Inspection on 16/07/07 for 40 Fir Tree Road

This inspection was carried out on 16th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

40 Fir Tree Road 26/08/08

40 Fir Tree Road 16/10/06

40 Fir Tree Road 01/11/05

40 Fir Tree Road 05/04/05

40 Fir Tree Road 20/09/04

40 Fir Tree Road 24/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Fir Tree Road (40) 40 Fir Tree Road Banstead Surrey SM7 1NG Lead Inspector Pat Collins Unannounced Inspection 07:50 16th July 2007 X10029.doc Version 1.40 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 DS0000013494.V338543.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 Older People and 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. DS0000013494.V338543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fir Tree Road (40) Address 40 Fir Tree Road Banstead Surrey SM7 1NG 01737 379242 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) firtreeroad@c-i-c.co.uk www.c-i-c.co.uk. Community Integrated Care Mrs Judith Eleanor Conteh Care Home 8 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (5), Physical disability (2), of places Physical disability over 65 years of age (4) DS0000013494.V338543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Up to 3 (three) residents aged 47-64 years. Up to 5 (five) residents aged over 65 years. Of the 3 (three) adults with learning disabilities (LD) accommodated, 2 (two) may have an additional physical disability (PD). Of the 5 (five) older people with learning disabilities LD (E) accommodated, 4 (four) may have an additional physical disability PD (E). 16th October 2006 Date of last inspection Brief Description of the Service: 40 Fir Tree Road is a care home providing personal care and support for eight adults with learning disabilities of mixed gender. Some of the people using services may be over 65 years of age and/or may have physical disabilities as secondary conditions. The building is a large, detached, two - storey house situated in a residential area, on a busy main road. A parade of local shops is within walking distance of the home. All community amenities are within close proximity in Banstead village and in nearby towns. All bedrooms are single occupancy and arranged on the ground and first floor, accessible by passenger lift. One bedroom has an en suite bathroom. Bathrooms and toilets are located on both floors and have suitable adaptations and aids to meet the specialist needs of the people accommodated. Communal areas are on the ground floor. These include a large combined lounge/dining room, a separate small lounge, a spacious fitted kitchen, separate utility room and an office. Car parking facilities are at the front of the home and to the rear is an attractive, enclosed garden. The building is wheelchair accessible and service provision includes a wheelchair accessible vehicle. Fee charges range from £1192.91 to £1365.60 per week. DS0000013494.V338543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit formed part of the key inspection process using the new ‘Inspecting for Better Lives’ (IBL) methodology. This was the home’s first key inspection and incorporates observations made at the time of this visit to the home. Judgements are based also on the cumulative assessment, knowledge, and experience of service provision since the time of the last inspection in October 2006. The inspection was undertaken by Ms Pat Collins, Regulation Inspector, starting at 07:50 hrs and finishing at 14:55 hrs. The registered manager was on extended leave at the time and the ‘acting’ manager, who is the deputy manager, facilitated the inspection process. All people using the home’s services have severe or profound learning disabilities. Owing to their high support needs they were unable to have indepth conversations with the inspector to express opinion about their care and life at the home. The inspector had contact with all people using services though contact with one person understood to have verbal communication skills was brief owing to day care arrangements. Judgements about the wellbeing of people using the home’s services have relied heavily on observations of their appearance, mood, demeanour, behaviours and gestures. Also on observation of care practice, interaction between staff and people using services, from the content of records and discussions with staff. The inspection process also took into account information sent to the Commission for Social Care Inspection (CSCI) each year by the care provider and feedback from relatives/advocates surveyed by the CSCI. The inspector would like to thank the people using services and staff for their hospitality and cooperation during the inspection visit. What the service does well: The physical design and layout of the premises ensures provision of an overall safe, well-maintained, accessible and comfortable environment. The home is suitably equipped with appropriate specialist aids to meet the care needs of people using services. At the time of the inspection visit the home was clean and free from malodour. There is a clear admissions criteria, which promotes anti-discriminatory practice. Admission decisions are based on holistic, comprehensive needs assessments ensuring the different and lifestyle needs and aspirations of prospective people using services can be met. Assessed needs and risks are mostly addressed in care plans and effort made to afford choices in the daily lives of people using services, wherever possible and however small. Provision includes a balanced, wholesome diet that accommodates food preferences and dietary needs. Staff have knowledge and understanding of safeguarding adults issues and robust procedures are in place for reporting suspicions or evidence of abuse or neglect. This ensures the safety and welfare of people using services. Feedback from a relative/advocate demonstrated overall confidence DS0000013494.V338543.R01.S.doc Version 5.2 