Inspection on 24/10/06 for 374-376 Winchester Road

This inspection was carried out on 24th October 2006.

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 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

374-376 Winchester Road 18/05/09

374-376 Winchester Road 16/07/08

374-376 Winchester Road 27/11/07

374-376 Winchester Road 18/05/07

374-376 Winchester Road 15/02/06

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 376 Winchester Road Southampton Hampshire SO16 6TW Lead Inspector Liz Normanton Unannounced Inspection 24th October 2006 09:50 376 Winchester Road DS0000062649.V289387.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 376 Winchester Road DS0000062649.V289387.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. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 376 Winchester Road Address Southampton Hampshire SO16 6TW 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) 023 80 789786 Integra Care Management Ltd Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 Brief Description of the Service: 376 Winchester Road is a small home providing twenty-four hour care and support to up to five service users with learning disabilities with complex needs and who may have challenging behaviour. The service provider is Integra Care Management Limited, a Midlands based service. The home provides a comfortable environment where the residents have a room of their own which has been designed and decorated to meet their individual needs and personal preferences. The home has one bathroom and all residents have their own shower or bathroom facility. There are two lounges, a communal kitchen and large enclosed garden. 376 Winchester Road is situated close to local community facilities, Southampton Common, Southampton Sports Centre and shopping facilities in Shirley and Southampton. Monthly Fees are from £1,500.00 to £3,000.00. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home and focussed on what the Commission considers to be core standards for a care home for younger adults as defined in the Department of Health (DOH) National Minimum Standards. The inspection was undertaken over one day and the manager and responsible individual assisted the inspector. The inspector spoke with three staff, viewed two residents’ personal files and documents held in respect of staff and the home, and toured the home. The inspector also spoke with a social worker and a parent prior to visiting the home. This information was then triangulated to access outcomes for people living at the home. Since the last inspection a new manager has been appointed and had been in post for just eight weeks. In discussion with the manager and responsible individual they notified the inspector that Integra Care are planning to raise the numbers of the home from five to eight following the completion of building works to the property they have purchased next door to the home. Due to the service users’ complex communication difficulties the inspector was unable to verbally seek the views of all the residents. However observation of staff with residents demonstrated that the residents appeared happy at the time of the visit. The outcome of this inspection was that there had been improvements made in the management and administration of the home, and there was evidence that the majority of the requirements made at the last inspection had been complied with. Four requirements and four good practice recommendations have been made at this inspection. What the service does well: The home obtains information on the residents prior to moving into the home, working closely with specialist health care teams and current staff to ensure they are able to meet the service users’ needs. The home provides a comfortable environment for the service users to live, with individual bedrooms that reflect their needs and personalities and alternative communal space to allow them to have time on their own of they wish, fitted with appropriate furnishings. The staff team appear dedicated and willing to learn. The staff were observed going about daily activities in a professional manner and respectfully engaging with the residents. The home supports the service users to maintain community and family links, on the day of the visit two service users were observed going out for a leisurely walk. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 6 The health and welfare needs of the service users are promoted and protected ensuring referrals are made to primary and specialist health care professionals such as GPs and occupational therapists when required. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides relevant information to prospective service users’ representatives to enable them to decide whether the home can meet their clients’ needs. Prospective service users would benefit from the provision of this information being provided in a format, which is meaningful to them. The home will undertake a comprehensive needs assessment of prospective service users prior to admission and will not admit people that it cannot support. EVIDENCE: There had been a requirement made at the last inspection that the home should update the statement of purpose/service user guide to reflect the actual service provided. An updated version was evidenced however as there has been a recent change in manager the details will need to be changed again. The information is not available in a format which would be meaningful to service users. In discussion with the acting manager they agreed to update the statement of purpose and send a copy to CSCI. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 9 In discussion with a care manager prior to the inspection visit they confirmed that their client had been visited at their previous residence by the responsible individual and manager who had undertaken a needs assessment. They also confirmed that their client had been to visit Winchester Road on several occasions prior to admission. One service user’s file was viewed for evidence of needs assessment, which was present. The information in this was limited and this was discussed with the responsible individual who explained that the information was limited as this was all the previous home had provided. There was evidence on file of the personal plan, which held assessment information obtained from the service user’s placing authority. In discussion with a member of the support staff who had worked at the home since it opened confirmed that all the service users had visited the home on several occasions prior to being admitted. They also stated that support staff had spent time meeting service users at Tatchbury Mount Hospital to learn to understand their support needs and work with them. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 8 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had complied with the three requirements made at the last inspection. The home has produced an individual plan for each service user, which has good information about a person’s support needs, however at present these are not person centred and service users do not participate in their support planning and would not be aware of their individual plan. The home should consider implementing person centred planning and try to engage service users to participate in the review of their individual plan. The home encourages service users to make decisions about their lives and provides the assistance required. The service users have diverse and complex support needs and will never be able to live independently, however the home encourages and supports individuals to take risks on a day-to-day basis and promotes the continued development of the service users. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 11 EVIDENCE: At the last inspection eight areas were identified as a concern in the area of support planning and three requirements were made. From evidence gathered at this inspection visit the inspector was satisfied that the previous manager had begun to address the issues, however there is still room for improvement. The inspector viewed two residents’ personal files. Each service user has two files, one which holds personal information and the other as a daily working file (which is easily accessible to staff). The personal file held relevant contact details, such as DOB, NOK, GP, details of placing authority and dates to remember such as relatives’ birthdays etc. The personal files were “bulging” with information, some of which could be weeded out and archived to make the files easier to read. The second daily file held good documentation to record the service user’s daily routines, daytime activity, health and medication and behaviour charts. In individual discussions with four of the support staff they all stated that they found the information in support plans helpful and relevant to peoples’ needs. Although it was evident that individuals’ care needs are documented and met the home does not use a person centred planning approach in providing support. Due to the service users’ limited communication skills the inspector was not able to ask formal questions about how they view their care. One service user said “I’m happy”, two made no comment and one was not present. The inspector observed positive interaction between the staff and service users. The support plans are reviewed on a two monthly basis, by the service users’ key-workers. Any changes to an individual’s support needs are recorded and documents are signed. The service users are not currently involved in the review of their support plans. It was evident from discussions with support staff and observation that service users are able to make choices about their lives. One service user has access to an advocate. Service users are able to take risks on a daily basis, one person is able to make hot drinks, toast, etc. Two are encouraged to participate in household tasks, such as mopping floors and setting tables. All the service users go out into the community with assistance from support staff. One service user’s file was viewed and was seen to contain risk assessments. Following an incident in the home since the last inspection, where a service user had a serious fall, a risk assessment has been undertaken and the 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 12 person’s bedroom has been moved to the ground floor to ensure their safety and welfare. 376 Winchester Road DS0000062649.V289387.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards have been audited. The home supports the service users to maintain links with the local community, take part in peer and age appropriate activities and maintain links with family and friends. Service users are encouraged to maintain independent living skills. The home provides service users with a healthy diet. EVIDENCE: One of the service users continues to attend a day centre service five days a week following his permanent move to the home. In individual discussion with four staff and the manager they explained that service users are supported out in the community to visit shops, pub, and go 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 14 out for walks. The manager stated that the proprietors are going to purchase a vehicle for the home and this should enable service users them to have greater access to the local community. The manager has developed a daily activities plan for the service users taking into consideration their likes/dislikes and is hoping to build up the level of opportunities available for the service users to access such as a local hydrotherapy pool. In discussion with one member of staff they stated that they had supported one service user to visit the Isle of Wight on short weekend breaks on occasions throughout the summer. Service users are supported to maintain contact with their relatives. In discussion with a parent prior to the inspection visit they confirmed that they and another family member have regular visits to the home and are always made welcome. In discussion with a member of staff they confirmed that one service user is supported to visit their family monthly. Service users are encouraged to participate in the daily household tasks and a staff member stated that one service user enjoys mopping their bedroom floor. One service user was observed setting