Inspection on 03/05/07 for 45 Sycamore Grove

This inspection was carried out on 3rd May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

45 Sycamore Grove 15/11/07

45 Sycamore Grove 08/11/06

45 Sycamore Grove 23/01/06

45 Sycamore Grove 05/07/05

45 Sycamore Grove 10/03/05

45 Sycamore Grove 28/01/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Sycamore Grove (45) 45 Sycamore Grove Trowbridge Wiltshire BA12 9LE Lead Inspector Malcolm Kippax Key Unannounced Inspection 3rd May 2007 09:20 Sycamore Grove (45) DS0000028260.V339921.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 Sycamore Grove (45) DS0000028260.V339921.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. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Grove (45) Address 45 Sycamore Grove Trowbridge Wiltshire BA12 9LE 01225 760956 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) Ordinary Life Project Association Mrs Keri Hendy Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2006 Brief Description of the Service: 45 Sycamore Grove is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). 45 Sycamore Grove is a detached bungalow in a residential area of Trowbridge. Trowbridge College is nearby and there is a convenience store at the end of the road. Each service user has their own room. There is a lounge and a dining room for communal use. The home has a domestic style kitchen, with a separate laundry and utility area. Service users receive support from a manager and permanent staff team. There were staff vacancies at the time of this inspection, which was resulting in the high use of relief staff and agency carers. There is at least one person working in the home throughout the day. Extra staff are deployed at certain times. The range of fees is £864.62 - £942.79 per week. Information about the service is available in the home’s ‘Statement of Purpose’. Copies of inspection reports are available from the OLPA head office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. They are also available through the Commission’s website: www.csci.org.uk Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home, which took place on 3 May 2007 between 9.20 am and 4.40 pm. The inspection looked at what has changed since the previous inspection in November 2006 and how the requirements from that inspection have been responded to. Information from the last inspection has been included as evidence in this report. Evidence was obtained during the visit through: • • • • Time spent with the service users in their own rooms and in the lounge. Meetings with the manager and with a staff member. Observation and a tour of the home. Examination of records, which included the service users’ personal files. Other information and events have been taken into account as part of this inspection: • • • • • • An improvement plan that the OLPA Chief Officer produced following the last inspection. A pre-inspection questionnaire that the manager completed about the running of the home. A visit to the OLPA office on 21 May 2007. A meeting that took place at the offices of the Community Team for People with Learning Disabilities in Trowbridge. The views of the service users’ relatives, who were invited to complete a survey about the home (one survey was received by the Commission). Copies of the staff rota and house development plan were received from the manager after the visit to the home. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: The service users’ needs and personal goals are discussed with them and recorded in individual plans. This helps staff to be aware of what the service users want to achieve. Staff can then provide support, which will improve the service users’ quality of life. A relative has commented that they feel the service users are happy and well cared for. Service users are encouraged to meet together regularly. This gives service users the opportunity to talk about things that affect them. Staff help with this and suggest ways in which any problems can be sorted out. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 6 Other meetings are arranged when service users can make decisions about more personal issues, for example family matters and how they want to spend their time. This helps service users to develop relationships and to take part in activities that suits their lifestyles. The service users receive practical support, which helps them to keep in touch with their families and with the wider community. Staff talk to service users about the menus, so that service users can have meals that they enjoy. There is a flexible approach, which means that service users can choose to have something different on the day. Information is available to staff about diet and individual needs, so that they can advise service users about healthy eating. The accommodation is homely and suits the service users’ needs. There is a comfortable lounge and a domestic style kitchen, which the service users like to use. Staff respect the service users’ privacy. They have supported service users with decorating and personalising the bedrooms. This has helped service users to make the most of the space that is available to them. The home has an experienced manager who is undertaking relevant qualifications. The manager knows the service users well, which is particularly important because of the staffing situation at the time of this inspection. What has improved since the last inspection? There has been progress with updating the service users’ individual plans, which needed to be reviewed at the last inspection. Staff now have better information about the service users’ needs and the personal support that they require. Further guidance for staff has been produced in particular areas. This was written in conjunction with outside professionals. The new guidance shows a more person centred approach and encourages staff to consider the service users’ individual rights. A service user’s health condition has improved and their needs have been reviewed. Staff have helped this person to establish a more varied daily routine. There have also been changes in the way