Page 6 that staff have the right skills and experience to properly look after people using services “ Generally we are very happy with the staff and their skills----Staff present (the person we/I visit) well and (this person) is always happy and smiley”. What has improved since the last inspection? What they could do better: Two requirements made at the time of the last inspection have not been met. Specifically diabetes awareness training for staff and other statutory training could not be evidenced. Records of staff training were incomplete. Information available at the time of this inspection indicated the need for review and improvement in care planning processes for this to be a continuously inclusive process consulting and communicating with family and/or advocates not just at the time of annual reviews. Additionally feedback from a relative/advocate confirmed the need to develop appropriate methods for supporting people using services to keep in touch/communicate with relatives/advocates. It was concerning to receive feedback in the same questionnaire of failure to communicate significant information affecting the health and welfare of a person using services examples being if this person has been unwell. Also concerning was feedback from the same relative/advocate that the complaint procedure is not clear or always effective, examples of this stated to be sometimes a slow response to concerns and on occasions, letters of complaint not receiving a response from head office. A copy of the home’s quality assurance report stated to be in the home could not be located and not all staff had received infection control training or had training in the management of epilepsy. DS0000013494.V338543.R01.S.doc Version 5.2 Page 7 Attention is necessary to aspects of infection control practice. Liquid soap and paper towels need to be provided in bedrooms for hand washing for staff after engaging in personal care tasks. The provision of soap and other toiletries in bedrooms, bathrooms and toilets also need to have risk assessments carried out to minimise the potential for these to be accidentally ingested by people using services. If provision of liquid soap in bedrooms is not considered safe then alternative methods should be considered for ensuring adequate infection control practice. Additional charges not included in fees must be stated in the service users guide document, which tells people how the service works. The statement of purpose, which is a document that tells people who the service is for, service users guide and complaint procedure also need a minor amendment updating contact details for the Commission for Social Care inspection (CSCI). Care plans and personal and environmental risk assessments need to be further developed. Improvements are also necessary to medication practices and procedures. A copy of Surrey’s multi-agency safeguarding procedures should be available in the home for staff’s reference. 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. DS0000013494.V338543.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) DS0000013494.V338543.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: OP 1, 3,5, 6, & YA 1, 2.4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people using services and/or their representatives are provided with information about the home to enable informed choice about its suitability to meet individual needs and aspirations. It was agreed that amendment would be made to these documents including contact details for the CSCI and details of additional charges not included in fees. Arrangements for assessing needs are satisfactory ensuring the aspirations and needs of prospective people using services can be met by the home. EVIDENCE: The home’s documents that tell people who the service is for (Statement of Purpose) was comprehensive in content however needed to be updated with DS0000013494.V338543.R01.S.doc Version 5.2 Page 10 current CSCI contact details. The document that tells people how the service works (Service Users Guide) has been produced in a pictorial and symbol format, designed to make this information accessible to people for whom the home is intended. This document also needs updating with current CSCI contact details and details of charges not included in fees. The complaint procedure also requires updating with the CSCI contact details. The home’s admissions policy includes procedures to be followed when referrals are made to the home and promotes anti-discriminatory practice. The policy clearly states that assessments of needs and an in-depth history of the potential person using services must be obtained from their care manager; additionally, two to three visits to the home must be arranged for people using services to determine the home’s suitability to meet their needs and aspirations. Information sent to the CSCI by the registered manager states that the home’s robust, pre-admission process ensures value for money by securing correct funding from those responsible for fees, enabling individual needs to be met. There had been no admissions since the last inspection at which time the standard for pre-admission assessment was found to be met. Currently there are no vacancies and the gender of people using services is balanced (four males and four females) whose ages range between 54 and 86 years. The deputy manager confirmed services do not include intermediate care provision. DS0000013494.V338543.