Inspection on 09/07/08 for 4 High Street

This inspection was carried out on 9th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 4 High Street 4 High street Oakley Bedfordshire MK43 7RG Lead Inspector Sally Snelson Unannounced Inspection 9th July 2008 10:45 DS0000071545.V368393.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 DS0000071545.V368393.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. DS0000071545.V368393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 High Street Address 4 High street Oakley Bedfordshire MK43 7RG 01234 828706 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) The Fremantle Trust Marion Jean Gant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000071545.V368393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD The maximum number of service users who can be accommodated is : 6 21/12/06 2. Date of last inspection Brief Description of the Service: 4 High Street is a residential home for up to six adults with learning disabilities. It is managed by the Fremantle trust in conjunction with Bedfordshire Pilgrims Housing Association (BPHA), who are responsible for the maintenance and upkeep of the building. The home is situated in the North Bedfordshire village of Oakley, which is approximately 5 miles from Bedford town centre. Oakley has a number of facilities, which include a small local shop/post office, a hair and beauty salon, a pub and two churches. A local bus route is in easy access of the home, and the home provides it’s own transport. The home is a large bungalow, with individual bedrooms for service users of varying sizes. Some of the individual and communal space is limited. Communal space consists of a narrow conservatory, which is used as a lounge, a kitchen/dining room, bathing/shower facilities, and a separate laundry room. There is a substantial, enclosed garden to the rear of the property, and a small amount of car parking space is available directly outside the front entrance. DS0000071545.V368393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Up until 1st March 2008 4 High Street, a home for up to six adults with learning disabilities, was managed by Bedfordshire and Luton Partnership NHS Trust (BLPT). Fremantle now runs it in conjunction with Bedfordshire Pilgrims Housing Association - who are responsible for the maintenance of the building. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for younger adults that takes account of residents’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. The inspection was a key inspection, was unannounced and took place from 10.45am on 9th July 2008. The registered manager, Marion Gant, was present throughout, and Mark Kingman, the operational manager joined the inspection. Feedback was given throughout the inspection and at the end. During the inspection the care of two people who used the service (residents) was case tracked. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home were observed for their reaction to situations and staff were spoken to and their opinions sought. Any comments received about the home, plus all the information gathered on the day was used to form a judgement about the service. Since the 1st January 2008 13 staff, five service users and one relative had completed surveys, and the manager had completed an AQAA. People at the home have varying degrees of learning disabilities and staff support them to understand documentation including the information included in an inspection report. The inspector would like to thank all those involved in the inspection for their input and support. DS0000071545.V368393.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? At the last inspection 19 requirements were made. Most of these were now fully or partially met. Where they have been partially met they may have become a recommendation following this inspection. Since the last inspection a Spanish-speaking advocate had been found for a lady whose first language was Spanish. All residents had access to an advocate. At a previous inspection it was noted that an intrusive listening devise was being used without the agreement and knowledge of the person involved. This system had been removed. People had better access to their money and the staff were working to secure appropriate bank accounts for the people using the service. Since the last inspection the people living at the home had worked with staff to agree and record the name that they preferred to be called by. There had been an improvement in medication procedures, which ensured people got the correct medication at the correct time. DS0000071545.V368393.R01.S.doc Version 5.2 Page 7 Since the last inspection more specific training had been sourced to which staff were encouraged and supported to attend. The fact that the home is one of only two non nursing homes in the area where staff have been trained to administer insulin is a credit to the staff team. 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. DS0000071545.V368393.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000071545.V368393.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 People who use this service experience adequate quality outcomes in this area. A well-produced service users guide gave the people living at 4 High Street the information they needed about the home. To ensure that any families or other representatives on the resident’s behalf have similar information, the Statement of Purpose must be produced to the same standard. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff had worked extremely hard to produce a Service Users Guide of a good quality, that was in a format that was appropriate for all the people living at 4 High Street. The guide was in words and pictures and included all the information required. It was clear it had been written with the people living at the home, as it included their experiences of the home. Staff were good at ensuring the people living at the home were involved as much as possible in the running of the home, and spent time explaining documents and inspection reports to them. Unfortunately the Statement of Purpose had not been given the same treatment as the Service Users Guide. The manager assured us that it would be reviewed and updated before any new service users were assessed for the home. DS0000071545.V368393.R01.S.doc Version 5.2 Page 10 There had been no new admission to this home since the last inspection so it was not possible to assess this standard under the new providers. The home had one vacancy, but no plans to