that staff are deployed during the day. This has meant that staff are better able to support service users with their activities outside the home. The method for administering medication has been changed to a monitored dosage system, which the manager feels has been an improvement. It was reported at the last inspection that service users were not wholly protected from harm. The way in which one person was supported was having an impact on the service users’ freedom and independence in the home. The Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 7 guidelines for managing incidents have been reviewed. This has helped staff to meet the service users’ needs in ways that respects their rights and has less impact on their usual routines. There had been a delay in the investigation of a complaint that was made at the time of the last inspection. A requirement was made about the need to investigate complaints promptly, in accordance with the organisation’s own procedures. OLPA confirmed their intentions in the improvement plan that was produced following the inspection. Service users and their representatives who raise concerns in the future should receive a better response from the organisation as a result. The manager is looking at quality assurance and has described the core elements that need to be present. It is stated that the home strives to be person centred and supports the diversity of the people supported. Service users and staff have been involved in developing a house development plan. One objective included in the plan is for the home to acquire a personal computer. A number of benefits have been identified, which include service users and staff having better access to knowledge about local facilities and resources. What they could do better: As reported above, the main personal support parts of the service users’ plans have been reviewed. Some new guidelines had been produced, although the health needs care plans did not show that they were being reviewed at least every six months. It is important that all parts of the individual plans are regularly reviewed, so that that they reflect the service users’ current needs. The guidance for staff should be consistent and sufficiently detailed, so that there can be no misunderstanding about the type of support that is required. There was guidance for staff about how they should support a service user with epilepsy when having a bath. However this was open to different interpretation, which could put the service user at risk. Risk assessments in some areas had not been reviewed since 2005. It is important that all assessments are regularly reviewed, to ensure that service users receive the support that is appropriate to their current needs. A lot of information was recorded and guidance for staff in certain areas had been updated in recent months. However, the distinction between guidance, assessments and care plans was not always clear. A system of crossreferencing could be used, which would highlight the most important information and identify the other documentation that is relevant to a particular issue. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 8 The service users’ needs and personal goals have been identified and recorded using a system called ‘Shared Action Planning’. As part of the system, it is expected that progress with achieving the goals will be regularly monitored and recorded. This has not happened consistently. The system needs to be fully implemented, to ensure that service users make the progress that they are capable of. Changes to the system are being made, which will provide the opportunity for a new, person centred approach to be taken. A relative has commented that they sometimes feel that service users have too much free choice and could be encouraged to participate more in external events and to try new experiences. It was reported at the last inspection that service users were not wholly protected by the way in which their medicines were administered. There had been occasions when staff had not initialled the record or entered the appropriate code when administering medication to service users. Since the last inspection, the Commission has been informed of an error that was made by an agency carer and another error was noted at the time of the visit. There was a recommendation at the last inspection that the process of recruiting a new member of staff is started at the earliest possible opportunity. It was reported that the use of agency and relief staff was likely to increase and that the home should aim to reduce their use. This was so that service users would benefit from having the consistent support of a permanent staff team. A new staff member did start in January 2007, but had since left. Following other changes affecting the team, the permanent staff at the time of this inspection consisted of the manager and a support worker. There continued to be a high use of agency and relief staff. The vacancies meant that and it was not possible to establish an effective permanent staff team. However, the manager was hopeful that the staff team would increase in number in the near future, as a result of some internal transfers. The manager intends to develop the home development plan by gaining more feedback about the quality of the service provided. This will ensure that the views of service users and their representatives can be fully reflected in the plan. Please contact the provider for advice of actions taken in response to this Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 9 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. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Standard 2 did not apply at the time of this inspection as no new service users had moved into the home. The standard was met when last inspected in 2005 after a new service user had been admitted. EVIDENCE: Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. The service users’ needs and personal goals are reflected in individual plans. Service users can make decisions about their lives. They benefit from guidance that has been produced, which promotes risk taking as part of an independent lifestyle. EVIDENCE: The service users’ files contained records of ‘Shared Action Planning’ (S.A.P.), which is the system used for identifying the service users’ wants and needs and their personal goals. Individual goals had been identified and recorded. These reflected a range of interests, such as attending local events, musicals and participating in sports. There were forms for recording the different stages of S.A.P. It was reported at the last inspection that the benefits for service users were reduced because of how the system was used and a lack of consistent recording. It was not always clear how progress with achieving their goals was being measured. A Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 13 recommendation was made that the system of Shared Action Planning is consistently completed with each service user. Two service users still had the same S.A.P. documentation on file, with personal goals that had been agreed in 2006. Mrs Hendy said that S.A.P. was being replaced by a new system of Person Centred Planning (P.C.P.). One service user had attended an initial P.C.P. meeting in March 2007. It was too early to make a judgement about the merits of this different system. However it will be an opportunity to make a new start and to ensure that service users benefit from a consistent approach. Service users could decide how to personalise their rooms. The rooms reflected their interests and choice of décor. One room was relatively small. The service user had made the most of the space to display their collection of music posters and pop related items. In contrast, another service user had very few personal items on show, but was happy to have it this way. The service user did have some photographs that were important to them and had some special memories. There were locks on the bedroom doors although not all the service users wanted to have their own key. The service users had been given files to keep in their rooms. These contained the minutes of the meetings that they had together, known as ‘tenants’ meetings. Service users could make decisions at the meetings about things that affect them. For example, there had been discussions about changes in day activities, the choice of curtains for the lounge and how to decorate the home at Christmas. Service users said that they helped to choose the meals each week. The menus showed when each service user had chosen a particular meal. For example during the week of the visit, the service users’ choices included lasagne, chilli con carne and baked potato. It was stated on the menus that breakfast was ‘clients’ choice’. One service user said that they chose to have toast and meat paste for their breakfast, which they made themselves. Another service user liked to make their own drinks from a mix of ingredients. There was guidance for agency carers, which stated that it was not appropriate for staff to comment on these ‘unusual concoctions’, but they would need to be aware of health & safety issues. During the visit, each service user spent time in the lounge and in their own rooms. They could move around the home as they wished. The kitchen was available to service users and one person made their own lunch during the visit. Mrs Hendy explained that the there were some procedures in place concerning the use of the kitchen. These were designed to help service users use the facilities safely and hygienically. Some items were kept in a locked cupboard. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 14 There was information in the kitchen about the use of particular items of equipment. Risk assessments had been undertaken for the use of the kettle and for making hot drinks. One service user used an adapted kettle and there was guidance for staff about how they needed to be involved in managing the risk. There was a file for relief and agency staff, which included sections on ‘Home guidelines’ and ‘Personal information’. This provided information about the service users’ preferred routines. Guidance was available about particular events that might arise and how to respond. For example, one service user was encouraged to receive personal calls on the portable phone in their own room. This was so that they would have privacy. There was also guidance about how a service user could be helped to make their telephone calls a positive experience for both themselves and the family member that they were talking to. Risk assessments had been undertaken in respect of other activities undertaken by service users in the home. Some of these had not been reviewed for a over a year. See section, ‘Personal and Healthcare Support’. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 15 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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users have individual lifestyles, which are reflected in their occupation and daily routines. Service users receive support with their relationships, which helps them to keep in touch with their family and with the wider community. Service users’ rights and responsibilities are recognised in their daily lives. Service users help to choose the menus. Alternatives are provided to meet individual needs and preferences. EVIDENCE: Each service user attended a number of activities outside the home each week. Details of these planned activities were recorded on weekly schedules. One service user attended a resource centre on four days a week. On the day of Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 16 the inspection this person was having a home-based day, but they went out in the afternoon to a yoga session at the nearby college. Another service user had a varied week, which included going to college on two days, working at a garden centre for one day and having two home-based days. This service user said that they enjoyed the garden work. They had a bus pass for getting to the garden centre. They had made items on their college woodwork course, such as a CD rack, which they were using in their room. It was reported at the last inspection that one of