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: OP 7, 8, 9, 10 & YA 6, 9, 16, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using services are supported and cared for in a dignified and respectful manner and their health and personal care needs are met. Attention is needed to aspects of medication practice, care plans and risk assessments. EVIDENCE: The inspection process included looking at the care plans, medical and review records, risk assessments and daily care notes of two people using the home’s services. Needs assessments included nutrition, mobility, incontinence, moving DS0000013494.V338543.R01.S.doc Version 5.2 Page 12 and handling and mental stimulus. Care plans mostly include how the needs of people using services are to be met. Weights are monitored though some gaps in record keeping noted. Some shortfalls were found in risk assessments and care plans and these discussed with the deputy manager who agreed to review and develop the same. Examples of areas discussed for improvement included the importance to include in care plans specialist guidance, for example, professional advice from a speech and language therapist who assessed a person using services with swallowing difficulties to need all drinks thickened to a syrup consistency was not documented in a care plan. A protocol was not in place for the management of seizures for the same individual. Staff training records and discussions with staff did not evidence staff training in on all aspects of diabetes or in epilepsy awareness and management of seizures. Four people using services were observed to be chairbound. The inspector was informed that none of the people using services had pressure sores and it was noted that pressure sore prevention equipment was in use. Care practice included pressure sore prevention strategies including bedrest for individuals during the day. The home did not routinely carry out pressure sore prevention risk assessments however and it was recommended these be instituted ; additionally for pressure sore prevention management to be documented in care plans. It was noted that the district nursing services visits regularly monitoring this area of care and offer advice, support and training to the staff team. Whilst noting risk assessments were not in place for use of bedrails and their compatibility with beds and mattresses, there had been physiotherapy input in this area. A care plan for the management of diabetes needs to be developed and records maintained of random monitoring of blood sugar levels for a person using services who has diabetes. The home manager was stated to monitor this individual’s blood sugar levels from time to time in addition to routine monitoring carried out by a diabetic clinic. The deputy manager agreed to review and address this shortfall also implement risk assessments for the potential hazard of accidental ingesting hazardous substances in bedrooms and bathrooms, for example, toiletries; also to risk access access to a razor in the ensuite bedroom. The inspector was unable to engage people using services in conversations about their care plans but asked staff about needs. This is called case tracking. Only one person using services was stated to be able to engage in conversation about his care plan. He was out at the day centre for most of the inspection visit and no opportunity available for the inspector to receive feedback from him. Staff gave accounts of the content of care plans for the person for whom they were key workers. They stated they supported people using services to make choices in every day life, the activities they like to do and the food they would like to eat. The home’s procedures enable people using services to have opportunity to make choices about what they want, how they live their lives and promote independence. Discussions with staff indicate DS0000013494.V338543.R01.S.doc Version 5.2 Page 13 they strive to implement these though constrained by degrees of disability and communication limitations. Observations confirmed care plans were now reviewed monthly. It was suggested that consideration be given to reviewing risk assessments for people using services monthly. Discussions with the deputy manager included the need for care plans to be further developed to address the different and lifestyle needs of people using services. Also sensory impairments. The deputy manager agreed to review the same. Key workers evidently strive to involve people using services, within individual levels of understanding and capacity. It was stated that relatives or advocates are included in the care planning process and involved in decisionmaking. This information conflicted with feedback from the only relative/advocate who responded to the CSCI survey. Whilst it was stated that comment was invited at annual reviews it was felt that there was never enough information received to involve this person(s) in decision making. A person centred planning approach (use of Essential Life Plans) was demonstrated based on observations of care records. To demonstrate involvement of relatives/advocates in the ongoing process of care planning in accordance with requirement made at the time of the last inspection, tures of relatives/advocates should be requested to sign care plans. The reason for not doing so, where this is not practicable, should be documented in care plans. The need to monitor the content of the Essential Life Plans was also discussed, to ensure appropriate language and adequate detail. Staff were respectful of the privacy and dignity of people using services at the time of the inspection visit. They carried out intimate personal care in private, knocked on bedroom doors before entering rooms and addressed each person using services by their preferred names. The need to address gender sensitive care needs in care plans was discussed and agreed. Risk assessments were examined for two people using services who went out on the morning of the inspection visit to use a hydrotherapy pool. They were escorted by the home’s driver/support worker and a second support worker. The driver was observed to take care in clamping their wheelchairs securely in the home’s vehicle to ensure their safety. The inspector spoke with both people in the vehicle who smiled and appeared to be enjoying the experience. The staff confirmed that trained hydrotherapists carried