Inspection on 02/04/07 for 39 High Barn Close

This inspection was carried out on 2nd April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

39 High Barn Close 13/12/05

39 High Barn Close 12/07/05

39 High Barn Close 30/11/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 39 High Barn Close 39 High Barn Close Rochdale Lancs OL11 3PW Lead Inspector Jenny Andrew Unannounced Inspection 2nd April 2007 09:30 39 High Barn Close DS0000062678.V334389.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 39 High Barn Close DS0000062678.V334389.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. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 39 High Barn Close Address 39 High Barn Close Rochdale Lancs OL11 3PW 01706 648535 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) Pendleton Care Ltd Mr Anthony Lee Walsh Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 3 service users to include: up to 3 service users in the category of LD (Learning disability) The service should employ a suitably qualified and experienced manager who is registered by the Commission for Social Care Inspection. 13th December 2005 Date of last inspection Brief Description of the Service: High Barn Close is a large, semi-detached house set in a cul-de-sac, in its own grounds and can accommodate up to three younger adults with learning disabilities. The organisation specialises in the care of young adults with autism. The home provides roomy communal accommodation in a lounge, separate dining room and kitchen. All bedrooms are single and one is situated on the ground floor in order that service users with physical disabilities may also be accommodated. A post office and corner shop are in walking distance and Rochdale town centre, supermarket and other amenities are within half a mile radius. Buses to and from Rochdale and other local towns pass close by. A car park is not provided although on-street parking is available. Access to the main door is via four steps. A lift to the first floor accommodation is not provided. The weekly fees are dependent upon the assessed needs of the individual. No additional extra charges are made. The owner makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new service users. A copy of the Commission for Social Care (CSCI) Inspection’s report is held in the office. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four and three quarter hours. The home had not been told beforehand the inspector would visit. The inspector looked around the building, at paperwork about the running of the home and the care given. In order to find out more about the home the inspector spoke with the manager, one support worker, two service users and, briefly, with the agency support worker and visiting behavioural psychotherapist. Before the visit, comment cards were sent out to service users, relatives and other visitors to the home. Three service users, one relative and two care managers returned the comment cards and this information has been used in the report. Other information, which has been received about the service, over the past year has also been included. What the service does well: Client Inv olv ed Service users’ care plans record how each person wants to be supported. The staff find out from service users about what is important to them in their daily lives and routines. All this is written down so that the staff can help them to follow their chosen routines. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 6 Mak ing decisions The staff are really good at finding out what service users think about the service and what changes they want to make in their daily lives. The staff put the service users first when any decisions are being made about their health, food, activities and daily routines. They also make sure they support the service users to do as much as possible for themselves. men u The staff know how important it is for the service users to follow a healthy diet and they really try to make sure the service users are offered tasty, well cooked meals. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 7 EXA MINING DR Service users health is well looked after. The staff make sure their medicines are given at the right time and that doctors and other medical people are asked to visit if they feel the service users health is not as it should be. Big Bosses The manager and staff work well together and have meetings so they can plan how best to support the service users living at the house. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? Clients Room All the things that needed to be put right in the house such as decorating and plastering work had been done. The service users were choosing colour schemes for their bedrooms as these rooms were soon to be decorated. What they could do better: Please train us phone Whilst all the staff had done training in what to do if there was a fire, they needed to do another course to make sure they kept up to date should a fire in the house happen. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 9 house The roof of the house was leaking and needed repairing so that it would not spread to the rooms the service users used. 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. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 10 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 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The admission procedure was thorough and service users received a full assessment before moving into the home, ensuring their health, social, emotional and personal care needs could be met. EVIDENCE: Since the last inspection, one service user had moved out but no new service user had moved in. The two service users currently living at High Barn had lived there since it opened and their initial assessments were seen at the last inspection. These documents were detailed and contained information that would enable the staff team to meet their initial needs until support plans were formulated. The organisation’s behaviour psychotherapist was visiting at the time of this visit. He detailed his part in the pre-admission process and confirmed he would always be asked to undertake an independent assessment prior to any new service users being admitted. This assessment would be in addition to care management assessments and would look at compatibility with the existing service users. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 12 The service user would be supported and encouraged to be part of the full assessment process and the carer/advocate’s interests would be taken into account. The thorough assessment process ensures the home can meet the holistic needs of any new service users. Part of the admission procedure was to encourage any prospective service user to visit the house and spend differing amounts of time there over an agreed period. This would enable the new person and existing service users to get to know each other before making final plans to live there permanently. Any restrictions on choice or freedom would be discussed as part of the initial care planning process and agreed with the service user and/or their relative/ advocate. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Support plans were detailed, accurately reflected each service user’s changing needs, choices, goals and support requirements, thus ensuring service users were supported to increase their independence, self-esteem and ability to make informed choices within a safe environment. EVIDENCE: The home had an effective care planning system in place, which incorporated monitoring and reviewing arrangements. The support plans of both service users were seen. The plans were comprehensive, covering: biography information, preferences about daily routines, communication abilities, leisure/ social activities, independence and identified any potential adult protection safeguards. Given the specialist nature of the care provided, detailed behavioural profiles and management strategies for challenging behaviour were also in place. All documentation had been reviewed and updated on a regular basis. From speaking to staff, it was clear they were familiar with the content of the support plans, which were used as a working tool. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 14 In addition to the support plan, each service user had a Person Centred Plan (PCP), illustrated with photographs and/or picture-bank illustrations, which were meaningful to the individuals. Whilst neither service user held their own support plans, key workers went through their plans with them on a regular basis during their one to one meetings. During the inspection, one service user pointed to where his plan was kept and spent time with the inspector talking through what his plan was about. It was clear he was aware of the contents and had been fully consulted when the plan was written. As both service users needed to follow very prescriptive daily routines, these were fully recorded as part of the support plan, ensuring that any agency or new workers would be clear about each person’s specific needs. An excellent key worker system was in place, with regular one to one meetings being held with each service user to talk about tasks outstanding, what they were enjoying or finding problems with and whether they wanted to change anything. These meetings gave the service users a real opportunity to have their say in how the service was run. Since the last inspection, a new method of setting goals for each of the service users had been put in place. The goals were measurable and achievable and staff found the new system was much clearer in respect of what they could expect of each of the service users. Three monthly goal-planning reviews were being held, copies of which were on each person’s file. The notes showed discussions had taken place around independence and communication skills, literacy/numeracy and health care topics. Review summaries were circulated to care managers, family and/or advocates together with a feedback questionnaire where comments could be recorded. In addition to in-house reviews, annual care management reviews also took place. Service users’ right to make decisions about their lives and every day routines was respected by the staff. Evidence of this was seen in the staff communication and handover books and in the daily diaries, which were kept for each of the service users. Where service users had declined to take a bath/ shower or had refused a meal offered to them, the staff had clearly recorded their preferences. This good practice is commended. The high level of staff commitment towards motivating service users, identified at previous inspections, has continued. The manager and staff spoken with were clearly aware of the individual needs of each of the service users and were able to communicate effectively with them. Both service users indicated they were happy living at the home, although it was difficult to identify whether they felt their needs were being met. One service user was able to convey he liked all the staff who worked at the home. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 15 Feedback from one relative’s comment card indicated full satisfaction with the service, except that sometimes, because of staffing issues, her son could not always go out as much as he would like. Feedback from two returned care manager questionnaires were both positive in respect of the home working in partnership with them, staff demonstrating a clear understanding of the needs of the service users and the overall care provided. Due to the level of need of the service users, detailed risk assessments and behaviour management strategies were in place for the protection of service users/others. The behavioural psychotherapist was consulted as and when necessary in respect of drawing up strategies and, at the time of the inspection, staff were using his services in respect of mapping one service user’s behaviour. As part of the risk assessment process, service users and/or relatives/advocates were fully involved. All risk assessments had been reviewed and updated on a monthly basis. From checking the restraint log, it was noted that appropriate recordings were in place when staff had used agreed intervention techniques. The manager supported the concept of calculated risk taking which enabled service users to increase their independence and participate more actively within the local community. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The range of opportunities available for service users to pursue educational, community and leisure activities reflected their diversity, social, intellectual and physical capabilities, thus increasing their independence and self-esteem. EVIDENCE: The home’s philosophy was based around the principles that service users’ rights to live ordinary and meaningful lives should be promoted. From checking support plans and reading weekly timetables, key worker reports and daily diaries, it was clear the staff team had a strong commitment to encouraging and enabling service users to develop their individual skills, both in-house and within the local community. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 17 Individual daily routines were in place for each service user and staff spoken with knew and respected them. Weekly activity plans were negotiated and agreed with each service user and reviewed at the beginning of each week. Both service users were supported to attend a development centre for either one or two half days per week. These sessions were not, however, compulsory and either service user could choose not to go if they wanted to do something else. During the inspection, one service user was making up his mind whether or not to go to the centre and the staff on duty were assisting him in the process. At the centre they worked to a planned programme, which included numeracy and literacy skills. One service user indicated he really enjoyed a trampoline session and recordings on the other person’s support plan showed he enjoyed rambling. From discussion with service users and staff, it was evident that the service users were encouraged to utilise a wide range of community activities. Whilst some problems had been experienced in the past, in respect of maintaining sufficient staff on duty to support each person’s preferred activities, the manager had revised the rota so that each weekday from 12.00 to 18.00 there would be three staff on duty. This enabled each service user to undertake different activities with the right level of staff support. Community activities enjoyed by the service users included: visits to the cinema, bingo, library, Rochdale market, pubs, cafes, McDonalds, supermarkets, shops and parks. The use of public transport was also encouraged, subject to a risk assessment having been done. At the time of the inspection, one service user was, with staff support, going the short distance to Rochdale on the bus, as a prelude to longer journeys. This was so that if the staff on duty were unable to drive, his social activities would not be restricted. Service users’ cultural/religious needs were identified as part of the preadmission assessment process and recorded on the support plan. The needs of the current service users were being met. Notes on support plan files and review recordings identified that staff supported service users to maintain family links. Each service user plan recorded significant birthdays so that each person could be supported to send cards and buy presents for their friends/relatives if they chose to do so. Whilst relatives/advocates were invited to attend review meetings, if they could not, summaries of the reviews were sent out to relatives/advocates so they were kept fully updated of progress made towards the planned goals of each service user. One service user had recently had a birthday and had invited a friend to tea. The following day, his brother had visited and had tea with him and it was clear he had really enjoyed both days. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 18 Both service users were encouraged to be independent and this was evidenced during the inspection. One service user made a cold drink and another person was supported to make himself some custard at lunch time. It was also noted that one service user was responsible for cleaning his bedroom in a morning, with staff support. Both service users were supported to put their laundry in the washing machines and assist with some meal preparation. Both service users had different ways of communicating and throughout the inspection staff were seen to interact well with them in a respectful way. It was apparent that positive relationships had been formed between the service users and staff on duty, including the agency support worker. Whilst staff were aware of the importance of offering a healthy, varied diet to the service users, one person frequently refused the planned meals. This was because he had a very limited range of foods that he enjoyed. All meals were recorded on menu sheets, which showed that the likes/dislikes of each person were being catered for. The meals offered to each person were recorded, together with the meal chosen which showed that the staff were really trying to promote health eating. Where nutritional needs were identified, appropriate health care professionals would be consulted and such advice had been sought for one of the service users. As a result, prescription nutritional drinks were offered twice a day and recorded on the individual’s medical administration record. Flexibility of meal times was essential to fit in with each person’s chosen routines and this was observed during the visit. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The health and personal care that service users’ received was offered in such a way as to promote and protect their privacy, dignity and diversity. EVIDENCE: Each service user had a medical file that recorded all visits and involvement with health care professionals. Medical appointments were noted in the diary and reinforced at shift handovers. Staff supported service users when they attended any medical appointments. Support plans recorded what help service users needed, along with their preferred routines. Staff said they followed these, ensuring consistency in approach. The agency worker spoken to said she had spent her first shift at the home reading the support plans for each person and spending time observing how each person liked to be supported. It was clear that the staff on duty knew each individual’s chosen routine and effective ways of working with them and were able to give good examples of how they ensured each person’s privacy and dignity needs were met. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 20 Both service users living at the house were male and from a total of eight staff, the manager and one other team member were of the same gender. This ensured that, if needed, a male could support a service user when undertaking community activities. Staff supported service users to be as independent as possible in managing their healthcare. One service user, as part of the goal planning process, was being supported to manage his personal toilet needs and he was making good progress in this area. One service user with limited mobility had a ground floor bedroom, which he could access independently throughout the day. Aids and adaptations had been fitted in the en-suite shower/toilet so the service user could remain as independent as possible. The staff team closely monitored the health care needs of both the service users. Evidence of this was seen from diary recordings and support plans. Service users received specialist support and advice as needed from dietician, podiatrist, optician, dentist, psychiatrists and the organisation’s own behavioural psychotherapist. The district nursing service was also involved and visited on a regular basis. Health care needs were reviewed on a regular basis and changes recorded as they occurred. The weight of both service users was being monitored on a monthly basis. Where staff had needed to use physical intervention with a service user, this was detailed on file. According to the staff training matrix, all staff