the placements on the dining table prior to lunch. One service user has the capacity to make hot drinks, sandwiches etc and supported to maintain these skills. Support staff were observed treating the service users with dignity and respect throughout the inspection visit. In discussion with the manager she explained that she is reviewing the menu as she felt the four weekly rotating menus was too restricting and minimised choice available to the service users. The manager has asked staff to bring in pictures or photos of meals to develop these as pictures of reference to assist service users in choosing a meal. Fresh vegetables and fruit are purchased twice weekly. The lunchtime meal at the inspection visit was chicken and mushroom pie, with fresh cabbage, carrots and sweetcorn, a casserole was prepared for teatime. Service users have access to hot and cold drinks throughout the day. Most meals are taken sitting up to a dining table and are relaxed and unhurried. 376 Winchester Road DS0000062649.V289387.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. Service users physical and emotional health needs are met. Service users are not able to administer their own medication and are supported by the staff team who do this on their behalf. The home has policies and procedures in place for the safe handling of medication, however there was evidence that staff have omitted to sign the medication administration record charts on several occasions. This omission can be detrimental to the welfare of service users. EVIDENCE: Evidence of details of how people prefer to be supported was written in individual plans. All personal support is provided in privacy. The home employs both male and female staff, which offers service users a choice as to who provides their intimate care. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 16 In discussion with support staff they stated that service users can retire and awake when they choose but that most prefer to go to bed before 10.00pm and one rises at 06.00am. Nobody currently requires technical aids or equipment, however one service user’s parent is considering purchasing a specialist bed for her son. The home has a small staff team who are aware of the service users’ needs and can offer consistency and continuity and care. The inspector observed that the staff had developed positive relationships with the service users who appeared to be relaxed and well cared for. All service users are registered with a local general practice. There was evidence on service users’ files and through discussion that service users have access to support from external health professionals, which includes psychological support and occupational therapy. Service users also have access to podiatrist, ophthalmic care, and continence nurse. The service users are not able to take responsibility for the administration of their medication and rely on support staff to administer their medication. There is one designated member of staff responsible for the medication being received into the home and this is recorded on to the Medication Administration Record (MAR) chart. In discussion with a member of staff they stated that they had received in-house training in administering medication and had been shadowed by a colleague until they were considered competent to undertake this task unsupervised. In discussion with the manager they stated that they are requesting that all staff have medication training. There was evidence that support staff record that medication has been taken, however there were several omissions in when staff have failed to sign the MAR charts, this matter was raised directly with the responsible individual who agreed to look into the matter. The home is currently storing oral and skin preparations together, these need to be stored separately from each other. 376 Winchester Road DS0000062649.V289387.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives of service users would have sufficient information to enable them to make a complaint if they were concerned about the service. The service users rely on support staff to understand their likes and dislikes and would need to rely on them to recognise if they were not happy with the service. The home does not have a complaints procedure in a format which would be meaningful to service users. EVIDENCE: The home has a clear complaints policy and procedure which is written in plain English and includes details of how long a complaint will be dealt with and how to contact CSCI. The complaints procedure is not available in a format which would be meaningful to the service users. Details of how to make a complaint are now available in the statement of purpose. The inspector acknowledges the complex communication and behavioural needs of the residents provides difficulty for the staff team to establish if the residents wish to make a complaint, however the home must consider alternative solutions to meeting this need. In discussion with two staff there was a mixed response with one knowing that the home had a complaints log-book and the other did not think there was one. There is a copy of the complaints procedure available to staff in the home’s staff handbook. Both members of staff stated that they would pass on all concerns to the manager or the responsible individual. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 18 There have been no complaints since the last inspection. There was evidence that the home has an adult protection policy and procedure. There has been an incident at the home since the last inspection, which has been fully investigated following the home’s adult protection procedures. In discussion with three support staff they confirmed that they would be able to recognise adult abuse and would use the home’s “whistle-blowing” policy. One member of staff had received adult abuse awareness training in a previous employment. The home’s policies and practices regarding management of the service users’ money and financial affairs ensure that they are protected from financial abuse. There was evidence that the home had obtained Criminal Record Bureau checks for all current staff and they had been checked against the POVA list. 376 Winchester Road DS0000062649.V289387.