Inspection on 21/03/07 for 4 Vallance Gardens

This inspection was carried out on 21st March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Vallance Gardens 13/01/06

4 Vallance Gardens 26/07/05

4 Vallance Gardens 11/01/05

4 Vallance Gardens 13/07/04

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

CARE HOME ADULTS 18-65 4 Vallance Gardens Hove East Sussex BN3 2DD Lead Inspector Niki Palmer Key Unannounced Inspection 21st March 2007 2:40 4 Vallance Gardens DS0000014142.V319212.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 4 Vallance Gardens DS0000014142.V319212.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. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 Vallance Gardens Address Hove East Sussex BN3 2DD 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) 01273 749626 www.caremanagementgroup.com Care Management Group Limited Mrs Sharon Lesley Lacey Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That service users are aged between 25 and 65 years upon their admission The maximum number of service users to be accommodated is 10. That the category of service users admitted have a learning disability, not falling within any other category Two service users aged over 65 years at the time of admission, within the service user category of learning disability (LD) may be accommodated. 13th January 2006 Date of last inspection Brief Description of the Service: 4 Vallance Gardens is a care home, which is registered to provide accommodation for up to 10 residents with physical and profound learning disabilities. The home is owned and run by Care Management Group (CMG) who are a large organisation that provides care for people with learning disabilities. The home is located in a quiet residential area in Hove near to the seafront. There is good access to local amenities and public transport. There is no parking available at the home, but free parking is available in the adjacent streets. The home is a three-storey building, which comprises of 10 single bedrooms, three of which have en-suite facilities, in addition to two bathrooms. There is a large communal dining / living room area on the ground floor with level access to a rear garden. The home has recently undergone some refurbishment, which has created an additional bedroom, a user-friendly kitchen and a sensory room. All bedrooms are located over the ground and first floor. There is a stair lift available to assist residents to access the first floor landing. The home provides personal care and support to residents who are funded by Social Services. The home’s fees as of 22nd November 2006 range between £971.00 and £1621.00 per person per week. Additional costs are charged for hairdressing (£20 - £25, personal toiletries (£3 - £5 per week) and some social activities (£variable). Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. A copy of the home’s most recent inspection report is available on request. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at 4 Vallance Gardens will be referred to as ‘residents’. This unannounced inspection took place on Wednesday 21st March 2007 between 2.40pm and 8pm, which enabled the Inspector to spend time with residents and observe the evening routine. 10 residents were accommodated on the day of the inspection; six men and four women aged between 54 and 84 years of age. In order to gather evidence on how the home is performing, the Inspector was introduced to all residents and spent much of the afternoon and evening observing the routine and staff interactions. Detailed discussions took place with the Registered Manager and three members of care staff who were on duty. Two care records were examined in some detail for the purpose of monitoring care. The Inspector was shown all communal areas of the home and some individual bedrooms. Other records and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, medication practices, the provision of activities, quality assurance systems, the home’s complaints procedure and the systems in place to safeguard residents from harm. A pre-inspection questionnaire was received prior to the visit to the home. This provided the Inspector with information relating to the premises, maintenance and associated records, staffing details and the provision of relevant training and details of the home’s policies and procedures. What the service does well: 4 Vallance Gardens is managed by a competent, experienced and dedicated Manager who has a good understanding of the needs of the residents. Many of the residents have lived at Vallance Gardens for a number of years, prior to it being owned by CMG. This has enabled residents to develop good relationships and friendships with each other. The compatibility of the residents is at this time, good. Residents are supported by a reasonably stable, well-trained and supervised staff team. The home has good systems in place to ensure that residents are safeguarded by the home’s recruitment procedures. As a matter of good practice, the Manager asks all interested applicants to visit the home on an 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 6 informal basis, prior to short-listing for interview in order to give the applicant a ‘flavour’ as to what they can expect working at the home. All newly appointed persons are offered a good induction to the home in order to introduce them to the needs of the residents. A small number of residents’ bedrooms were viewed. They were found to be well decorated and reflective of individuals’ personalities. Most rooms contain personal belongings and furnishings, a TV, video and DVD player and CD player. What has improved since the last inspection? What they could do better: Many of the staff have worked at the home for number of years. Whilst this promotes a sense of continuity and familiarity for the residents, it is important that regular refresher training is provided to all staff to ensure that the ethos and commitment of the staff team are in line with the principles of Valuing People. The home needs to consider ways in which residents can be supported to lead fulfilling and valued lives based on a person centred approach. Care plans, risk assessments and Health Action Plans need to be updated accordingly. The home is required to have a medication error policy and procedure in place. This should encourage staff to report any errors no matter how minor. This will help to support the home to identify any faults in their current procedures and training needs for staff. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 7 Due to the complex physical disabilities of the residents accommodated, the home is required to ensure that suitable assisted bathing equipment and facilities are in place. This will also help to safeguard the safety and welfare of staff. It is recommended for the Manager to obtain and recent the most recent inspection report for the employment agency that is being used to cover additional shifts. This will help demonstrate that the home are confident that the staff who are working in the home have the relevant skills, recruitment checks and training to meet the needs of the residents accommodated. 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. 4 Vallance Gardens DS0000014142.V319212.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 4 Vallance Gardens DS0000014142.V319212.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 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives are provided with sufficient information prior to admission in order to support their decision of where to live. Good systems are in place to ensure that only residents whose needs can be met are admitted to the home. EVIDENCE: The home has a detailed Statement of Purpose and Service Users’ Guide in place, both of which have been updated following the most recent building works. The Statement of Purpose provides the reader with an introduction to CMG including the home’s aims and objectives, details of the Registered Provider and Manager, organisational and staffing structure and colour photographs of the accommodation provided. The Service Users’ Guide offers a good level of information regarding the services and facilities provided, residents’ charter, contact details of the CSCI and the arrangements in place for health and social care support. Both documents are presented in an easy to read and understand format, which incorporate the use of colour pictures and symbols. It is recommended that the new contact details of the CSCI be updated within these. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 10 Many of the residents accommodated have lived at the home for many years together, prior to it being owned by CMG. Following the recent building works, a new resident moved into the new bedroom. It was pleasing to note that the Registered Manager undertook a detailed assessment of their needs prior to admission in order to determine if the home could meet their needs and aspirations. This involved gaining as much information as possible from relatives and a number of health and social care professionals. Detailed reports regarding this process were seen on the day of inspection. Completed copies of residents’ terms and conditions of contract were seen in individual care records. These provide the person and their representatives with information regarding what residents can expect for the fee they pay and sets out the terms and conditions of occupancy. This is improved since the last inspection. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are mostly met by the home’s care planning arrangements, however residents would benefit from a more person centred approach in order to promote their individual needs, decisions and choices. EVIDENCE: All residents have a template care plan in place, which has been produced by CMG. The main areas within these include: a pen portrait of the person, their health, how they manage their emotions, how they communicate, their cultural beliefs, their relationships with others and activities of daily living. Albeit that clear guidelines are in place for staff to follow in relation to meeting the assessed needs of residents, it was noted that the current care planning format is not based on a person centred approach e.g. some of the language used within the plans of care was quite negative and focused on areas that were not necessarily important for that individual. This was the same for additional daily records, which are maintained separately from the care plans. In addition, some guidelines and written documentation was dated 2004/2005, 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 12 indicating that some areas have not been reviewed for some time. The home is required to ensure that all plans of care are regularly reviewed, based on a person centred approach and be focused on the individual needs and preferences of each individual. Most of the residents living at the home have moderate to profound physical and learning disabilities and are therefore reliant on care staff, their relatives and other health and social care professionals to make decisions on their behalf about many aspects of their lives. Throughout the duration of the inspection staff were observed to respect some residents’ decisions and choices e.g. whether residents preferred to stay in their own bedrooms, take part in activities or interact with others. Albeit that some residents’ verbal communication is limited, staff working in the home were observed to interpret individuals’ subtle level of communication and include residents in the daily routines of the home wherever possible. Due to the capabilities and of the residents, limited risk taking can be initiated, however detailed risk assessments are in place for all activities of daily living and personal health care needs. Not withstanding this, it was noted that a number of these were standardised templates, produced by CMG, which bared no significance to many of the residents. This indicates that some risk assessments are being completed as a matter of course, rather than being person centred and specific to individual needs. Risk assessments have been undertaken regarding the suitability of door locks on individual doors as required at the last inspection. 