had successfully completed physical intervention training. The pre-inspection questionnaire identified that the home had medication policies and procedures in place. A monitored dosage system was in use and staff were following the correct procedures. Wherever possible, two staff were signing the medication administration record (MAR) sheets and when homely remedies or creams/ointments were in use, separate recordings were being made. Service users’ medication was reviewed regularly and records seen showed that both service users had had their medication reviewed in January and March of this year. The service users had both signed to say they consented to staff giving them medication and these forms were held with their support plans. Records of medication received into and leaving the home were maintained. When service users were away from the home, a form had been introduced to record details of how medication was supplied to them. Medication was securely stored. Since the last inspection, medication was now being regularly audited as part of the quality assurance system within the home. All the staff had received training in how to give out medication safely. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There was a clear, understandable complaints system in place, which ensured that service users’ views were listened to and acted upon by a staff team who had received adult protection training. EVIDENCE: The complaints procedure was included in the statement of purpose and service user guide, which had both been translated into Boardmaker (symbols and pictures rather than script) to make it more easily understandable for service users. This information was kept in their care plan file. From interviewing the manager and speaking to the staff on duty, it was clear they took every possible step to ensure that an open culture was promoted, where service users felt safe and supported to share any concerns. Regular weekly key worker meetings and quarterly review meetings took place and staff encouraged the service users to say whether or not they were happy with their routines, if they had any concerns/worries or whether they wanted to change things. A complaints book was in place and since the last inspection, two complaints had been logged, from service users about not being able to be supported to attend the day centre. Appropriate action had been taken in respect of the complaints and as a result, the manager had reviewed the staff rota to make sure that each person could pursue their chosen individual activities during the day. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 22 Adult protection policies/procedures were in place and staff were not employed to work at the home unless all checks had been done. Inspection of service users’ files showed individual risk assessments were in place for the protection of service users and these were regularly reviewed. From checking the staff training matrix, it was noted that all the staff had done protection training as well as physical intervention training. Physical intervention was only used as a last resort as the staff would use de-escalation methods as set out in the individual service user support plans. Regular refresher training was arranged as needed. Any form of restraint was recorded in a book kept for that purpose and full reports recorded any serious events. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The house was clean, adequately maintained, decorated and furnished, providing a comfortable, safe environment for the service users living there. EVIDENCE: The home was located near to the local Post Office, corner shop, bus stop, etc., and was in keeping with the local community. Communal areas were, in the main, comfortable, personalised, airy, clean and free from offensive odours. Since the last inspection one of the settees had been replaced and another settee was due to be replaced. Some plastering and re-decoration of the building had also taken place. The service users showed the inspector their bedrooms, both of which were personalised. They were in the process of choosing colour schemes for their bedrooms, as they were also to be redecorated. At a review meeting in early March, one service user had requested a new chair. Estimates had been obtained but no further progress made in this area. The manager said this was a funding issue but that he would ensure the chair was purchased without further delay. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 24 The landlord was responsible for maintenance of the building and the manager kept a record book of outstanding works. The majority of jobs had been completed. Work still outstanding included the repair of the roof, as there was a leak coming through to the office ceiling. This work must be undertaken to ensure the leak does not spread to other areas of the home used by the service users. A private contractor had recently inspected the fire safety precautions within the home and the report identified that the fire doors in the kitchen and dining room were sticking. This had been reported to the landlord and the manager said he would ensure that urgent action would be taken to address the problem. Infection control practices were in place in respect of soiled linen. Red bags were used to carry it to the laundry. Disposable gloves and aprons were held in stock which staff used as necessary. They also tried to encourage one of the service users to use them when he was cleaning his en-suite toilet. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The staff team had the collective skills, training and expertise to undertake their roles efficiently and effectively which ensured the needs of the service users were being well met. EVIDENCE: There was a good match of well-qualified staff, offering consistency of care within the home. Since the last inspection, one of the service users had moved out leaving two service users living at the house. As a result of this, the staff numbers had dropped and the team now totalled seven, plus the manager. From checking the rota and speaking to the manager and support staff on duty, it was identified that this number was sufficient to meet the needs of the service users providing that staff did not go off sick or take annual leave. When this occurred, agency staff were employed and one such staff was providing cover on the day of the visit. She was knowledgeable about the needs of each service user and said she had spent a lot of time initially, reading support plans and observing how staff communicated with each person. The agency was requested to supply the same staff in order to ensure some continuity for the service users. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 26 Whilst staffing levels were currently meeting the day-time needs of the individual service users, staffing levels in the evening were not and this was preventing service users going out on an individual basis. The manager had already identified this shortfall and was currently in negotiation with the placing authority in respect of additional funding to meet the person’s reassessed needs. It was apparent from observation and interviews with staff that they worked well together as a team to provide consistent care to service users. The manager gave good support to the staff with regular staff meetings and 1:1 supervision. The support worker interviewed said he felt well supported and showed the inspector evidence of regular supervision and appraisal meetings. Evidence of induction training was seen on the staff files checked but no new workers had started since the Skills for Care training had commenced. The manager stated the organisation had introduced this induction training programme and that he would do so if any new workers started. Given the specialist nature of the service, the majority of the staff had received training in challenging behaviour, learning disability/autism and Asperger’s Syndrome, as well as principles of care, sensory perceptual differences and challenging behaviour. In addition, of the seven staff employed, excluding the manager, one person had completed NVQ level 3 and three had completed NVQ level 2. Two support workers had also enrolled on NVQ level 2 training courses. This meant the home had over 50 of trained staff. Whilst copy training certificates were in place in some files, in others they were missing. The manager said that the originals were kept at head office and were not always photocopied. It was agreed that, in the future, proof of training would be held on staff files held at the home. There was a rigorous recruitment and selection system in place but no-one had been employed recently. Previous inspections had identified good practice and staff had confirmed they had been given a copy of the General Social Care Council Code of Conduct as part of their induction training programme. The files of three staff were checked. Two contained all the relevant information, but the file for the most recently recruited staff did not have a copy application form or references in it. These were however, e-mailed from the head office during the inspection. Criminal Record Bureau checks had been made in respect of all staff. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager provided clear leadership, guidance and direction to staff which ensured service users received consistent quality support. EVIDENCE: At the last inspection, the manager had almost completed his NVQ level 4/Registered Manager’s Award. Since this time, no further progress had been made. His portfolio had been completed but not verified. He said the company whom he was undergoing the training with had been having problems fulfilling their contractual obligations and that he had had no assessor for the past seven months. In an effort to complete the training, he had enrolled with a new company and would be re-commencing the training at the end of April 2007. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 28 The home had an effective quality assurance system in place, which was based on achieving the service’s aims and objectives in general and service users’ needs in particular. This system included service user surveys and three monthly reviews to which care managers and relatives were invited. Reports of the meetings were sent to participants along with a questionnaire regarding the review, management and staffing of the home. Completed questionnaires were held on file and any comments were actioned as appropriate. One relative had asked that the review meetings were typed instead of sent out hand-written and this had been done. As previously described, regular key worker meetings with service users took place where they could say what they thought about the service and look at how well they were meeting their goals. Other quality initiatives included regular medication audits and monthly health and safety checks of the building, with recordings of all findings made. Representatives of Pendleton Care were undertaking regular audit visits to the home and reports were held in-house and also sent to the Commission for Social Care Inspection. Policies/procedures were regularly reviewed and updated in the light of any changes in the legislation. Supervision was held regularly and from May 2006 to March 2007, minutes of six staff meetings were seen. According to information recorded on the pre-inspection questionnaire, all necessary maintenance and associated checks had been made and accident report sheets appropriately completed and filed. Random checks were made of the fire log book and insurance cover, both of which were up to date. Fire drills were held and one of the service users was able to say what he would do if the fire alarm went off. From checking the training matrix, it was noted that all staff had received fire safety training. However, given some staff had not had training in this area since October 2004, refresher training must be arranged. The staff training matrix showed that, with the exception of first aid, all staff had undertaken the necessary mandatory health and safety training although some were in need of up-dates. The manager was aware of this and confirmed he would be arranging further training dates. The manager and two support workers had not done first aid training. This had been booked for the day following the inspection, but had been cancelled due to illness of the trainer. The manager was to re-arrange this. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 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 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 4 X X 3 x 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 YA24 Regulation 23(2)(b) Requirement The leaking roof must be repaired so that the leak does not spread to the rooms used by the service users. Timescale for action 30/06/07 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 YA35 YA42 Good Practice Recommendations In-house files should contain copy training certificates as proof that the staff have done the training as recorded on the matrix. All staff should receive refresher fire training in order to keep them up to date about what to do if there is a fire at the home. 39 High Barn Close DS0000062678.V334389.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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 39 High Barn Close DS0000062678.V334389.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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