fill it until the proposed building works had been completed. Under the previous providers the registered manager had had little say in who could be admitted to the home, as a panel made the decision. The manager was aware of the procedure for assessing a prospective resident, to ensure that the home could meet their needs and that they would appear to fit in with the current client group. Staff had had a variety of different training and considered the collective needs of the clients when planning training. This is discussed in the staffing section of this report. Service users had not had new contracts since transferring to the new providers. Contracts had been incorrect with the old provider as they suggested that people living at the home had to pay for their own bed linen and towels etc. New contracts should be put into place as soon as possible to ensure that service users, or a representative on their behalf, were aware of entitlements to care provision and any additional costs to the individual. DS0000071545.V368393.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. People who use this service experience adequate quality outcomes in this area. The service is working towards individuals having control over their lives and making decisions. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The care plans of two people living at the home were looked at in detail. Most of the plans of care had been reviewed and updated and it was apparent that changes had been made as care needs had altered. However the service had not fully moved to Fremantle documentation, so it was not always obvious which of the many documents in the file were the most current. On the whole plans and assessments had been signed and dated but we noted some omissions. Also there was no evidence that service users had been involved in their care planning, other than what staff told us. Some plans had been written DS0000071545.V368393.R01.S.doc Version 5.2 Page 12 in a person centred way but this needed to be expanded to all the information in the care plans, and any supporting documentation needed so that it was apparent that this was the homes approach to providing care. One of the people whose care was tracked had medical needs and the plans to support these needs were in detail and described the care staff needed to provide to support him. Care files included a capacity assessment that had been undertaken by the GP and drawn up with a solicitor. This indicated that staff had an understanding of the Mental Capacity Act 2005 and the documentation they needed to have in place to support how care was decided and given. Where a care need had changed, the rationale for the decision was recorded. For example, a person who had not had a seizure for over a year and was being checked hourly throughout the night was to have these checks reduced. A plan had been drawn up to gradually reduce the checks and consider equipment that would alert staff to unusual activity, suggestive of a seizure. The plan was to be reviewed in three months time. At a previous inspection it was noted that an intrusive listening devise was being used without the agreement and knowledge of the person involved. This system had been removed. Also since the last inspection people had been provided with keys to their room, so they could choose to lock their bedrooms when they were out if they wished. The people living at 4 High Street regularly met together, with and without the housing association. Minutes and agendas for the meetings were also produced in a pictorial format. During the inspection we witnessed people making decisions, for example two service users had gone out with staff shopping for clothes and items for the home, two were up and about, and one had chosen to have a lazy day and did not get up until 11.30am. Other decision making processes were not so apparent, for example at lunchtime sandwiches were on the menu and were made, but an alternative was not offered. One of the shoppers came back with a card that he had bought because he liked the picture. Something that he could do now that people using the service could, if they wished, carry small amounts of money with them. Since the last inspection a Spanish speaking advocate had been found for a lady whose first language was Spanish. However the advocate felt the language being spoken was a dialect, and then very likely much of it was a language she had invented for herself, so the advocate was not able to help. Risk assessments were in place and most had been updated, but care must be taken that old or unnecessary information is removed. It is also important that people are supported and encouraged to take some risks, particularly in a move towards independence or to help them gain more essential living skills. DS0000071545.V368393.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): 12,13,14,15,16,17 People who use this service experience adequate quality outcomes in this area. A range of activities had been sourced, but there was still a need to demonstrate that the people living at the home were spending their time doing things that they wanted to, and that benefited them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: None of the service users were able to work, and there were limited opportunities for them to attend external day care activities and courses. At the time of this inspection, the staff from the home were providing the majority of the activities to service users. A Community Experience Officer (CEO) had been employed to take the lead in arranging activities, although all staff were expected to participate. At the start of the inspection two people living at the home were out on a shopping trip, with two members of staff. DS0000071545.V368393.R01.S.doc Version 5.2 Page 14 The trip was primarily to change some clothes, but they were also going to buy some letter racks for their bedroom doors and have lunch out. Staff had put paper folders on resident bedroom doors so that their post, newspapers etc could be put in these, and as all but one of the residents liked the idea, they were now buying a more substantial wooden letter racks for the bedroom doors that could be decorated by the individual. The person who did not like the idea of the letter rack would have the option to have one of the new ones or not. Three residents remained at home with the manager and the CEO. An unexpected visitor kept the staff away from the residents for some of the time and consequently there was very little interaction between