out hydrotherapy sessions which is a regular activity for a number of people using services. People using services are registered with a General Practitioner (GP) and visit the medical practice. If unable to go to the surgery a GP visits them at the home and examines them in private in their bedrooms. The home follows Community Integrated Care medical policy and procedure. Records sampled confirmed staff received training in medication administration. The deputy manager stated staff are required to complete this training which includes a DS0000013494.V338543.R01.S.doc Version 5.2 Page 14 practice assessment before permitted to administer medication. The home uses a monitored dosage medication system supplied by a community pharmacy. Observations confirmed poor practice in the retrospective signing of medication records on the day of the inspection visit. Records were maintained of medication received and disposed of back to the pharmacy. None of the people using services are capable of self-medication. Discussion took place with the deputy manager regarding the need for a written protocol to be to be set up for recording messages by designated staff received from medical professional providing verbal instructions for changes to prescribed medication. At the time of the inspection visit medication administration for a person using services was not in accordance with the dose recorded on the medication record. Communication records evidenced verbal instruction received from a hospital doctor adjusting the dose of a prescribed drug. This had been verbally agreed with the deputy manager by the GP, who was imminently expected to visit and amend the medication record. The deputy manager was advised to in future request confirmation of changes to prescribed drugs by fax wherever possible and to attached the fax to the relevant medication chart. The home’s medication policy should specify the action to be taken for future reference in similar circumstances. A controlled drug register is maintained in the home and procedures in place for two staff to sign controlled drug records. Night staff had not recorded and witnessed administration of a controlled drug on the night prior to the inspection visit. The deputy manager confirmed this omission would be discussed with the staff concerned and medication practices would be reviewed with them. A new development was noted to be use of a ccontrolled drugs metal cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. DS0000013494.V338543.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: OP 12, 13, 14, 15 & YA 12, 13, 15, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the home’s services are able, in accordance with individual abilities, to make choices in their lifestyles, social activities and keep in contact with family and friends. Social, cultural and recreational activities are met though attention is required to record keeping in this area of care. A balanced, varied menu is provided which meets individual food preferences and dietary needs. DS0000013494.V338543.R01.S.doc Version 5.2 Page 16 EVIDENCE: The staff team is stable and most staff have worked at the home for a number of years. They have sound knowledge of the needs of the people using the home’s services. Those consulted emphasised their commitment to improving the quality of life of people using services, offering them a full and varied programme of activities despite their profound disabilities. Discussions with staff on duty confirmed their understanding of the social model of disability. Information sent to the CSCI by the manager and obtained through discussions with staff verified people using services engage in a variety of activities in the community. These include going to the theatre to watch musicals and other shows, visits to parks, museums, local attractions, pubs, local fish and chip shop and fast food outlets as well as excursions at weekends and holidays. Other activities include use of day centres, hydrotherapy, phsiotheraphy and aromatherapy. Staff have developed a pictorial activities album and pictorial menu to enable people using services to make choices in their daily lives. For example, in going shopping, selecting where they wish to go on holiday, when buying christmas and birthday present for their family and choosing what they want to eat. Feedback from a relative/advocate identified their expressed wish for the individual concerned who uses services to be offered other opportunities for activities to extend the range. Observation made of record keeping identified shortfalls in recording activities. This was discussed with the deputy manager who agreed to ensure improvement to activity records to evidence social needs are met. The activity records for two people case tracked were not an accurate reflection of the activities they had engaged in and some were blank for months at a time. Evidence was found through fragmented record keeping practices that these individuals engaged in fulfilling activities. Owing to their high support needs some activities were chosen on a daily basis and one to one support provided. On the day of the inspection visit one person spent the day at a day centre in Banstead, which he attends four days a week. As stated previously in this report two people attended a hydrotherapy session, escorted by two staff in the morning. In the afternoon a person using services was transported by staff to attend a day centre in Reigate. A part time driver has been employed since the last inspection and this support has helped staff to increase activities outside of the home. There are plans to employ a full time support worker/driver to further enhance social and leisure opportunities outside of the home. The home manager stated in information sent to the CSCI that this development is as a result of consulting and listening to people using services. DS0000013494.V338543.R01.S.doc