CARE HOME ADULTS 18-65
Horsebrook (45) Calne Wiltshire SN11 8HG Lead Inspector
Tim Goadby Key Unannounced Inspection 26th September & 2nd October 2007 16:10 Horsebrook (45) DS0000033510.V347676.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 Horsebrook (45) DS0000033510.V347676.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. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Horsebrook (45) Address Calne Wiltshire SN11 8HG 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) 01249 811222 www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th September 2006 Brief Description of the Service: 45 Horsebrook provides care and accommodation for up to six service users with a learning disability. It is operated by Cottage and Rural Enterprises Ltd (CARE). The property is owned by Westlea Housing Association. The service was first registered in 2003. It is a semi-detached building on two floors. Each service user has a single room with an en-suite shower and toilet. There is also a bathroom on the first floor. The communal space includes an open plan lounge and dining room. Service users take an active role in the household routines. There is a domestic type kitchen with a separate laundry area. The home has its own vehicle. 45 Horsebrook has close connections with CARE Wiltshire, a larger project in the nearby village of Rowde. This provides various social, therapeutic and work based day activities. Some administrative and personnel support is also provided through the CARE Wiltshire service. Fees charged for care and accommodation are based on the assessed needs of individual service users. Service users also contribute additional sums for ‘social’ journeys in the home’s vehicle, up to a maximum of £7 per week. Information about the service is on display within the home, including a copy of the most recent CSCI inspection report. Service users have their own copies of documents such as the complaints procedure and service user guide. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was completed in October 2007. The process included a review of what we know about the home since its last main inspection, which was in September 2006. This included a shorter follow-up visit, known as a ‘random inspection’, which took place in March 2007. For this key inspection we asked the home to complete an Annual Quality Assurance Assessment (the AQAA). This document contains key information about the service, as well as their own judgements and evidence about how well they are doing in all areas of service delivery. We also sent out survey forms. We received replies from all six service users, four relatives and four members of staff. An unannounced visit was made to the home on a weekday evening, to ensure that service users would be present. This visit lasted around four and a half hours. A return visit took place by appointment the following week, to meet with the home’s manager and conclude the inspection process. This visit lasted two and a half hours. The fieldwork at the visits included sampling of records, discussions with service users and staff on duty, sampling a meal and a tour of all the communal parts of the home and one service user’s room with their consent. The judgements in this report are based on all the above sources of evidence. What the service does well:
The admission of new service users is managed effectively, ensuring that someone thinking about moving in can make an informed choice. Prospective service users can undertake trial visits to the home, and make their own contribution to their assessment. Once they have moved in, an initial review takes place after a few weeks to check that they are happy with the home. Service users have choice and independence in all aspects of their daily lives. They can decide how they wish to spend their time at home, and what activities they would like to undertake elsewhere. Risk assessments are used to support service users in having new opportunities, such as accessing local employment, or spending time at home alone. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 6 The accommodation offered to service users is of a good standard and meets their individual and collective needs. All service users have their own bedroom with en-suite facilities. These are of a good size, and are attractively furnished and decorated, in line with the preferences of their occupants. Communal areas are homely in scale, and service users are comfortable in using them. Service users benefit from a well run home. The service has access to organisational support from administrative and senior staff based at Rowde. This helps to ensure that some systems in areas such as health and safety are overseen regularly. It also means that issues which cannot be resolved within Horsebrook can speedily be taken to another level within CARE. CARE has an effective organisational system for quality assurance. The range of measures used includes obtaining feedback from service users and staff. Service users can be confident that their views contribute to an overall philosophy of continuous service development. Service users appear confidant and settled in the surroundings of the home. They get on well together and with staff supporting them. They also make visitors welcome. Service users are engaged and enthusiastic about various events in the home and outside. They spoke about a range of topics, such as the manager’s puppy which he sometimes brings in, a new fish tank in the lounge, how they choose menus, and the various activities, outings and holidays which they undertake. The clear impression is of service users benefiting from a secure and stimulating home environment. One wrote in their survey response “I do like it living at Horsebrook”. What has improved since the last inspection?