staff and the people living at the home until the shift changed and more staff came on duty. We appreciate that some of this was due to the inspection process. At lunchtime two of the three resident helped to prepare the sandwiches and were happy to do so. This was an improvement from the last inspection when the staff made the sandwiches. One resident told us he was involved in more meal preparation and enjoyed it. Staff were ordering more specialist kitchen equipment such as a tilting kettle to enable this to happen safely. Mid afternoon one person was given a pot of tea and he sat at the table and poured out his drink, as this was how he liked to take his tea, others had mugs. Since the last inspection the people living at the home had worked with staff to agree and record the name that they preferred to be called by. We saw from comments made that families were consulted about the care provided and in some cases made decisions. This was not reflected in the care plans by signatures. We were disappointed that staff had not been able to access an appropriate swimming session for a person who wished to take up swimming again, and that another person who had spent many years walking with staff to the local shop daily to buy a newspaper was still no more independent. When we spoke to staff they believed that he maybe able to go into the shop alone, or take his money from his purse. However staff had noticed that recently he was becoming less enthusiastic about this task and an opportunity may have been lost. People were planning trips away and were planning who they wanted to go with. To date two people had chosen to go together and one wanted to go in an aeroplane. We did not see how these plans had progressed or what preparations had been made. The service users guide was clear that residents would be expected to pay for their holidays but the company would pay for staff time. This needed to be in the new contract and signed to ensure that it was an agreement residents, or their representatives, were aware of. DS0000071545.V368393.R01.S.doc Version 5.2 Page 15 We sampled the activity files for the people at 4 High Street and asked to see how any reactions to particular activities had been recorded. This involved looking at three different files and although some of the documentation was comprehensive it was not easy to work through and understand the coding. The CEO recorded outcomes to different activities on an eight week rolling cycle. Therefore if we wanted to know how on the day before the inspection a certain person enjoyed a visit and what they gained from it would not necessarily be possible unless it had been written as part of the daily log. The manager explained, that since the last inspection, a staff member showing the residents pictures of various plated meals and asking for their approval had compiled the weekly menus. However three of the people found this a difficult concept, so now staff were preparing meals and offering the plated meal at mealtime. Menus were discussed at resident meetings. On the day of the inspection the main meal was in the evening and was chicken pie or chicken casserole; we saw more examples of similar meals on the same today. For example fish or fish pie, which does not give an option to people who do not like the main ingredient i.e. the chicken or the fish. Residents were provided with support and aids to make mealtimes enjoyable. Plate raisers and guards were available. Staff had recorded exactly what people had eaten and drunk over a threeweek period. A dietician, who made some suggestions about changes that would make the menus more nutritious, examined these to ensure a wellbalanced menu. DS0000071545.V368393.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use this service experience good quality outcomes in this area. The staff team ensured that the health needs of the people living at the home were considered at all times. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All of the people living at the home needed some degree of support with their personal care. One of the people whose care was tracked had medical needs and the plans to support these needs were in great detail and described the care staff needed to provide to support him. Staff ensured that service users kept appointments with GP’s, consultants and other health professionals. Staff had recognised the need for additional specialist equipment to support the people living at 4 High Street as they aged. One lady had been supported to get used to using a new walking frame and it was hoped that another person would have a hand brace and a tilting commode following an Occupational therapists (OT) assessment. This additional equipment has an DS0000071545.V368393.R01.S.doc Version 5.2 Page 17 impact on the environment as discussed in the environmental section of this report. Each person living at the home had a communication passport which clearly described their methods of communication to the reader. For example we read that if one person chewed his hand it meant he was agitated. This record had been kept up to date and additional information added. People were weighed regularly, but staff must take care to detail what they may have done when noticing an extraordinary weight gain or loss. For example we saw a weight loss of 4 Kg and written next to it was the comment ‘no clothes’. We believed that this would still be a significant loss, as clothes generally do not weigh this much and some action may have been necessary. The medication and medication records of the two service users case tracked were looked at in detail and it was apparent that procedures had improved, and that staff were ensuring that Medication Administration Charts (MAR) were completed accurately, including using the back of the chart to record when a medication was refused or destroyed for any reason. All medications were correctly accepted into the home, administered and stored. We were able to correctly reconcile those medications that were given as required, and from original boxes and bottles. We had been informed correctly when it had been noted that a medication had been forgotten. These omissions were identified quickly and acted upon. Staff responsible for any of the errors had either been given extra training, or an agreement had been reached that they would not administer medications. The supplying pharmacist had offered some medication training update to all the staff. Community nurses had trained and observed some staff administering insulin to