the service users also had a place at a resource centre although they were choosing to stay in the home, rather than to attend. Mrs Hendy said that this situation had changed and the service user now attended the centre on most days. The service users’ files contained information about their family relationships and contact details. Each service user regularly saw one of their close relatives. In the comment cards that were received at the last inspection, three relatives confirmed that they are welcome in the home at any time and can visit in private. The relative who completed a survey as part of this inspection, commented that they sometimes feel that the service users have too much free choice and could be encouraged to participate more in external events and to try new experiences. The relative also commented that service users were well fed and encouraged to participate in food shopping. One service user said that they went shopping and did their laundry. They explained how they how they brought their washing to the utility room and used the washing machine independently. On occasions, service users had participated in an event, for example going to the pantomime, as part of their S.A.P. objectives. One service user spent time with a Church group, which included going on an annual outing. The service user had a photograph of such an outing on display in their room. Mrs Hendy said that she hoped that the home would be able to get internet access in the near future. A number of benefits were anticipated, included service users and staff getting better knowledge about local facilities and resources. There was a record of the service users’ ‘one to one’ activities, although an example seen did not have any entries after 12 February 2007. Mrs Hendy said that this needed to be updated. The service users’ personal money was brought into the home each week and kept safe on their behalf. Staff supported service users to access their money. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 17 Transactions were being recorded on individual account forms. Service users also had individual savings accounts. There was discussion with Mrs Hendy about whether service users could take a more active role in managing their own money, for example by having a card that they could use at a cash point machine. A menu was written with service users each week. This showed a varied range of meals throughout the week. The main meal was prepared in the evening and the service users usually had rolls or sandwiches for lunch when at home. Details of the day’s main meal were written on a blackboard in the kitchen. On the day of the visit this was lasagne and salad. Service users could have their meals in a dining room. During the visit, service users had lunch informally in the lounge. There was a bowl of fresh fruit that was available to service users during the day. Information about a service user’s dietary needs was included in their personal file. Some foods were being avoided and the record of meals showed when the service user had an alternative dish. The file for relief and agency staff also contained relevant information about the service users’ needs, for example a service user who does not have citrus fruits. There were guidelines about the content of lunch boxes and the service users’ likes and dislikes. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 18 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visit to the home. Service users are benefiting from staff who are getting better information about their day to day needs. Consistency of support and risk to service users may be affected by a lack of up to date or detailed guidance in some areas. Service users are generally protected by the home’s procedures for dealing with medication, although occasional errors are arising. EVIDENCE: Service users had individual support plans for personal care, which had been reviewed and updated since the last inspection. There were new ‘Review Record Sheets’, which showed when parts of the plans had been amended. The service users’ individual files contained other information about their personal and healthcare needs. This included for example, Personal and Medical Profiles; Health needs care plans and guidelines about particular needs. A lot of information was recorded and guidance for staff in certain areas had been updated in recent months. However, the distinction between guidance, Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 19 assessments and care plans was not always clear. The health needs care plans did not show that they were being reviewed at least every six months. This was discussed with Mrs Hendy. A system of cross-referencing could be used to highlight the most important information and show the range of documentation that was relevant to a particular issue. One service user’s Personal Profile included guidance on support that was open to different interpretation, which could put the service user at risk. This was particularly significant because of the use of agency staff who may not know the service users well. The guidance referred to bathing as being a particular risk to a service user with epilepsy. The guidance stated that staff needed to ‘maintain a supportive presence around the bathroom’ while making verbal checks and maintaining the service user’s dignity. Mrs Hendy confirmed that the guidance would be made clearer. Risk assessments in some areas of personal support had not been reviewed since 2005. A service user’s assessments for bathing and for transferring in and out of the home’s vehicle had been assessed annually up to 2005 but not since. It is important that all assessments are regularly reviewed, to ensure that service users receive the support that is appropriate to their current needs. Records were kept of the service users’ health related appointments, including visits to dentists and chiropodists. The service users’ health was regularly discussed in staff meetings, including the need for outside specialists to be involved and for the service users’ weight to be monitored. There was some discussion