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home complied with the majority of requirements made under the environment standard. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home is a two-storey house currently providing accommodation for four residents. The home is registered for five adults with learning disabilities. The home provides spacious communal facilities and alternative rooms for the residents to use if they wish. On arriving at the home the inspector noted that the front door and side window were fitted with UPVC and not glass, which gives the home an institutional look. The reason for this was explained by the manager and was 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 20 considered to be a satisfactory explanation and was for the overall welfare of one of the service users. The home has been decorated with relaxed and calming colour schemes and tastefully furnished throughout with furniture and furnishing recommended by occupational therapists, such as recessed lighting and rounded edges on furniture. There are no wall hangings or ornaments in the lounge area and dining area as one service user would destroy them, however an attempt has been made to soften the environment with the painting of a mural directly on to the wall, which has been undertaken by a member of staff. The home has a separate kitchen and laundry facilities and a spacious safe enclosed garden. At the last inspection the manager was advised to keep kitchen cupboards clean and ensure corrosive substances hazardous to health (COSHH) kept in the kitchen, such as dishwasher powder, are safely locked away. In discussion with the acting manager they stated that all COSHH materials used in the home are now stored appropriately. The COSHH cupboard in the hallway has been fitted with a lock and was locked at the time of the inspection visit as required at the last inspection. Each resident has a bedroom of their own that has been decorated to their liking and personalised to reflect the resident’s character and interests. Two bedrooms on the ground floor have been specifically designed to meet the complex needs of the residents, such as boxed-in radiators, specialist flooring and easy to clean walls and robust quality furniture. One of these rooms was particularly stark due to being sparsely furnished, however the manager explained that the service user cannot cope with any furnishings other than a bed. Currently the en-suite shower rooms have been boxed-in as advised by the occupational therapist with a view to changing when and if the residents’ needs change. The residents have access to a bathroom and toilet facility on the ground floor. There was an noticeable difference between the bedrooms, with one ground floor bedroom having been was equipped with a double bed, modern furnishings etc and was personalised to reflect the service user’s tastes and was very warm and comfortable. The broken window in the first floor front bedroom has been replaced. The radiator in the first floor bathroom has not been covered as required, as the service user using this bathroom is considered to be at low risk of harm. In discussion with the manager they stated that they have asked for the house to be fitted throughout with cold touch radiators. There was a restrictor fitted to the service user’s bedroom on the first floor. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 21 The lounge/dining room, which was situated on the first floor is now being used as an office. The inspector observed staff carrying out domestic duties, the care staff are responsible for the cleaning and cooking and to support the residents to maintain and develop daily living skills. The home was observed to be clean, tidy, and safe throughout. Staff are equipped with gloves and aprons to avoid cross infection and the home has a contract for clinical waste and laundry facilities to deal with soiled laundry. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the home’s recruitment procedures but there is still a need to improve in this area in relation to the obtaining and storing of documentation to evidence that robust procedures are in place. Staff in the home are trained, skilled and experienced to support the service users in line with their terms and conditions and to support the smooth running of the home. EVIDENCE: In discussion with the manager she explained that Integra Care were recruiting staff to work at the home and had moved away from employing people who had previously been recruited by an employment agency. There was evidence on staff files that those staff previously employed through an employment agency have been checked against the Protection of Vulnerable Adults (POVA) list, and Criminal Record Bureau checks (CRBs) have also been obtained. There was also evidence of terms and conditions of employment in staff files. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 23 The inspector spoke with the most recently employed member of staff who confirmed that they had completed an application form and provided photographic identification to support their CRB application and had submitted two names as referees. They also stated that they had been employed following receipt of the CRB disclosure form. There was evidence in the staff file to confirm that the home had undertaken a CRB check and two references had been obtained, one from the last employer, however there was no evidence of the POVA 1st check, no ID and no application form. Information not being available on staff files was raised at the last inspection, there has been some improvement in this area but the manager must ensure that the home is undertaking robust recruitment procedures and all information is available on staff files as required under regulation 19 schedule 2. There was evidence on staff files that the home has provided staff training. In discussion with three staff they confirmed that they have undertaken Food Hygiene, Moving and Handling, Fire Safety and Health & Safety. All three staff had previous knowledge and experience of working with people with a learning disability. There was evidence of a staff induction plan on the most recently employed staff member’s file and when spoken to they confirmed that they had begun their induction programme. The service users were not able to express whether the staff cared for them well and would not know if staff had been trained, however observations of staff and service users’ relationships was positive with service users’ needs being met. 376 Winchester Road DS0000062649.V289387.