Version 5.2 Page 17 People using services maintain contact with family/friend/advocates and the local community in accordance with their wishes. Those without involved family members have advocates from an advocacy scheme. There are no restrictions on visits to people using services unless it is their expressed wish. Social events take place to which relatives and advocates are invited. A barbecue took place in the garden where a small band played music on the Saturday prior to the inspection visit. The deputy manager stated some relatives/advocates of people using services had attended and the day was enjoyed by all. Staff spoke with the inspector about past holidays enjoyed by people using services. This year a long weekend is planned for some people in Blackpool. Recently five people using services went with staff on an excursion to the seaside. All of the people using services are recorded to be of Christian religion and in the past staff have supported individuals’ to attend church services. The deputy manager stated they no longer attend church owing to higher support needs. Instead arrangements are in place for the parish Vicar to visit the home once a month. During these visits he takes tea with people using services and talks with them. This is in accordance with the homess Statement of Purpose where is states under the philosophy of care that the the racial, religious and cultural needs of people using services with not lead to discrimination; and opportunities for religious observance will be provided for people of different faiths. All people using services are White British ethnicity. Though the staff team is multi-cultural they have good awareness of British culture and demonstrated how this is addressed in the home’s day to day operation. Examples include menu planning which marks significant days such as Sunday with a traditional roast meal and Friday’s with fish and chips. Staff emphasised they ensure menus remain varied by offering different roast meats, yorkshire pudding and seasonal vegetables on Sundays; in addition to battered fish and chips on Fridays, mashed potatoes, salmon, white fish in sauce and fish pie is served. The food preferences of people using services were stated by staff to be known and met. Dietary requirements are clearly identified in initial assessments. Dieticians and speech & language therapists are consulted as necessary.People using services were stated by staff to encouraged and supported in making choices and involved in planning the weeks menu at weekends with use of pictorial prompts. Records of meals sampled demonstrated balanced and varied meals were provided.There are three meals a day and drinks and snacks throughout the day Each meal is recorded for each individual. Most people using this service have light or pureed diets and the meal served at lunch time on the day of the inspection visit was nicely presented with colours and textures of food seperated on plates. Guidelines for diabetic dietary needs were held in the the kitchen also for food fortification. It was stated that a local pub accommodated needs for pureed meals if contacted in advance of going there for pub meals. DS0000013494.V338543.R01.S.doc Version 5.2 Page 18 Food is bought fresh from the local supermarket and stored in accordance with the Food and Hygiene/Assured Safe Catering System policy and procedure. The service maintains daily records of the fridge, freezer and cooking and serving temperatures. It was suggested that bottles and jars of food stored in refidgerators be dated when opened. Recommendations arising from last Environmental Health Department’s report had been part met. The one outstanding item, for replacment of a cupboard by the cooker is imminently due to be met. A new fitted kitchen is planned. The home manager stated in information sent to the CSCI that improvement made in the last 12 months include staff training in Food & Hygiene. DS0000013494.V338543.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: OP 16, 18 & YA 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints system however feedback fro a relative/advocate indicated the need for improvement in the management of complaints. Staff have received training and have an understanding of safeguarding adults matters and procedures to enable people using services to be protected from abuse and neglect and have their rights upheld. A copy of Surrey’s safeguarding adults procedure should be accessible to shift leaders. EVIDENCE: The home has a complaints policy and procedure that includes time scales and the name, telephone number, and address of the area manager, a Surrey advocacy scheme and the CSCI, though contact details for CSCI needed updating. A copy of the complaints procedure is displayed on the notice board in the entrance hall. The Service Users Guide, which is a document which tells people how the service works, contains a complaint procedure produced in widget symbols format. The symbols are intended to make this information accessible to people using services. It was stated however that none of the people using services are able to understand these symbols. The deputy manager described ways in which staff identified signs of unhappiness or distress in people using services who had minimal or no speech, enabling them to resolve their concerns. Family members and advocates were stated to be DS0000013494.V338543.R01.S.doc Version 5.2 Page 20 aware that they can complain to staff members, the home manager, external management and draw concerns to the attention of the CSCI at any time. The deputy manager stated there had been no complaints since the last inspection. This information conflicted with feedback received from a relative/advocate, however who was unclear of this procedure, commenting that some letters of complaint had not received response from head office. It was noted that it was also stated that concerns