Care plans for service users now include more of the relevant details about key issues for each individual. This helps to demonstrate that service users are receiving effective support for all their needs and wishes. Suitable procedures are in place for each service user to ensure that they receive effective support with personal care. These show an appropriate balance between the wishes of individual service users, and the need to uphold minimum standards and the duty of care. The same balance is being maintained in supporting service users to keep their environment clean and hygienic. This helps to ensure that service users live in a pleasant environment. Practices for medication include a record for all stages in the administration of the drugs prescribed for service users. This helps to promote the safe and effective management of medication, and to protect service users. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 7 The service has resolved complaints issues which were current at the time of the last main inspection. Feedback from one relative confirms that they are now more satisfied with the approach of the home to their concerns. The manager is working to promote good relationships with families, so that issues can be identified and addressed at an early stage. Service users can be confident that the home takes concerns seriously and acts appropriately when these are received. Record keeping systems have improved. All required documentation was available for inspection. Notes which could form part of the confidential overall record about individual service users are no longer being made in places such as handover books, where they might be alongside information about other people. These improvements help the more effective operation of the service, to the benefit of its users. Arrangements for fire safety have been reviewed to ensure that they are providing effective protection for service users, staff and other visitors to the home. The property has a current fire risk assessment. Issues arising from this have been addressed, with advice from relevant experts. Review of staff cover has increased the times when there are two staff on duty. This benefits service users because it enables them to undertake more of the social and leisure opportunities that they want to. Service users’ relatives and Horsebrook’s staff comment that it would be beneficial to offer service users more alternatives to the day service facilities at Rowde. Progress has been made on this, with more service users starting to spend part of the week accessing other facilities. These include other day centres, college courses and voluntary employment. These opportunities offer service users a wider range of experiences and social contacts. One relative is especially happy that a service user has gained confidence from being supported to find a job. A new home manager took up post in January 2007. Service users and relatives express confidence in his ability to conduct the home effectively. They are pleased with the response when they raise any concerns. What they could do better:
Some service users are now being supported to manage their own medication. This needs to be backed up by a documented risk management framework. This must show the judgement about a service user’s capability to take on this task; explain the individual systems in place for each person; and make clear when these are to be reviewed. The home produced initial risk assessments during this inspection but these needed some further work to address all the relevant points. A suitable risk management framework will help to protect service users by enabling them to manage their own medication safely. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 8 Some developments in recording will help to show more clearly that suitable and effective support is in place. Firstly, support guidance in service users’ individual plans should be developed into more detailed instructions, where appropriate. For instance, if goals have been set in line with a service user’s assessed needs or wishes it is relevant to show how these are being worked towards. Clear guidance is also important if the type of support being given is potentially sensitive, and requires consistency and clear boundaries. Secondly, records made in separate locations should be clearly crossreferenced if there is a link between them. For instance, when daily notes refer to a medical consultation but the detailed outcome is recorded in a different file. This allows a clear evidence trail and shows that identified support needs are followed up. Finally, entries in each service users’ records should be made with a suitable minimum frequency. This helps to show that there is appropriate ongoing overview of care. Service users would benefit from the support of staff who have had training in topics relevant to their specific needs. Staff themselves identify the need for additional knowledge and skills. The service is aiming to make progress on this as one of its development targets for the next twelve months. The home’s manager needs to complete the process of registration so that there is a person based within the service who is accountable to the Commission for the welfare of its service users. The home has previously failed to ensure that all necessary recruitment checks were completed before new staff began working with service users, which may have placed them at risk. There have been no new staff appointments since the previous inspection, so up to date practice in this area could not be checked. It is anticipated that this problem should not recur. The issue will be assessed again at future inspections. 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. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 9 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 Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have their needs assessed and make a positive choice about moving into the home. EVIDENCE: One new service user has moved into Horsebrook since its last inspection. Records were seen for this individual. They include assessment and life history information. The contribution of the service user and their relatives to the assessment process is clearly shown. Relevant information was also obtained from other professionals and agencies, with the service user’s consent if necessary. The service user had a one week trial stay at the home in June 2007, before moving in the following month. A service user’s relative commented that all service users are always involved in decisions about who moves into Horsebrook if there is a vacant place. Horsebrook (45) DS0000033510.V347676.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their needs and wishes set out in their individual plans. Support could be enhanced by further improvements in the content of their personal records. Service users can make choices and decisions in their daily lives, and about the conduct of the service. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: Two sets of service user records were sampled during this inspection. Information in care plans describes the type of learning disability an individual has. It also sets out their likes and dislikes, strengths and needs, routines, activities and relationships.
Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 12 Care plans are focused on the service user’s own perspective. They are written in the first person. Strengths and abilities are set out, as well as needs. The service user’s wishes and preferences are made clear. Sections include ‘Good things about me’ and ‘Things important to me’. Service users sign their own plans where possible. One service user is updating their own care plan on their laptop computer. The same person prepared their own notes for their review meeting earlier in the year, with some support. Work has begun with service users on person centred planning. Individuals are supported to identify their own objectives, and then plan suitable steps towards achieving these. The home is involving other people who can help with this, widening the circles of support for service users. There has already been progress in helping individuals meet some objectives. One example was a trip in March 2007 to a farm in Devon, where service users saw several animals and were able to see lambs being born. Photos from this and other visits are on display in the home, and service users spoke with enthusiasm about some of the trips they have been on. General information about support needs has not been developed into detailed guidance. This would be appropriate where particular goals have been set, or where the support to be given needs to be carefully defined. For instance, it was observed that the approach taken with one service user is deliberately assertive and challenging. But there is no guidance to explain why this is appropriate, or how to do it consistently and within suitable boundaries. Ongoing records about service users are not made as a matter of course but when there is felt to be anything noteworthy. This produces a varied and inconsistent pattern of recording. A service user who moved in to Horsebrook in July 2007 had only five entries covering the 13 weeks since their admission. Failure to cross-reference between different records can make it difficult to track the support that is being given. One service user’s records contained a note that they needed to see a GP. No further information was recorded to follow this up. A separate folder of medical information showed that the service user had seen a GP on the date in question and contained details of the outcome. But there was no link between the two sets of records. Service users exercise choice and independence. For instance, they make their own drinks and decide where to spend time within the home. Service users’ meetings are held regularly. Minutes of the most recent one showed that service users were informed about this inspection. The manager also explained about the Annual Quality Assurance Assessment (AQAA) which he had to complete and discussed this with them. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 13 Risk assessments are used to support judgements about the activities undertaken by service users. For instance, decisions are reached by all relevant persons about whether service users are safe to spend periods of time at the home unsupported by staff. One service user has a part-time job in a local shop and is not supported by staff of Horsebrook whilst there. This arrangement was reached after a period of training with the service user. There is informal monitoring to check that it remains suitable. All six service users state in survey responses that they are involved in making decisions in the home. They also all agree that their privacy is respected. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 15 EVIDENCE: The first unannounced visit to Horsebrook, on a weekday evening, showed a lively and homely atmosphere. All service users interacted confidently with each other, with the manager who was on duty, and with the visiting inspector. Five service users were at home, with one away staying with family. Service users arrived back from their various daytime activities. Four had been to CARE’s day service facilities at its nearby project in Rowde. One had been out with a relative. On arrival home they had an evening meal together. All service users helped with preparing for and serving this, and with clearing away and washing up. Four of them then got ready to go out again for the evening, to a club in Chippenham. The fifth remained at home, working on a hobby of card making. The second visit, on a weekday morning, began just as service users were finishing breakfast and going out for the day. Five were again going to Rowde, whilst the other was due to go into Calne to a voluntary part-time job. Service users were again chatty and welcoming and appeared to be at ease with their lifestyle in the home. The Care Wiltshire site in Rowde offers a range of opportunities, including arts and crafts, gardening and information technology. Most of the service users at Horsebrook attend this facility. One service user who has expressed a wish not to do so is provided with an alternative programme. This includes attendance at other day centres, participation in college courses and some voluntary employment. Other service users are also beginning to broaden their range of activities in similar ways. Service users have regular activities and outings outside the home. They spoke about various trips planned for the coming months. These include a Christmas shopping trip to Calais, going to see a couple of musicals and a Christmas meal at a local pub. The home has obtained a selection of menus for this last activity, which service users are using to choose where to go. Service users are able to maintain contact with their families and friends. Some have regular visits from relatives, or go and stay with them. Contact is also maintained through telephone calls. Service users have opportunities to go on holiday. The group all went to the Lake District earlier in 2007. Some service users have also been on holiday with their families. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 16 All six service users state in survey responses that they like the food at the home. Menus are chosen by the service users at the beginning of each week. They are displayed on a noticeboard in the dining room. The evening meal during the first inspection visit was quiche with salad. The home ensures that there are always options in case someone does not like the main meal. Some service users have particular dietary needs, linked to the genetic cause of their learning disability. The service has done research and offered staff training to develop knowledge about these conditions and how best to support the individuals concerned. Survey responses from staff included a comment that the home could improve its practice in offering service users meal choices and healthy options. They feel that service users and staff would benefit from relevant training. The home’s AQAA indicates that basic food hygiene training for some service users is a plan for the next year. Menus are due for further review in any case, due to a change of practice at Rowde. Service users attending this facility will no longer have a cooked meal during the day but will be taking packed lunches. The allocated food budget for Horsebrook is to be increased to reflect this change. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their personal and healthcare needs met. Service users are protected by most of the home’s policies and procedures for dealing with medicines, but practice needs to improve in the support to service users who self medicate. EVIDENCE: Service users’ survey responses show that five of them feel well cared for in the home. The other service user responded ‘Sometimes’ to this question. Some service users need to be observed or monitored whilst carrying out personal care, for reasons of safety. This is shown in risk assessments. Individual plans also set out the support service users need to ensure that they maintain appropriate standards in their personal care. They describe the prompting and encouragement that service users may need. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 18 Information about service users’ health care needs is included within their records. This includes any contacts they have with other health care professionals. Records show that service users have had various appointments, including with dentists, opticians and a neurologist. Two of the home’s service users retain their own medication. They are issued with a week’s supply at a time and have appropriate storage in their own rooms for this. The service users are also expected to sign a record chart to show when they have taken the medicines. The home has records to show how service users were assessed for their competence and understanding before they took responsibility for their own medication. But it did not have risk assessments in place to show a judgement about each individual’s capability, to explain the system agreed with each or to ensure that arrangements are kept under review. Initial risk assessments had been produced by the second inspection visit. These needed some more work on presentation and content. In particular, they did not yet show the review frequency, or make clear that review must take place when there is any change to a service user’s prescriptions. Other service users who have prescribed medication have this managed on their behalf. All staff receive training and instruction and are assessed for their competence in administering medication. Arrangements for the storage, administration and recording of medication were seen to be mainly appropriate. Two areas could be improved. Firstly, the home’s staff sometimes make their own handwritten additions or changes to the printed medication administration record charts received from the pharmacy. This is usually to reflect a change to a prescription. When it is necessary to do this, staff are not signing the chart or making a clear link to where the new advice has come from. Secondly, some service users keep items such as creams in their own rooms. There are no documented risk assessments in place about this. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 19 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by suitable procedures for responding to concerns, complaints or allegations. EVIDENCE: Service users’ survey responses show that four of them know who to speak to if they are unhappy. One service user responded ‘Sometimes’. The other did not answer this question. Five of the six service users also stated that they feel safe at Horsebrook, with the other answering ‘Sometimes’. The service has a complaints procedure. Information about this is given to service users and their representatives. It includes contact details for the CSCI. Service users are given the information in an accessible version, with the use of pictures to support the text. Records are kept of issues raised and actions taken in response. The service has not received any complaints since the previous key inspection. Records show that concerns raised around that time have been addressed effectively. The manager described how he is working to establish good links with service users and their families. People are encouraged to raise any concerns as they occur, which should help to resolve them at an early stage. The home has also started a compliments folder, which now includes positive feedback received from a relative who previously had concerns.
Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 20 One survey response from relatives included a view that service users should receive independent support if they make a complaint and that they should be informed of the outcome. CARE has procedures for adult protection, and also works within the local multi-agency process. Issues have been referred to this when necessary. This has helped to identify agreed strategies for managing known risks for some individuals. All staff receive training about abuse and protection. The home supports some service users who may present behaviours which challenge. Staff have not yet received specialist training for this. The home involves other relevant professionals in developing management strategies. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean, comfortable and safe environment which is suitable to meet their needs. EVIDENCE: Horsebrook is a new property in a development of similar buildings. It was registered as a care home in 2003. The service is a short walk from the centre of Calne, which offers a number of local amenities. The town is on the main A4 trunk road, providing access via public transport to larger nearby centres, such as Chippenham and Bath. All six service users have single bedrooms, with en-suite shower and toilet. One of these is on the ground floor and was seen during the inspection visit, with the consent of the service user concerned. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 22 There is a bathroom for general use on the first floor. Another separate toilet is also available downstairs. Communal areas are all on the ground floor. The kitchen is domestic in scale, and has a separate utility room with a washing machine and tumble drier. There is also a dining room and a lounge. A sleep-in room and office for staff is also on the ground floor. The home was seen to be clean and hygienic in all the areas viewed during this unannounced inspection. Information in service users’ care plans sets out how they are supported to maintain appropriate hygiene in their own rooms. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by adequate numbers of suitably trained staff. Systems for the recruitment of staff appear to offer service users the necessary protection. EVIDENCE: Service users’ survey responses show that five feel that staff treat them well, with the other service user responding ‘Sometimes’ to this question. Staff cover has been reviewed since the last key inspection. The home has an increased complement of allocated staff. There is at least one staff member on duty at all times when service users are at home. This includes sleep-in cover overnight. There are now always two people on duty at ‘peak’ times of the day, both mornings and evenings. This enables more effective support to service users, both at home and when any wish to go out. It helps to enable service users to undertake activities. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 24 A service user who is funded for 25 additional hours of one-to-one support each week regularly receives these from the same relief staff. The provision of these separately funded hours is clearly shown on the home’s rotas. There is a range of training available to all staff. This is overseen by a training co-ordinator, based at Rowde. New staff have a six week induction programme. The first two weeks of this is spent being introduced to key policies and guidelines, and shadowing other staff members on shifts to observe care tasks. New starters also receive a handbook of relevant information, including the national codes of conduct for social care staff. Induction is carried out in accordance with the national framework for staff working in learning disability services. CARE participates in a scheme within Wiltshire where different organisations act as markers for each other’s staff. This leads into staff undertaking National Vocational Qualifications (NVQs) in care. Senior staff have the opportunity to go on to take the qualification at a management level. Around 60 of the present care staff team at Horsebrook have achieved an NVQ. The rest are either completing their induction training or working towards an NVQ. There is a range of mandatory courses that all staff undertake, with more training required for more senior roles. Training is also provided in topics such as safeguarding adults. Individual training records are maintained for all staff. There is also an overall database, which helps to keep the service plan updated. CARE has its own training staff who can deliver many of the courses which are needed. Other sources of training are accessed as necessary. There is a training room on site at Rowde. Survey responses from staff included a comment that they are not given paid time for training. However, the manager said that this is not correct, and that staff attending courses are either paid or given time off in lieu. Staff survey responses expressed a wish for more training in specific disability topics. A relatives survey also commented on this need. A session took place earlier in the year about a syndrome which some of the home’s service users have. A relative commented on how useful this had been. The manager confirmed that he is hoping to arrange more sessions on other topics which are directly relevant to the home’s service users. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 25 CARE has a central human resources department, which generates all recruitment and selection policies. The actual process is managed locally. Service users are involved wherever possible. This has included some of them participating on interview panels, after receiving suitable training. There have been no new staff recruited at Horsebrook since its last inspection. This means that compliance could not be checked with carrying out necessary recruitment checks before new staff start working with service users. The service has indicated that the error identified at the last inspection will not be repeated. This will be assessed again at future inspections. Staff records are available for inspection in the service. Both the manager and his deputy have access to these. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 26 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home, but will be better protected when the home’s manager completes the process of registration, making them accountable for service users’ welfare. Quality assurance measures underpin service developments, and include actions based on the views of service users. Service users’ health and safety are protected by the systems in place. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 27 EVIDENCE: The home’s previous registered manager stood down and is now the deputy manager. Mr Anthony O’Mahoney transferred from Rowde to Horsebrook in January 2007 to become home manager. He has applied for registration and this application was being processed by the CSCI at the time of this inspection. Mr O’Mahoney has recently completed the Registered Managers Award. The deputy manager has also achieved this qualification. CARE has a number of management and administrative staff based at Rowde, who oversee various areas of service delivery. These include staff training, health and safety, quality assurance, financial issues and day services. There are regular management meetings covering all aspects of service delivery. There is a locality manager for CARE’s Wiltshire services, including Horsebrook, and clear systems for reporting to the senior levels of the company. Managers from Rowde carry out monthly visits to Horsebrook to report on the overall conduct of the home, as required under Care Homes Regulations. CARE has an organisational quality assurance system. One staff member, based at Rowde, is responsible for overseeing its local implementation. The process involves auditing all areas of service delivery, with checks at various frequencies. This includes obtaining feedback from service users and staff. Any actions identified from the quality assurance process are planned in order of priority. Records specify what action is to be taken and who is responsible for this. There are regular meetings to oversee progress. The home also completed its Annual Quality Assurance Assessment (AQAA) for this inspection. Service users and staff were involved with this. The document identifies plans for improvements over the next twelve months. These include offering more individualised support to each service user; promoting independence skills, and addressing staff training and development needs. Health and safety arrangements are also overseen from Rowde. CARE has a wide range of standard policies and manuals covering all aspects of this topic. The organisation has a consultancy agreement with another company specialising in health and safety, which advises on various aspects of practice. One member of staff at Horsebrook is the allocated lead person on health and safety and spends one day per month focusing on the topic. They attend health and safety meetings and also oversee the carrying out of all planned checks at Horsebrook. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 28 Risk assessments are carried out on various safety topics. These may be for specific service users, or for general issues. Generic risk assessments are usually completed by CARE’s health and safety co-ordinator from Rowde, or by a specific expert on topics such as fire. Risk assessments for individual service users are completed at Horsebrook by the manager, deputy or allocated health and safety lead. They are then copied to the health and safety co-ordinator. The property’s fire risk assessment was completed in November 2006. It identified some issues for follow up, including the arrangements for evacuation from the first floor, which doesn’t have an external escape route. The home now has documented evidence, after consulting with a fire safety expert, to support the view that the current arrangements are suitable. The home keeps records of daily checks of its fire safety systems. Information also highlights those service users who are known to be particularly at risk in any emergency situation and who would need assistance. Service users’ meetings are used as an opportunity to discuss health and safety issues with them and give reminders about how to keep safe. For instance, the most recent meeting included a discussion about fire safety. Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 N/A 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 17-1a Sch3-3m Requirement Service users who are supported to manage their own medication must do so within a documented risk management framework. Timescale for action 02/10/07 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 Refer to Standard YA6 Good Practice Recommendations A suitable minimum frequency of entries should be maintained in service users’ notes, to maintain an effective overall care record. Records on related topics, which are made in separate places, should be clearly cross-referenced to enable effective tracking of support. Key goals and support areas identified within individual plans should be developed into explicit guidance, to promote safe, consistent and effective support. 2 YA6 3 YA6 Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 31 4 YA20 There should be documented risk assessments for any topical preparations such as creams or ointments which service users may keep in their own rooms, to demonstrate that the arrangements are suitable. If staff need to make alterations or additions to printed medication administration record charts they should sign these and cross-reference to the relevant prescribing advice, to minimise any risk of errors occurring. The service should pursue its plans to provide more training on topics relevant to the needs of its service users, so that staff have more knowledge and skills which will enable them to give effective support. 5 YA20 6 YA35 Horsebrook (45) DS0000033510.V347676.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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
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