley Road provides accommodation for up to 4 service users with learning disabilities. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Valley Road has provided a strong service and has performed well during inspection. During inspection the Inspector noted the staff team were almost entirely new, absence of a manager or deputy manager, and an inappropriately placed service user. Staff at the home were struggling to meet one service users needs and given the absence of senior staff this had a detrimental effect to the entire service. The Brandon trust is attempting to support staff and service users with support from another home manager during the current managers absence. The Inspector noted the efforts of the staff team to maintain the standard of care within the home, however as a result of the previously mentioned problems the home was unable to meet national minimum standards over of variety of areas. What the service does well: What has improved since the last inspection? What they could do better:
During inspection, the Inspector noted the home and 3 major flaws. Due to sickness there was no manager or deputy manager available to support the new staff team. Due to the deterioration of a service user, the home was unable to meet their needs. This should have been addressed at an earlier point. Insufficient staff were on duty to maintain the health and safety of those living within and working within the home. This was subject to immediate requirement, and with the relocation of one service user, is no longer subject to requirement. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 6 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. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, Prospective service users are supplied with the information they need to make an informed choice about the home. Prospective service users individual needs and aspirations are assessed by the service. Prospective service users know that the home can meet their needs and aspirations. EVIDENCE: The inspector observed an up-to-date statement of purpose. The inspector noted the service user guide was particularly good incorporating clear photographs and written from the clients perspective. The homes last admission was in 1991 when the current service users moved into the home as a group. This group of service users have been together for in excess of 20 years. Previously the inspector noted potential difficulties of introducing a new service user to this client group. The Inspector noted that one service user in particular was inappropriate for the service. The home had drawn up an appropriate care plan for the service user but was unable to meet its own assessed interventions due to staffing and environmental issues. The service user has moved on and this situation has now been remedied.
35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 The inspector audited three care files. The inspector noted a clear assessment of the service users needs, a social history, photographs, and person centered planning to a high standard. The documentation in one service users notes indicates the needs of the service user and an increased level of support was required. the staff team were providing the support but at the cost of time to the rest of the service users. The inspector noted records to be regularly reviewed, up to date and clear. The inspector observed the home has used some of Brandon trusts documentation and also designed their own documentation to any areas of weakness. The standard of documentation was reasonable at the home. The inspector noted comprehensive risk assessments, which were sufficiently varied and in-depth. However, the Inspector observed that risk assessments for one service user were out of date and did not reflect the current needs of the service user. The Inspector attributed this to a combination of staff sickness and the service users deteriorating physical abilities. The Inspector noted the manager had placed all service users risk assessments into a single file for ease-of-use. The Inspector also noted the numbers of staff required to minimize risk to one service user were unavailable. The situation was resolved as the service user was moved to more appropriate care.
35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,17 The home support service users taking part in age peer and culturally appropriate activities. Service users are supported to become part of the local community. Service users are supported with appropriate personal, family and sexual relationships. The home offers service users a healthy varied diet and pleasant meal times. EVIDENCE: Service users have an active lifestyle involving courses at college, (offering pottery, printing, dance, horse riding, line dancing, rambling, etc). The Inspector noted the staff team have gone to some lengths to ensure that service users still have access to wide range of external facilities. However, this was impacted by the needs of one service user and insufficient numbers of staff to meet all of the service user groups needs. The Inspector imagines that
35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 11 the home will now be able to continue with the high standard of care it has offered previously. At the time of inspection the home did not meet national minimum standards. The inspector observed service users are well integrated into the community. Local store owners are aware of the service users and positively support them, local neighbours are supportive and friendly, local schoolchildren often know the service users by name, greet them in the morning. The staff team help support service users to maintain family links or any friendships established outside of the home. Given the service users age it is becoming increasingly difficult to maintain links with family members. Consequently in some cases staff are unsuccessful maintaining this relationship. The home meets national minimum standards. The inspector noted evidence that menus have been reviewed by local dietician. The manager for the inspector that the new menus were once again about to be checked by a local dietician. The home runs an eight weekly menu. Service users are encouraged to identify, (by means of small pictures of various meals), and chose their menu. Staff support service users in this process. The inspector commends the home on this approach. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, The home support service users with personal support it a manner they prefer and require The home supports service users meet their physical and emotional health needs. EVIDENCE: The Inspector noted that staff had gone to great lengths to support the service user group. During inspection the Inspector noted that the staff team treated the service users with dignity and respect. The staff team provide personal support in a private and respectful manner. The Inspector audited care files and noted from the care files audited that service users were registered with the local GP and received where appropriate, support from local agencies. Service users were supported to attend health care appointments by staff. At the time of inspection, this presented difficulties due to the staff numbers needed to care for one service user. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The home listens to service users abuse and acts upon them where appropriate. The home protects service users from abuse, neglect and self harm. EVIDENCE: The Inspector noted evidence of the homes complaints policies and procedures. These were clear and simple, staff spoken with were aware of them. The homes complaints procedure met national minimum standards. The Inspector noted the home had robust training for the identification and prevention of abuse. Brandon trust offers a high standard of training in this area. Staff who may be unsuitable to work with vulnerable adults are referred to the POVA list. Staff training is provided so that staff may understand acts of verbal or physical aggression. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home is clean and hygienic throughout. EVIDENCE: Given the staff shortage at the time of inspection, the Inspector omitted the majority of environmental standards. The home was clean and hygienic on inspection with no offensive odours. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36 The staff team was unable to support the service user group. The home was unable to support service users with an effective staff team. Service users benefit from a supported and supervised team. EVIDENCE: The Inspector noted staff were approachable to the service users, and comfortable with them. The staff team appeared interested motivated and committed toward providing a high standard of care. However the Inspector noted that as a group, the staff team was very new with the longest standing member having served only 4 months. During inspection it became clear that there were insufficient staff on duty to meet all service users needs. Two staff were required to be with one service user. As there were only 2 staff on duty there was little staff resource available for other service users. This has now been addressed as the service user has moved to more appropriate surroundings. Generally, two staff would be sufficient. The Inspector noted, that both the manager and deputy manager have been off sick. In the short term, the Inspector accepts the trusts proposition of supporting the home by giving support from a local manager.
35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 16 However the Inspector would point out that if the manager is likely to be off sick for an extended period, the trust will need to appoint a temporary manager. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41,42 The service users are safeguarded by the homes policies, records, and procedures. The service protects the health, safety and welfare of its service users. EVIDENCE: The Inspector audited a number of records at random. The homes records were up to date, stored securely and used in accordance with the data protection act. The Inspector noted, appropriate moving and handling training, fire precautions and equipment had been given to staff. 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 3 LIFESTYLES Standard No Score 11 x 12 3 13 2 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 2 3 x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
35 Valley Road Score 3 3 X x Standard No 37 38 39 40 41 42 43 Score X X X X 3 3 X DS0000008088.V256567.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 35 Valley Road DS0000008088.V256567.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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