raised with the home usually received an appropriate response though at time this was slow. No complaints about the home had been received by the CSCI during the same period. There had been no safeguarding incidents reported or investigated since the last inspection. The deputy manager was able to give an accurate account of the procedures to be followed in the event of an allegation or suspicion of abuse or neglect. Information provided by the home manager to the CSCI confirmed a copy of Surrey’s multi agency safeguarding procedure was available in the home. This could not be found on the day of the inspection visit however. It was also not available at the time of the last inspection when it had been removed by a staff member. The deputy manager was advised to obtain another copy and ensure this was accessible to all shift leaders. The organisations abuse procedure was viewed and noted to require updating with new CSCI contact details. The information provided by the home manager to the CSCI confirmed that the majority of staff had received safeguarding adults training and the remainder booked to receive the same on 24th July 2007. The staff recruitment procedures safeguard people using services. This is achieved by thorough vetting procedures which includes checks agains a national data-base of people unsuitable to work with vulnerable adults. Also by obtaining Criminal Record Bureau (CRB) Disclosures before new staff take up post. Existing staff were stated to have CRB Disclosues repeated every three years. There is a whistleblowing procedure for reporting suspicions or evidence of abuse by staff which is kept in the office. Attention was drawn to the ommission of some staff to sign confirming they had read this document, in accordance with the home’s policy. DS0000013494.V338543.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: OP 19, 26 & YA 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the environment enables people using services to access all areas. Overall the home is comfortable, well maintained, safe and clean and free from offensive odours. EVIDENCE: The home environment is fit for purpose and overall well-maintained, providing aids and equipment including grab rails, mobile hoists and bathing aids to meet individual care needs of people using services. DS0000013494.V338543.R01.S.doc Version 5.2 Page 22 A description of the home’s services and facilities, including details of the accommodation and room sizes, is contained in the Statement of Purpose & Service Users Guide. People using services are assessed for the level of support required in bedrooms, toilets and bathrooms. If equipment is needed to meet individual needs, appropriate professionals carry out these assessments and advise staff on the best way to support people using services. A call bell is available in most areas. The need to ensure call bells are accessible to people using toilets was discussed with the deputy manager. All communal areas are spacious and decorated and furnished to a good standard. The lounge area would be enhanced by provision of a suitable fitted carpet creating a more ‘homely’ setting. People using services have access to all communal areas and the front and rear exits are wheelchair accessible. Toilet and bathing facilities are of good standard and afford privacy. On the day of the inspection the home was found to be clean, tidy and free from offensive odours. The five bedrooms on the first floor and three on the ground floor were inspected. Bedrooms were spacious, had all been redecorated this year and were mostly, nicely furnished. Some bedrooms had height adjustable beds. Bedrooms were personalised reflecting individual occupants interests, and contained personal possessions, including televisions, videos, music systems and family photographs. Due to their high support needs people using services have not been issued with keys to their bedrooms. Staff stated they would be unable to use the same. Washbasins were installed in all bedrooms and one bedroom had an en suite bathroom. Some bedrooms did not have soap or towels and the deputy manager described staff using nearby bathroom, toilets facilities where soap dispensers and paper towels were available, for hand washing after carrying out personal care tasks in bedrooms. There is a need to review this area of practice to ensure infection control procedures are robust. It was noted that infection control training for staff was ongoing and four staff stated to have recently completed this training. An extension off the lounge/dining room had replaced a sun lounge since the last inspection. This had enhanced communal facilities affording a separate, second sitting room with a pleasant garden view. This could be used for privacy for visitors and for review meetings. A call bell should be fitted in this area for compliance with the national minimum standards for older people. It is acknowledged that this omission does not pose a risk to people using services as this area can be easily observed from the dining room and kitchen. The attractive, enclosed garden has mature shrubs and trees and is not overlooked by neighbouring houses. The garden is well maintained and has a furnished patio with sun parasols and separate barbecure area. An environmental risk assessment was viewed, also records for monitoring hot water and radiator temperatures and window restrictors noted to be fitted to upstairs windows to ensure the safety of people using services. Discussion took place with the deputy manager regarding the need to carry out a risk DS0000013494.V338543.R01.S.doc Version 5.2 Page 23 assessment for uneven/damaged surface outside a ground floor bedroom patio door which was open; this area lead down to the garden via some steps without a handrail. The deputy manager stated that the person accommodated in this room was non-ambulant and that none of the ambulant people using services used this route to access the garden. She confirmed a recent discussion with the maintenance officer in the matter of resurfacing this area in due course. All statutory safety checks of utilities on the premises were found to be up to date. The maintenance officer is responsible for ensuring that that everything is in good working order and for minor repairs. Staff were noted to undertake weekly health & safety audits. Service records for external contractors were also examined. On the day of the inspection the tumble drier was not working and though relatively new had a history of recurrent breakdowns. An engineer was in attendance. DS0000013494.V338543.