about nail cutting and who takes responsibility for this and for day to day monitoring. More details about this could be included in the service users’ records. A staff member said that they did not cut the service users’ toenails and fingernails. Staff members were supporting a service user with particular health needs at the time of the last inspection. A community nurse was visiting in connection with this. Mrs Hendy said that one of the main concerns at that time had now been successfully addressed, which had had benefits for the service user’s overall welfare and what they were able to do. There was a medication file, which contained an individual profile for each service user. The profiles were being updated when there was a change in medication. None of the service users looked after their own medication. Staff administered the medication and there were suitable facilities for its safekeeping. One service user was prescribed medication on a P.R.N. (as required) basis and there were clear guidelines for staff about when this should be administered. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 20 Staff members received ’in-house’ training from a service co-ordinator in OLPA’s procedure for dealing with medication. It has previously been recommended that an appropriate outside professional, e.g. a pharmacist, contributed to the training that staff receive in medication procedures and drug usage. In the improvement plan it was stated that the new system of administration would be monitored externally. There was a requirement made at the last inspection concerning the need to keep accurate records when medication is administered to service users. OLPA responded to this in their improvement plan and confirmed a change to using a monitored dosage system. Two errors in recording were discussed with Mrs Hendy. These involved agency carers who were reported to have administered the medication as prescribed, but had omitted to sign the record at the time. One error had arisen in April 2007. Mrs Hendy said that she had contacted the agency about this, but had not received confirmation that the error had been followed up with the carer concerned. The other error had occurred on the day before the visit. There was a note in the home’s diary as a reminder that the agency carer needed to sign the record. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users are listened to within the home. Concerns raised with OLPA should be better responded to following discussions that have taken place with the organisation since the last inspection. Service users benefit from staff members’ awareness of abuse and some new guidance that has been produced. EVIDENCE: As reported under the section ‘Individual Needs and Choices’, ‘tenants’ meetings were being held, which gave service users the opportunity to raise any concerns or issues directly with staff. During one of the meetings in 2006, there had been a discussion with service users about the home’s complaints procedure. One service user mentioned the people who they could talk to if they were not happy with something OLPA has produced a written complaints procedure, which provides guidance on how to make a complaint and the time it will take to respond to a complainant. It was reported at the last inspection that there had been a delay in the organisation investigating a complaint that had been made to the Chief Officer. The circumstances of this have been discussed further with OLPA since the last inspection. OLPA confirmed in their improvement plan that they would endeavour to investigate and respond to complaints as outlined in their complaints procedure, ‘barring unforeseen and unusual circumstances’. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 22 Mrs Hendy reported that no complaints had been received since the last inspection. A staff member confirmed that she had attended OLPA ‘in-house’ training in abuse awareness. Training about the prevention of abuse was also covered in their LDAF training. There was guidance in the home about the reporting of allegations and what constitutes abuse. OLPA has produced a range of relevant policies, including whistle blowing. Incidents had arisen during the last year, which meant that service users were not wholly protected from harm. The Commission has not received any notifications of such incidents since the last inspection. Mrs Hendy confirmed during the visit that no further incidents had arisen. Guidelines were available to staff about how to respond to behaviour and incidents involving a particular service user. It was reported at the last inspection that the home needed to find ways in which the needs of service users could be met without compromising their rights and freedom of movement. After that inspection, the Commission was represented at a meeting that took place at the offices of the local Community Team for People with Learning Disabilities. The arrangements in the home were discussed. New and more appropriate guidelines for staff have since been produced in connection with the service user’s behaviour. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. The accommodation is homely and well personalised. Service users are well supported with keeping the home clean and tidy. EVIDENCE: 45 Sycamore Grove is an ordinary detached bungalow in a residential area. There had been no changes made to the premises since the last inspection. The home has a front and rear garden. The accommodation was decorated and furnished in a homely and domestic manner. There was a spacious sitting room and a separate dining room. Each service user had their own room, which was close to a bathroom and a separate toilet. There was a well kept kitchen and a small utility room where the laundry was done. The floor coverings in the bathroom and toilet were starting to deteriorate in places. This had been discussed at a staff meeting. Replacement of the Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 24 flooring was not mentioned in the home development plan, however this will need attention in the near future. Files and records were kept