a service user. The community nurse continued to be responsible for the process, but was happy for these trained staff to administer the insulin, to allow the person more flexibility and opportunities to leave the home. DS0000071545.V368393.R01.S.doc Version 5.2 Page 18 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): People who use this service experience adequate quality outcomes in this area. People living at the home were protected by staff who had a greater understanding of keeping vulnerable people safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A copy of a user-friendly complaints procedure was part of the Service Users Guide but as an updated Statement of Purpose of purpose was not available there maybe some stakeholders unaware of the policy. Staff must make sure that all local contacts and telephone numbers are updated on all complaint information. Service users monies were now being appropriately held on their behalf and used correctly. Staff had worked to get bank accounts that suited the residents so that could have easy access to their money when they needed it. This must continue until everyone has the type of account that suits their needs. Staff were checking the balances of service users monies at the change of every shift. This needs to assessed and reduced if at all appropriate as it is very time consuming and can become the focus of the staff handovers. There had been an improvement in staffs understanding of safeguarding vulnerable adults (SOVA). This had come about as the result of additional DS0000071545.V368393.R01.S.doc Version 5.2 Page 19 SOVA training and a better relationship with the safeguarding team. Any allegations of abuse, including service user on service user, were now being correctly reported to us via Regulation 37, and to the safeguarding team at the Local Authority. Over the last year in order to ensure that any incidents were reported correctly the staff team had possibly been over vigilant and many of the referrals had not resulted in a strategy meeting. There was one outstanding SOVA issue that was still under investigation. The manager should be commended for not using staff from a particular recruitment agency when she became aware that some staff did not have current Criminal Record Bureau checks. It was planned that staff would undertake Non-Aggressive Physical and Psychological Intervention (NAPPI) training; this would minimize the need for physical restraint. 4 High Street was a house where generally all the residents got on well together and this may not be needed, but the training would be useful. DS0000071545.V368393.R01.S.doc Version 5.2 Page 20 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): 2425,26,27,28,30 People who use this service experience poor quality outcomes in this area. There continued to be significant shortfalls with regard to providing adequate individual and communal space, for people who required mobility aids, and specialist equipment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: It was disappointing to discover that there had been no real change to the environment at 4 High Street. The home continued to operate in conjunction with Bedfordshire Pilgrims Housing Association, who were responsible for the maintenance and upkeep of the building, fabrics and furnishings. Previous reports had highlighted concerns regarding the lack of useable communal space within this home. The last report stated,‘ the home had a small lounge area, which was part of a narrow conservatory. The communal DS0000071545.V368393.R01.S.doc Version 5.2 Page 21 space did not meet the requirements of the current service user group who had increasing mobility issues, and included a service user who required specialist equipment’. Four of the five people living at the home were over the age of 60 and consequently mobility aids and the need for specialist furniture could continue to increase. The new providers in discussion with the housing association had changed the plans of the way that they expected the communal space would be increased. However we would expect this work to be carried out as soon as possible. Not only were people living in cramped conditions, but the people at the home and their relatives and families had been told about the planned building work for so long, any explanations had become meaningless. The new plans did not require the home to be closed and for service users to be moved out, but may mean one of the more dependent people having to move out for a short time. The operational manager told us that the situation would be regularly risk assessed and decisions made as and when. People who had been to look at alternative accommodation in which to move during the whole period of the alterations had yet to be told that this would not now be happening and risk assessments relating to the move were still in the care plans. Despite issues with the environment the staff had made the communal areas of the home look homely and lived in, but because of the planned work, the home had not been decorated, and some areas looked scruffy now and in need of refurbishment. Bedrooms had been personalised, according to the wishes of the individual, and some floorings had been replaced; this had got rid of the unpleasant odour noted at previous inspections. The bathrooms were particularly dull, staff had put up framed pictures to improve the atmosphere. A person who had a specialist chair for mobility could not access the laundry area but a tabletop at the correct level had been installed in the kitchen so he could help with meal preparation. It was hoped that a tilting kettle would benefit people and that any plans for a new kitchen would include kitchen drawers, as currently the kitchen was base and cupboard units only. DS0000071545.V368393.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): 32,33,34,35,36 People who use this service experience good quality outcomes in this area. The manager safely recruited staff and supported training so that the staff team were suitable to care for the people living at 4 High Street. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Rotas identified that there was a minimum of three staff on duty at anytime during the day with extra staff employed between 9am –5pm Monday to Friday. There were two staff on duty at night but this was being reviewed as it was considered (and staff agreed) that one would be sufficient to meet the needs of the current service user group. There had been no new permanent staff employed under the new providers, but the manager was in the process of interviewing. At the time of the inspection there was a reliance on agency or bank staff to support the staff team. Where possible the home block booked agency staff so that the people living at 4 High Street got to know the staff and had a consistent staff team. DS0000071545.V368393.R01.S.doc Version 5.2 Page 23 Where possible staff worked as part of the bank staff in the first instance to ensure that they were suitable for the work and fitted in with the rest of the staff team before becoming permanent. The staff files sampled were well kept and included all the necessary checks to ensure that a person was safe to work with vulnerable adults. In the dining area of the kitchen there was a ‘photo board’ of the staff on duty, for residents to refer to. As already mentioned the staff team had had additional training to ensure that they could met the needs of the client group, this included autism awareness and diabetic and epilepsy training. The manager kept a record of the training done and a matrix to help her identify which staff should attend updates etc. New staff completed induction training and one staff member had done a LDQ (Learning Disability Qualification), which replaced the LDAF (Learning Disability Award Framework). 100 of the staff team had completed or were completing an NVQ level 2 or above. At the last inspection we were concerned that the training was not specific to the needs of the people at the home. Since then more specific training had been sourced to which staff were encouraged and supported to attend. The fact that the home is one of only two non nursing homes in the area where staff have been trained to administer insulin is a credit to the staff team. As staff were in and out with residents throughout this visit we did not have much opportunity to speak with them in depth, but were aware that they appeared happy in their role. Staff were being supervised by the manager and subsequent inspections would indicate if the 6 supervisions a year were in place. DS0000071545.V368393.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): 37,39,41, 42 People who use this service experience adequate quality outcomes in this area. The manager needs to ensure that the transition from the previous providers to the Fremantle Trust is completed as soon as possible so that there are no uncertainties. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last inspection a new manager, who had subsequently become the registered manager had been appointed. She was a qualified nurse, but was not employed in this capacity; she also had a management qualification DS0000071545.V368393.R01.S.doc Version 5.2 Page 25 The company had audited the service before taking it over and a member of the management team visited the home monthly to monitor it. This also provided the report required under Regulation 26 of the National Minimum Standards. The manager was aware of what she wanted to implement over the next year and was well supported by the operational manager but was hindered by not knowing when the building work would take place. At the time of the inspection there was no process to audit stakeholders views of the home but the manager was aware that this should be done regularly to ensure the service provided met expectations. Under the new structure staff were meeting together regularly as were the managers. Fremantle had held a relatives meeting and were surprised and delighted in the number of people who had attended. They were aware that the main agenda was to meet the new providers and find out what plans they had for the building which they already knew was not fit for purpose. The company held a business planning meeting that was open to any staff to attend. Residents were provided with pictorial minutes following any meetings that they were involved in. The Fremantle policy folders were in the manager’s office and staff must now adopt them and forget the old ways of working. The standard of record keeping and reporting was generally good. Records should be reduced so that files, particularly care files, included all the information about a particular person so that staff did not have to look through too many additional files. Also old and unnecessary paperwork should be cleansed from working files. Staff must take care to sign and date documents. No health and safety concerns were noted during the inspection. DS0000071545.V368393.R01.S.doc Version 5.2 Page 26 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 2 2 x 3 2 4 x 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 1 27 2 28 1 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X 2 3 x DS0000071545.V368393.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4,6 Requirement There must be a Statement of Purpose that covers all the matters in Schedule 1 of the National Minimum Standards. Any contract or statement of terms and conditions must be accurate and signed by, or independently on behalf, of the service users. Two bedrooms are very narrow and are becoming unsuitable for the people using them. The lounge/conservatory is inappropriate for purpose and needs to be revamped. This has been a concern and a requirement since 2005 and must be given immediate consideration. Timescale for action 01/09/08 2 YA5 5(b)(c) 01/09/08 3 4 YA25 23 (2)(f) YA24 23 (1)(2) 01/01/09 01/01/09 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 Good Practice Recommendations DS0000071545.V368393.R01.S.doc Version 5.2 Page 28 1 2 3 4 5 6 7 8 Standard YA6 YA8 YA9 YA12 YA13 YA14 YA17 YA22 YA39 People living at the home should know that their assessed and changing needs and personal goals are reflected in their individual plan and plans should be person centred. People should continue to be supported and encouraged to participate in the running of the home. People living at the home should be encouraged and supported to take appropriate risks. Staff should continue to consider ways in which service users can be stimulated and take part in even more meaningful activities inside and outside the home. Every effort should be made to support people to pursue leisure activities that they are interested in. Menus should be more varied on a daily basis. A wider group of stakeholders should be aware of the complaints procedure via the Statement of Purpose. The quality audits should be built upon and show stakeholder involvement. DS0000071545.V368393.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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