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: OP 27, 28, 29, 30 & YA 32, 34, 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using services are protected by a robust staff recruitment procedure and staff numbers are sufficient to meet their care and support needs. Record keeping for staff training did not evidence that all staff have received mandatory and refresher training and relevant service specific training. EVIDENCE: The staff team is stable and no turnover in staff has taken place in the last twelve months. Examination made of recruitment records for three staff confirmed robust recruitment procedures in place to ensure the safety of people using services. The staff duty rota was viewed for the week of the inspection. The home endeavours to have qualified staff members with skills to support the assessed needs of people using the home’s services at all times. Staffing levels afford DS0000013494.V338543.R01.S.doc Version 5.2 Page 25 four staff on the early shift, three on the late shift during the week and a housekeeper and two waking night staff. Staffing levels at weekends are 3 throughout the waking day. Since the last inspection staffing levels have been enhanced by recruitment of a part-time driver/support worker. The home manager stated in information sent to the CSCI that this has enabled an increase in activities outside of the home and a full time driver/support worker is to be recruited. Staffing levels are supplimented at times by care bank staff to meet the changing needs of people using services, to cover staff absences and provide escorts for hospital appointments, holidays and excursions. A maintence officer is employed, working across all the providers care homes in Surrey. The maintenance officer is an approved driver for the home’s vehicle and he will assist with transport if needed. Discussions with staff confirmed their opinion that staffing levels were generally adequate. Staff are informed of their roles and responsibilities to people using services, the home and their employer. This is clearly stated in their job description and stated to be revisited during induction and support and development sessions. Staff are expected from time to time to read the home’s policies and procedures, the General Social Care Council Code of Practice and Surrey’s Multi - Agency Safeguarding Procedures. Not all staff have met this expectation however. In the information provided to the CSCI by the home manager it was stated that all staff have a formal induction period at the end of which staff should have a clear idea of what is expected of them; also the aims and values of the service and their responsibilities to the people they will be supporting. The provider was stated to have launched a new E learning system for new staff to do some of their induction training on the computer.Within the Induction period it was stated new staff received training in Moving & Handling, First Aid, Food Hygiene, Fire Training, Infection Control, Adult Protection, Crisis Prevention & Intervention The records sampled however did not all contain evidence of this training. The ‘acting’ manager thought these records may be kept elsewhere. The manager has the only key to a locked cupboard and thought some records of staff induction and training might be stored there. The information provided to the CSCI by the manager stated that 50 of staff are trained to the minimum of NVQ level 2 and above. One member of staff is currently undertaking NVQ level 3 training in health and social care. Also that refresher training is available for staff each year. Annually the home manager liaises with the training co-ordinator based at the organisation’s regional office for the purpose of arranging internal and external training for staff. Record keeping available at the time of the inspection however did not verify all mandatory and service specific training received by staff. Discussed was the need for improvement in training records. Up to date minutes of staff meetings could not be found. Discussions with staff confirmed team meeting took place however on a regular basis. DS0000013494.V338543.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: OP 31, 33, 35, 38 & YA 37, 39, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was evidence of areas of good management and care practice in the day-to-day operation of the home; however improvement needed to care plans, risk assessments and staff training. DS0000013494.V338543.