4 Vallance Gardens DS0000014142.V319212.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 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The daily routines within the home do not always enable residents to experience a varied and person centred lifestyle. The food in the home is of satisfactory quality and is well presented. EVIDENCE: Due to the capabilities of the residents accommodated, no person at this time is in paid employment, although some of the residents do access a nearby day service, which is specifically set up to support older people who have additional disabilities. On the day of the inspection, most residents were at home when the Inspector arrived. Some were receiving 1-1 reflexology and homeopathy either in their own bedrooms or in the sensory area. Care staff commented that recent inhouse activities have included making Mother’s Day cards and Easter cards. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 14 Two of the care staff spoken with appeared keen to develop stimulating and meaningful in-house activities for the residents. The Manager commented that the home do try as much as possible to support residents to access their local community e.g. use local shopping centres, do for a walk along the seafront, visit the local allotment and use nearby entertainment venues such as the Brighton Centre and pubs and cafes. Residents have individual programmes of activities, which are detailed in their plans of care. It was disappointing to note that on the evening of the inspection a small number of residents were supposed to visit the local pub. Instead, after dinner they were seated around the TV in the main living area whilst three out of the four care staff on duty attended to clearing up after dinner, attending to the laundry and bathing residents [one member of staff did engage with residents during this time]. 4 Vallance Gardens receives additional funding for 1-1 support for one of the residents. The majority of this money is to provide the person with 1-1 support at night as they are often awake during this time and are prone to wandering. Following the evening meal, the Inspector observed that this person remained seated at the dining table asleep [whilst staff attended to the laundry and bathing residents etc.] up until 8pm when the Inspector left. The Manager explained that this person often sleeps during the day, with the exception of long walks. The home is required to ensure that suitable arrangements are in place for all residents to engage in meaningful and stimulating activities both within and outside of the home as per their individual plans of care and funding arrangements. One of the residents spoke with the Inspector on the day of the inspection and said that they were looking forward to going on holiday later in the year. The Manager said that all holidays are planned in advance and vary in location: Wales, Bournemouth, Dorset and Clacton. None of the residents go abroad on holiday. All of the residents are supported to maintain contact with their relatives. Most visit the home on a regular basis. All meals are prepared by care staff in the home’s newly refurbished kitchen. Menus are devised on a seasonal basis and rotate on a four weekly basis. Hot meals are prepared at lunchtime, whilst lighter snacks are provided for supper. At present, menus are not displayed in the home. Whilst it is appreciated that very few of the residents would be able to read and understand a written menu, it is recommended that the home works with residents, as part of an activity to devise colourful pictorial menus for the week. On the evening of the inspection, the suppertime routine was observed. Most residents dine together in the lounge / dining area. The snack offered was 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 15 tinned soup. Some residents require support at mealtimes from staff. Additional cutlery and aids are provided where necessary to promote residents’ independence. Minimal interactions were observed between staff and residents during the mealtime; residents were given their soup, but not told what flavour it was and there was very little / no conversation between the staff and residents. In addition, it was noted that medication was being administered by staff during this time, again with no interaction with residents. On several occasions, medication was just put onto people’s spoons and given orally and at one point eye drops and a nasal spray were administered, interrupting the person’s meal, taste and flavour. All of the observations noted above, were discussed with the Manager on the day of the inspection. Whilst it is recognised by the CSCI that inspections can seem daunting for some staff and of course the residents whose home it is, the observations made on the day of the inspection indicate that the home is routinely run and that in some instances the routines of the care staff override the needs of the residents. The home is required to review the mealtime arrangements in order to ensure that the needs of the residents are prioritised. 4 Vallance Gardens DS0000014142.V319212.