in an office / staff sleeping-in room, where they did not intrude on the service users’ accommodation. The service users’ bedrooms varied in size. The smallest room had been well personalised, but had very limited space for socialising and for items of furniture. Service users had a choice of communal rooms for different activities. The lounge was well decorated and comfortably furnished. The dining room was available for quieter activities. There was a no-smoking policy operating in the home. As reported at the last inspection, the upkeep of the front garden could be improved, which would give a better first impression of the service users’ home. The main area of garden was at the rear of the property. A certificate was displayed in the home for ‘best hanging baskets’ in the OLPA garden competition. Service users had discussed at a ‘tenants’ meeting what they wished to do with the competition prize money. The home looked clean and tidy. The home was using the ‘Safer Food, Better Business’ file to record matters relating to food safety and cleanliness in the kitchen. The diary sheets were not being consistently completed. Mrs Hendy said that staff were getting used to a new system and the records that needed to be kept. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visit to the home. Vacancies at the time of the inspection meant that it was not possible to establish an effective permanent staff team. Service users have benefited from an increase in staffing at particular times of day. Service users will benefit from developments that have taken place in the induction and training of staff. EVIDENCE: There were guidelines for staff to follow when supporting service users on each shift. The file for agency carers and relief staff had been reorganised and updated since the last inspection. This looked very comprehensive, although there was no quick way of identifying new information that had been added to the file or when changes were made to the existing information. There was a recommendation at the last inspection that the process of recruiting a new member of staff is started at the earliest possible opportunity. It was judged that the use of agency and relief staff was likely to increase and that the home should aim to reduce their use. This was so that service users would benefit from having the consistent support of a permanent staff team. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 26 A new staff member did start in January 2007, but had since left. This person was already employed by OLPA and had moved to 45 Sycamore Grove from another OLPA run service. A combination of staff vacancies and absence meant that the permanent staff at the time of this inspection consisted of the manager and a support worker. As a result, there continued to be a high use of agency and relief staff. However, Mrs Hendy said that she was hopeful that the staff team would increase in number in the near future, following some internal transfers. There had been a requirement at the last inspection concerning the need to record certain information in connection with the recruitment of a staff member. This was followed up with the OLPA Personnel Officer during the office visit on 21 May 2007. No new staff had been recruited to work at the home. There had been a change in the deployment of staff, which meant that there were more times when there two staff on duty. Ms Hendy said that this was as a safeguard because of the incidents that had arisen previously and in response to the level of support that service users needed. Mrs Hendy confirmed that this enabled service users to receive the support that they needed with their planned activities, which had been a problem at the time of the last inspection. The arrangements for induction and training were discussed at the last inspection with a staff member who had recently been appointed. The staff member had a probationary period of six months, which was followed by an appraisal. The staff member’s induction had included Learning Disability Award Framework (LDAF) accredited training. The LDAF was a new development, which had been recommended at previous inspections. This staff member was met with again during the visit on 3 May 2007. Since the last inspection, the staff member had attended courses in first aid and health & safety. This was recorded in an individual training file. The staff member was due to attend a course in moving and handling. The staff member said that they were waiting to receive a LDAF certificate and that they would next be undertaking a National Vocational Qualification (NVQ) at level 2. The standard of 50 of care staff with NVQ at level 2 or above was not met at the last inspection. It has been recommended at previous inspections that the training programme is developed to include more learning disability specific training events and to give staff the opportunity to receive training from outside professionals and specialists. The arrangements for staff training will be looked at again at the next inspection, when it is expected that the permanent staff team will have increased in number. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users benefit from a manager who knows them well and is undertaking relevant qualifications. Quality assurance is being developed so that the views of service users and their representatives contribute to annual development in the home. There are systems in place so that the service users’ health and safety are protected. EVIDENCE: The home’s manager, Mrs Hendy is an experienced manager who has worked in a number of care services. Mrs Hendy said that she had completed the registered managers award at the end of 2006, but had not yet received her award certificate. Mrs Hendy was also undertaking NVQ in care at level 4, Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 28 which she expected to finish in July 2007. Mrs Hendy said that she continued with her studies to become a learning disabilities nurse. Mrs Hendy was asked about the time that was available to study for these qualifications. The organisation was not providing