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager was on extended leave at the time of carrying out this inspection. ‘Acting’ management arrangements were in place for the deputy manager to manage to home on a day-to-day basis, with support and supervision from the regional area manager. The area manager was stated to visit at least weekly, sometimes announced and other times unannounced. Reports of monthly statutory visits carried out by the area manager on behalf of the provider were sampled. The deputy manager was on duty at the time of the inspection visit, working supernumerary to staffing levels to allow time for attention to management and administrative responsibilities. It was stated that the home manager usually worked three supernumerary shifts each week for this purpose. The deputy manager has a relevant qualification in health and social care, NVQ Level 3. Discussions with her confirmed she is knowledgeable about the organisation’s policies and procedures and the needs of people using services. The deputy manager described the home’s systems for safeguarding the financial interests of people using services. Each person has money that is securely kept in the home, available to be used as for their personal spending. All financial transactions were stated to be recorded and receipts obtained for all expenditure. These records were not sampled on this occasion. The deputy manager stated one person using services has a bank account and is supported by his key worker in signing for his weekly benefit. The organisation directly receives benefit allowances for all other people using services. The manager and deputy manager are signatories to their accounts enabling withdrawal of money to an agreed maximum limit. If larger withdrawals are needed this is by prior agreement with the area manager. The manager stated in information sent to CSCI, that the provider undertakes an annual Quality Assurance survey of people using services, their relatives and advocates and of staff. Evidence of this survey could not be located at the time of this inspection and was not available at the time of the last inspection. Staff on duty confirmed they are consulted by management about people using services, on staffing issues and on organisational matters. This is done on a daily basis at shift hand-over, monthly staff meetings and during staff supervision sessions. The home was stated to have a monthly core standards review, which is a self-assessment of the work done and the line manager monitors, reviews and set action plans for the following month. Review of records demonstrated that health & safety audits were routinely carried out. Also fire drills, fire alarm and emergency lighting services and tests, and monitoring of hot water, fridge and freezer and food temperatures. Specialist beds, wheelchairs, hoist and baths were checked and all equipment properly maintained. It was recommended that the frequency of fire safety DS0000013494.V338543.R01.S.doc Version 5.2 Page 28 tests be reviewed noting the last recorded test was in February 2007. The environmental risk assessment was overall comprehensive though this should include assessment of external hazards outside a bedroom patio door and access by people using services to toiletries in bedrooms and bathrooms and razor in the en-suite bedroom. Staff training records sampled did not evidence that staff had all received mandatory training and updates and other service specific training to ensure the safety and welfare of people using services. Fire training records examined indicated the home’s policy for staff to have twice-yearly fire training was not followed and some staff, specifically bank staff had not had fire training or been involved in a fire practice since 2005. The home’s fire risk assessment was dated 12/06/06 and recommendation made for this to be reviewed and include the routine practice observed of wedging doors open. The deputy manager confirmed Surrey Fire & Rescue Service carried out a recent fire safety inspection however no report had been generated. She was not aware if comment had been made on this practice by the Fire Officer or whether use of door guards had been recommended. It was noted that one fire door was fitted with a magnetic holder that was integral to the fire alarm system, as was the digipad lock on the front door. It was agreed that the deputy manager would contact the Fire Officer to confirm any advice in this matter. DS0000013494.V338543.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 Older People 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 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 3 34 x 35 3 36 x 37 x 38 2 DS0000013494.V338543.R01.S.doc Version 5.2 Page 30 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 OP9 YA20 Regulation 13(2) Requirement Timescale for action 17/07/07 2. OP30 YA35 3. OP33 YA39 For medication procedures and practices to be reviewed to ensure medication is signed for at the time of administration. Procedures must also inform staff of appropriate action they must take in response to receipt of verbal instructions from medical practitioners for changes to prescribed medication. 18(1)(c)(i) For all staff to be in receipt of 16/09/07 statutory training and updates and services specific training, examples of which include diabetes and epilepsy training. Timescale not met from the last inspection and has been extended. 24 (2) The registered person must 16/08/07 ensure a copy of the quality assurance report is kept at the home for inspection purposes. Timescale unmet from the last inspection and has been extended. DS0000013494.V338543.R01.S.doc Version 5.2 Page 31 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 OP18 YA23 OP7 OP8 OP38 YA6 YA19 YA42 OP32 YA42 OP38 YA42 Good Practice Recommendations For the home to have a copy of Surrey’s multi-agency safeguarding procedures. Care plans and individual risk assessments for people using services, additionally environmental and fire risk assessments should be reviewed and further development. Suggested improvements are recorded in the report under sections: Health & Personal Care, Environment & Management & Administration. For review of infection control arrangements and practice. For the Fire Officer to be consulted and advice sought on the safety of staff’s practice of wedging doors open in the home. 3. 4. DS0000013494.V338543.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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. DS0000013494.V338543.R01.S.doc Version 5.2 Page 33 - 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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