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 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents are supported to access a range of healthcare services to meet their physical and emotional well-being, the home needs to consider ways in which it can support residents to receive flexible personal care. Residents are mostly safeguarded by the homes policies and procedures for the safe administration of medicines. EVIDENCE: All residents are registered with a local General Practitioner (GP) and dentist and are supported to all appointments as necessary. Due to the complex healthcare needs of some of the residents, specialist advice from the Community Learning Disability is sought on an individual basis including psychology, nursing and speech and language therapy. All personal care is carried out in the privacy of one of the communal bathrooms or in residents’ own bedrooms. Baths/showers are carried out according to a bathing rota. Again, this reiterates that the routines within the home are aimed towards care staff and not according to the preferences of each individual. It was pleasing to note however, that residents’ preferences 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 17 are respected in relation to who supports them with meeting their personal and healthcare needs e.g. a member of the same (or opposite) sex. Specialist equipment such as moving and handling equipment and height adjustable beds are in place where needed. A number of the residents living within the home are older and are therefore more susceptible to developing additional healthcare needs for example, reduced mobility, eating and drinking difficulties, epilepsy and early onset dementia associated with Downs Syndrome. It was pleasing to note that specialist advice and training has been sought in respect of this. CMG have provided each resident with a Health Booklet, which is aimed at keeping clear and accurate records of all healthcare appointments. Whilst those seen were found to be up to date, it is recommended that in line with Valuing People, Health Action Plans are implemented. The home’s medication records and storage systems were inspected. The home uses a pre-packed blister pack, which is delivered by the local pharmacy on a monthly basis. Only members of staff who have received the relevant training and have been assessed as competent in the administration of medicines are able to carry out this task, whilst only senior members of staff hold responsibility for the reordering and returning of medicines to the pharmacy. All medicines were found to be appropriately stored with accurate records maintained. As previously mentioned, concerns regarding the administration of medicines at mealtimes were noted during this inspection. In addition, staff spoken with were unaware of the home’s medication error policy and procedure and were unclear when asked, about the action that they would take in the event of an error occurring. The home is required to have a medication error policy and procedure in place. This should encourage staff to report any errors no matter how minor. This will help to support the home to identify any faults in their current procedures and training needs for staff. The lighting in the area where medicines are stored is poor. It was a recommendation in the previous report for this to be improved. As care staff on duty commented that improved lighting would be beneficial and safer for them when administering medicines, this has been reflected as a requirement this time. The home handled a recent death of one of the residents with sensitivity, dignity and respect. Every effort was made by the staff team to enable the person to remain at home with their possessions around them and receive 1-1 support from staff who knew them well. 4 Vallance Gardens DS0000014142.V319212.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): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good systems in place to ensure that all complaints are dealt with appropriately. Residents are protected from potential harm, neglect and abuse through the home’s policies and procedures and through staff receiving appropriate training. EVIDENCE: A copy of the home’s complaints procedure is displayed within the home. It is presented in an easy to read and understand format (including colour pictorial symbols), which clearly explains how complaints can be made, who they can be made to, how residents and their representatives can expect their complaint to be dealt with and the timescale within which it will be responded to. No complaints have been received by either the home or the CSCI since the last inspection. The home has a detailed Adult Protection and whistle-blowing policy and procedure in place in order to safeguard residents from potential harm, neglect and abuse. Both are in accordance with local multi-agency guidelines. Since the last inspection the home has updated it’s whistle-blowing policy to state that it refers to any practice in the home and not just abuse issues. One alert was raised by the home in April 2006, following an incident, which occurred in November 2005. Despite the significant delay in alerting the appropriate agencies, the appropriate was taken by the home. All staff have since received refresher training in respect of recognising potential abuse and making alerts. 4 Vallance Gardens DS0000014142.V319212.