support in terms of study leave. There was an on-call system, by which staff could contact an OLPA manager outside office hours or when the home’s manager was not working. The oncall rota was displayed in the office. Mrs Hendy was aware of ways in which people receiving a care service might be discriminated against. Mrs Hendy said that she did not feel that there were any major issues affecting people in the home. One service user had a physical disability, but Mrs Hendy felt that this did not disadvantage them within the home. The bathroom had some special equipment and the service user could move between the rooms independently. This was observed during the visit. Mrs Hendy said that she had made a referral to the local community team for one service user to be assessed for a particular condition, which could be significant because of the ageing process. Mrs Hendy said that there was some diversity in terms of the service users’ individual needs. This was being addressed in areas such as nutrition, menu planning and providing people with the opportunity to attend faith related events. Mrs Hendy said that although the home was small, she thought it was important that the service was not seen as ‘family type’, which could detract from service users being seen as individuals. OLPA have carried out a survey of its service users and stakeholders during the last year. This has given some indication of standards within the services that the organisation provides. The results of the survey have been collated although a report of the action to be taken has not yet been produced. There was no policy on improvement or annual development. Mrs Hendy had produced a ‘home development plan’. The most recent plan was dated December 2006. Mrs Hendy said that she had developed the plan to include the views of the service users at 45 Sycamore Grove. It was stated that the plan had been collated by team members and service users at meetings which took place in November 2006. The minutes of the tenants meeting in November showed that service users had been asked for their views. One service user had said that they hoped nothing changed. Another service user had said that they would like some more help with shopping. Mrs Hendy said that she intended to gain more feedback about the quality of the service provided and to incorporate this in the home’s development plan. This will ensure that the views of service users and their representatives can be fully reflected in the plan’s objectives. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 29 The relative who completed a survey said that they felt the service users were happy and well cared for. The arrangements for health and safety were looked at during the previous inspection. There was one requirement made, concerning the recording of fire instruction to staff. It was seen from the home’s fire log file that this had been addressed. Staff members had attended an OLPA fire training event on 20 March 2007. When looking at the home’s bathroom it was noted that the temperature of the hot water was being checked and the record of this was up to date. The hoist over the bath had last been serviced in February 2007. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 30 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 X 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 2 33 2 34 x 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 2 3 3 X 3 X 3 X X 3 X Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes, in part 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 YA18 Regulation 13(4)(b) Requirement That assessments relating to the activities undertaken by service users are kept under review and appropriate safety measures implemented as indicated by the assessments. That staff initial or enter the appropriate code on the appropriate forms, on each occasion that medication is administered to service users. (Requirement from last inspection met in part) Comment: When errors in the recording of medication are made by agency carers, the home should receive written confirmation from the agency that the errors have been appropriately followed up with the carers concerned and that the carers are competent to perform the tasks that they are required to undertake. Timescale for action 30/06/07 2. YA20 13(2) 04/05/07 Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 32 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 That the system of Shared Action Planning is consistently completed with each service user. (Recommendation from last inspection. A new system is being introduced) 2. YA12 That the record of the service users’ ‘one to one’ activities is consistently maintained. This is to ensure that the service users’ participation in activities can be accurately monitored. 3. YA16 That service users are given opportunities to take responsibility for managing their own money. This is to ensure that service users can exercise independence in their financial affairs, when they are safe to do this without staff support. 4. YA30 That the diary sheets in the kitchen are consistently completed. This is to ensure that the standards of food hygiene and cleanliness in the kitchen are well monitored. 5. YA33 That the process of recruiting a new member of staff is started at the earliest possible opportunity in order to reduce the need for agency carers and relief staff to be deployed. (Recommendation from last inspection) 6. YA35 That staff members have the opportunity to attend more external training events and training courses which include the contribution of outside agencies. DS0000028260.V339921.R01.S.doc Version 5.2 Page 33 Sycamore Grove (45) (Recommendation from last inspection) 7. YA39 That a policy on improvement and annual development is produced. This to ensure that there is a planned approach to quality assurance, which is consistent with the relevant regulation and standards. Sycamore Grove (45) DS0000028260.V339921.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Regional Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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