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been an improvement in the management and administration of the home since the last inspection, however there is continued need for improvements in relation to the safety and welfare of service users. EVIDENCE: There has been a change of manager at the home since the last inspection. The new manager has been in post since August 2006. In discussion with the manager they explained that they had many years’ experience of working with children with learning disabilities and some experience of working with adults. They have had previous experience of management of residential care establishments within social services. The manager intends to submit an application to become the registered manager of the home. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 25 The manager has completed the National Vocational Qualification in care and is currently undertaking the Registered Managers Award (RMA) and then plans to undertake NVQ level 4. In discussion with staff they stated that they found the new manager approachable and supportive. There are plans to increase the size of the home from five bedded to eight bedded. Integra Care Management Ltd have purchased the property next door and plan to integrate the two buildings to provide one residence. In discussion with the manager and responsible individual they believed that the extension would provided additional recreational space for the service users. At present the manager does not have any formal systems to self-monitor and review development of the home. Although service users are encouraged to maintain existing independent living skills and learn new ones there is no record being kept of an individual development plan. Due to the complex needs of the service users the home has not held service user meetings or developed a quality assurance questionnaire as it is believed these would be beyond the service users’ capacity to understand. The views of family, friends and stakeholders has not been sought. The home is advised to develop and implement systems to monitor and review the development of the home. As required at the last inspection the home was able to provide evidence of an electrical wiring certificate and gas boiler service certificate. A lock had been fitted to the COSHH cupboard and all substances considered harmful to health were stored safely. With regards to the risk from radiators detailed at the last inspection the manager explained that they have requested that the home be fitted with cool touch radiators. Only one service user currently uses the first floor and a risk-assessment has been done and they are considered to be at a low risk of harm from the uncovered radiators. A restrictor has been fitted to the first floor occupied bedroom, the other bedrooms are vacant with one is being used as an office. The home has provided training for staff in the areas of health and safety in the work place, fire safety, moving and handling and food hygiene. In discussion with one member of staff they stated that the fridge and freezer temperatures had not been read for sometime. There was provision for this to be done but staff have overlooked this. It is important to the welfare of service users that fridge/freezer temperatures are checked daily, and that these are recorded to observe that food is being stored at appropriate temperatures to prevent contamination. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 26 The fire alarm systems were checked at the time of the inspection visit and the fire log was viewed and evidenced that tests are done weekly. There has been an improvement to the safe-working practices in the home, however there were still shortfalls detailed in the report, which require addressing. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 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 3 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 x 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Stand ard No 18 19 20 21 Score 3 3 2 x 2 x 1 x x 2 x 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement Timescale for action 30/12/06 2. YA34 19 (1) (b) 3. YA39 24 (1) (a) (b) (2) (3) 4. YA42 12 (1) (a) &13 (3) The registered person shall ensure that systems are in place to monitor that staff responsible for the administration of medication are signing the MAR charts. The registered person 30/12/06 must ensure all required recruitment documentation is obtained before starting new staff in the home. The registered person 30/12/06 shall establish and maintain a system for reviewing the quality of care provided by the home. The registered person 30/12/06 shall ensure that staff undertake the daily temperature checks of fridge and freezers and record these. 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The registered persons are advised to develop the Service User Guide in an accessible format taking into account the residents’ sensory and cognitive disabilities. The registered persons are advised to introduce person centred planning for each individual and to encourage service users who have the capacity to participate in the ongoing development of their individual plan. The registered persons are advised to thoroughly review each service user’s personal individual plans and archive information, which is not relevant to their existing support needs. The service users would benefit from the home developing and implementing a complaints procedure in a format, which is accessible to them. 3. YA6 4. YA22 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 376 Winchester Road DS0000062649.V289387.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!