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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment, which has been improved and updated, however not all areas of the home are equipped to meet the assessed needs of residents. EVIDENCE: 4 Vallance Gardens is a large three-storey older style Victorian property. Residents’ bedrooms are located over two floors. There is a stair lift available to assist residents to access the first landing, then six steps must be negotiated independently to access the first floor. Since the last inspection, the garage has been converted into a good-sized bedroom with en-suite facilities, which has been pleasantly decorated. The laundry has been moved in order to create a large well-equipped kitchen, suitable for residents in wheelchairs to use and a new sensory room has been created. In addition, the home’s communal lounge / dining areas have been 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 20 increased in size, redecorated and new flooring laid down. This creates improved communal space for daytime activities and mealtimes. A small number of residents’ bedrooms were viewed. They were found to be well decorated and reflective of individuals’ personalities. Most rooms contain personal belongings and furnishings, a TV, video and DVD player and CD player. There is only one communal bathroom (with bath), which is located on the ground floor. Staff confirmed that this is used by eight residents. The bath is an ordinary household bath, without any specialist facilities to support residents with reduced mobility or specialist needs. There is overhead tracking in order to support residents and staff with getting into and out of the bath, however the needs of the residents accommodated require assisted facilities. This would also help to safeguard the health and safety of staff. The home is required to provide suitable assisted bathing facilities in order to meet the assessed needs of residents. The home should also consider providing a walkin shower room in addition to this. Some areas of the home were noted to be poorly lit, particularly in the area where medication is stored and in the downstairs corridor, which leads to a number of residents’ bedrooms. Given that a number of the residents have additional sensory impairments, the home must ensure that the environment is suited to their needs in order to promote and maintain residents’ independence to move around the home freely and safely. A number of suggestions were put forward on the day of the inspection. Some carpeted areas of the home are in need of replacing. The Manager confirmed that she is in the process of obtaining quotes for this. This will be followed up at the next inspection. The home employs a domestic worker to undertake the majority of cleaning duties. All areas of the home seen on the day of inspection were found to be clean, tidy and hygienic. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an effective staff team, many of which know the residents well. Residents are protected by the home’s robust recruitment procedures. The staff team are supported to provide consistent care and meet the needs of residents through regular supervision and training. EVIDENCE: In addition to the Registered Manager, 4 Vallance Gardens employs a total of 14 Support Workers, two senior staff and a Deputy Manager. Of these, five have achieved at least NVQ Level 2 in Care or are working towards this qualification, whilst seven hold a current First Aid certificate. Most of the staff spoken with confirmed that a good level of training is offered by CMG and that individual training needs are identified through regular staff supervision. Recent training includes: dementia, first aid, fire safety, manual handling, communication, health and safety and eating and drinking. The Manager confirmed that Makaton training is planned for the near future. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 22 Staffing rotas confirmed that there is usually a minimum of four care staff working between 8am-9pm. There are always two waking night staff on duty. Either the Manager on Deputy Manager are on-call at all times. Many of the staff have worked at the home for number of years, indeed some prior to the organisation being owned by CMG. Whilst this promotes a sense of continuity and familiarity for the residents, it is important that regular refresher training is provided to all staff to ensure that the ethos and commitment of the staff team are in line with the principles of Valuing People. The Manager confirmed that the home is currently recruiting for one waking night post, a full-time post and one part-time position. A number of vacancies have recently been filled following advertisements placed in the local job centre and more recently, a careers fair. In light of the current vacancies, the home has been reliant on using ‘bank staff’ and agency staff. It is recommended for the manager to obtain the most recent inspection report for the employment agency that is being used. This will help demonstrate that the home are confident that the staff who are working in the home have the relevant skills, recruitment checks and training to meet the needs of the residents. As a matter of good practice, the Manager asks all interested applicants to visit the home on an informal basis, prior to short-listing for interview in order to give the applicant a ‘flavour’ as to what they can expect working at the home. Staff spoken with confirmed that all interviews are undertaken by the Registered and Deputy Manager. Two recently appointed staff recruitment files were checked. It was pleasing to note that both files were found to contain all the required checks, including photograph identification, two written references, evidence of a PoVA First check and Criminal Record Bureau (CRB) check prior to employment. Newly recruited staff confirmed that they were given an induction to the home within their first two weeks of employment. This involved ‘shadowing’ experienced staff members for a period of two weeks, familiarising themselves with care plans, reading a number of the home’s policies and procedures and becoming familiar with a number of health and safety aspects such as what to do in the event of a fire. The Manager has recently attended additional training regarding Skills for Care Induction. She has assured the Inspector that this will be implemented for all new staff as a matter of priority. This has not been reflected as a requirement at this time, but will be followed up at the next inspection. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 23 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, 40 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from clear leadership within the home. Residents are safeguarded by the systems in place to monitor the health, safety and welfare of residents. EVIDENCE: The current Manager has worked at the home for 11 years. She has been the Registered Manager since 2005. She has recently completed a Registered Manager’s Award (RMA) and is keen to obtain NVQ Level 4 in Management. The Manager is supported in her role by an experienced Deputy Manager, who has also worked at the home for a number of years. All of the staff spoken with commented that they feel the home is managed well. Seeking feedback from residents can be a challenging role for 4 Vallance Gardens due to individuals’ complex care needs and limited verbal 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 24 communication skills. CMG head office sends out their own quality assurance documentation to residents’ families / representatives and provides the home with feedback. The Manager confirmed that verbal feedback is given regularly by relatives and visiting health and social care professionals, during their visits to the home. The Manager is supervised by a Deputy Regional Operations Manager. She visits the home on a monthly basis to interview staff and talk with residents in order to gain their feedback about the service, inspect the premises and a number of the home’s records. Detailed reports are written regarding the outcome of these visits. All policies and procedures are devised by CMG, a number of which were seen on the day of inspection. A quick reference guide for staff in relation to these has been implemented as per the last inspection report. The Manager confirmed that CMG are in the process of reviewing the home’s policies and procedures. The Manager is in the process of updating the home’s fire risk assessment as required by the Fire Safety Officer. This was discussed in some detail on the day of inspection. It is recommended that the Manager obtain a copy of the HMSO guidance, which is specifically for care homes. This will support the Manager in undertaking a detailed and comprehensive fire risk assessment of the premises. Evidence provided within the home’s returned pre-inspection questionnaire identified that all equipment is well-maintained and regularly serviced including: fire equipment, environmental health issues, electrical appliances central heating system and emergency call system. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 25 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 3 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 2 25 3 26 3 27 1 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 3 3 X 3 3 X 3 X 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 26 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. Standard 1. YA6 YA9 Regulation 15(1)(2)(a-d) Requirement That the current care planning format is reviewed. All plans of care and risk assessments should be based on a person centred approach and be focused on the strengths, needs and preferences of the individual. That suitable arrangements are in place for all residents to engage in meaningful and stimulating activities both within and outside of the home as per their individual plans of care and funding arrangements. That the mealtime arrangements are reviewed to ensure that the needs of the residents are prioritised. That the daily routines within the home are flexible to maximise residents’ privacy, dignity and control over their lives. These must be outlined within individual plans of care. That a medication error policy and procedure is devised and implemented. All staff must be aware of this and follow the correct procedures. DS0000014142.V319212.R01.S.doc Timescale for action 30/09/07 2. YA14 16(2)(m)(n) 30/09/07 3. YA17 12(1)(a) 30/09/07 4. YA18 12(1)(2)(3) (4) 30/09/07 5. YA20 13(2) 17(1)(a) Sch3 30/09/07 4 Vallance Gardens Version 5.2 Page 27 6. YA24 23(2)(p) 7. YA27 YA29 23(2)(j) That the lighting throughout some areas of the home be improved, particularly in the area where medicines are stored and in the downstairs corridor, which leads to a number of bedrooms. This must take in consideration the additional sensory impairments of the residents accommodated. That suitable assisted bathing facilities are provided in order to meet the assessed needs of residents. 30/09/07 31/12/07 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard YA1 YA17 YA19 YA27 YA24 YA32 YA33 YA35 YA42 Good Practice Recommendations That the home’s Statement of Purpose and Service Users’ Guide be updated with the new contact details of the CSCI. That the home works with residents, as part of an activity to devise colourful pictorial menus for the week. That in line with Valuing People, Health Action Plans are implemented. That consideration be given to providing a walk-in shower facility for residents. That the carpets in the communal areas are replaced. That a minimum ratio of 50 of care staff are qualified to at least NVQ Level 2 or equivalent. That the most recent CSCI inspection report is obtained by the home in respect of the agency employment that are being used to cover additional shifts. That regular refresher training is provided to all staff to ensure that the ethos and commitment of the staff team is in line with the principles of Valuing People. That the Manager obtains a copy of the HMSO Fire Regulations Guidance specifically for care homes. 4 Vallance Gardens DS0000014142.V319212.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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