Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 26/08/08 for 46a Court Road

Also see our care home review for 46a Court Road for more information

This inspection was carried out on 26th August 2008.

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

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

46a Court Road has provided a home for the people receiving a service for many years. There is an established group of staff supporting individuals. The service promotes the individuals involvement in their care/life planning and decision making within the home. Individual`s care files were person centred and well written. Individuals are supported to make full use of the local community and lead very active lifestyles based on choice. The Trust provides a rolling programme of training and there is a commitment that has exceeded the national targets to ensure staff have an NVQ in care.

What has improved since the last inspection?

Individuals can now be assured that their plan of care is reviewed at regular intervals ensuring it meets their changing needs. Staff having training on safeguarding better protects individual`s safety. Individuals are assured their safety with call bells being accessible and in good working order. Individuals have benefited from the step leading to the conservatory being made safe and the odour in the lounge area being eliminated.

What the care home could do better:

Individuals living in the home must have a clear contract that details who is responsible for paying the fees and any additional costs involved in living at 46 Court Road. Individuals should be assured that good communication is in place in relation to medication changes and where individuals self-medication they must be protected within a risk assessment framework.

CARE HOME ADULTS 18-65 46a Court Road Kingswood South Glos BS15 9QG Lead Inspector Paula Cordell Unannounced Inspection 26th August 2008 09:30 46a Court Road DS0000003380.V365386.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 46a Court Road DS0000003380.V365386.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. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 46a Court Road Address Kingswood South Glos BS15 9QG 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) 0117 909 5459 0117 970 9301 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Christopher Gerald Horgan Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2007 Brief Description of the Service: 46a Court Road is one of a number of homes operated by Aspects and Milestones Trust. Mr Horgan is the registered manager. The home is registered to provide accommodation and personal care to five residents with learning disabilities aged 18 years and over. The property is situated in Kingswood, five miles from the centre of Bristol. Shops are a few minutes walk from the home. There are local bus services and the home also has its own minibus. Accommodation consists of a main house with four bedrooms. Two bedrooms are situated on the ground floor. There is a purpose built bungalow to the rear of the property that accommodates one resident who is supported to live semiindependently. The fees at the time of publishing this report range from £847-886. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in September 2007. In addition to monitoring the quality of the care provided to the five individuals living in the home. There have been no additional visits between September 2007 and this visit. There have been no complaints received about the service. The inspection methods used included record checks, case tracking, a tour of the home and discussion with the manager, three staff, and people who use the service. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service. These were used as a focus for the site visit, along with the annual quality assurance selfassessment completed by the home and comments from people who use the service (5), relatives (3), staff (3) and visiting professionals (1). The visit was conducted over a period of six hours and ended with structured feedback. What the service does well: What has improved since the last inspection? 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 6 Individuals can now be assured that their plan of care is reviewed at regular intervals ensuring it meets their changing needs. Staff having training on safeguarding better protects individual’s safety. Individuals are assured their safety with call bells being accessible and in good working order. Individuals have benefited from the step leading to the conservatory being made safe and the odour in the lounge area being eliminated. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 7 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 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient information to enable the individuals to be informed about the service provided at 46a Court Road. The contracts do not reflect the true cost of the placement and could be misleading to individuals living in the home, however this is not putting individuals at risk. EVIDENCE: The home has a statement of purpose and a service user guide. These on past visits have met with the National Minimum Standards and the Care Home Regulations. These were not viewed on this occasion. The manager stated there have been no changes to the service provided since the last visit. The home has an established group of individuals living in 46a Court Road, with the last person to have moved to the home in October 2005. Standards relating to admissions and assessments were not viewed on this occasion. In the grounds of 46a Court Road is a small contained annex called the bungalow 46b Court Road. Whilst this is part of the care home this person 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 9 receives a specific number of hours of support rather than 24 hour care. From talking with the manager it is evident that the plan is for this to be deregistered to enable the person to live more independently enabling them to access supported living funding. Discussion took place with the manager on the process including an application to vary the certificate of registration to reduce the numbers from five to four and evidence in the form of a placing authorities assessment and care plan supporting the move to supported living from registered care. In addition if the person requires support in relation to personal care then evidence must be provided on how this is going to be delivered and by whom. The home was required to review the contracts of care to ensure that they include the breakdown of fees and who is responsible for paying it and any additional costs. It was evident that the manager had updated the contract to include the increase in the individual’s contribution but it still did not include the full fees or any additional costs (for example aromatherapy and transport). Although in the care plan documentation there was agreements for the additional costs good practice would be for this to kept with the contract of care including a note on the contract detailing the additional amounts. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 10 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. Individuals assessed care needs were being met. Individuals have a support plan that is person centred. The safe working practices, which do not curtail independence, protects individuals. EVIDENCE: Care plan documentation was viewed for two people. Information recorded was person centred and contained valuable information to support the individuals living in 46a Court Road. Each person had two files containing information relating to the care planning processes and health action planning. Each person had an essential lifestyle plan, which detailed how the person should be supported and what was essential and important to the individual. Monthly updates were being completed by the named worker (key worker), which included progress notes and identifying further goals that the individual wanted to achieve. It was 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 11 evident that the individual was involved in the monthly reviews. The home has demonstrated compliance to ensure that care records are reviewed in accordance with the National Minimum Standards and the Care Home Regulations. Daily records were positively written and demonstrated that individuals were supported according to the assessed need. It was noted on previous visits that some of the individuals are encouraged to complete their own daily records with support. This is good practice and evidenced that individuals are involved in their care. Risk assessments were in place and covered a wide spectrum of activities both in the home and the local community. Other areas included matters relating to health and falls. It is evident that the home is supporting individuals that are getting older and the home was able to demonstrate that they were meeting their changing needs. From conversations with the manager and staff it was evident that this is being kept under review. The manager acknowledges that the environment may not be suitable if the individuals mobility deteriorates to such that a wheelchair would be needed to enable them to move around their home. Care plans evidenced that individuals have access to other professionals including physiotherapists. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 12 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. Individuals are encouraged to lead full lifestyles based on choice. Individuals are supported to maintain relationships with relatives and friends. Individuals have a varied diet taking into account preferences. EVIDENCE: Care plans included how the person liked to spend their time and important people in their life including friends and family. From the support plans it was evident that individuals are supported to attend work placements, college courses and resource and activity centres. It was noted from reading daily diaries, speaking with people who use the service, staff and observations it was evident that there was a great commitment to ensuring that individuals lead full and active lifestyles. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 13 Individuals said they could go out when they like either with staff support or independently. One person said they were planning to retire. From talking with staff it was evident that discussions were taking place on what the person would like to do to occupy their time. One individual was keen to tell me about a forthcoming holiday that they were planning with one other person and three staff. Documentation was in place to demonstrate that the rationale for the staffing and the costing had been discussed at a home level and with senior management. It was evident that the holiday was planned with the individuals. Staff and the manager confirmed that all individuals would have a holiday. In addition it was evident that the individuals were supported to go out on day trips, visits to the pub, bingo and out for meals. Three people go to church on a regular basis. Individuals are consulted regularly about activities at their monthly care reviews and during house meetings. House meetings are taking place at regular intervals. The minutes provided evidence that the individuals were involved in the running of the home including decoration, purchasing new household items, activities, menus and holidays. Completed surveys from relatives confirmed that they were kept informed of changes, made to feel welcome and generally positive about the care provided by the staff at 46a Court Road. One relative stated that more staff could work at the home to encourage and motivate their relative. However, from the duty rota and talking to staff it was evident that there was a commitment to ensure that individuals live the life their choose. Additional staff were employed fortnightly to support one person with one to one activities. However, it was evident that this person was going at on a regular basis. Menus seen demonstrated that individuals have a varied and nutritious diet based on choice. Alternatives to the planned menu are offered where individuals either do not like what is planned or simply fancy something different. Each person is supported to choose an evening meal. Individuals are encouraged to assist with shopping, meal preparation and general household chores. The kitchen was well organised. There was a good stock of fresh and convenience food. There was a risk assessment relating to the preparation of food with good measures in place ensuring the safety of the individuals in relation to food hygiene. Good records were maintained of fridge/freezer temperatures. Less apparent was evidence of cooked food temperatures were being completed. Staff stated that this could be due to the number of bank staff that are working in the home over the last few months. Reassurances were given that this would be rectified. Staff training records provided evidence that all staff have a current food hygiene certificate. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 14 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. Individual’s personal and healthcare needs are being met. Gaps in recording of one person’s medication changes could potentially put them at risk. EVIDENCE: Each person had a Health Action plan that detailed the support required to enable them to stay healthy. In addition each person had a personal care statement that detailed how the person liked to be supported with bathing and dressing. It was evident that the individual had been consulted. 46a Court Road is staffed by both male and female staff. The manager was able to demonstrate that the individuals had been consulted on who they would like to support them. Whilst the manager tries to ensure that there is always a female member of staff on duty this is not always possible as there are three male staff employed to work in the home. From talking with staff and one of the ladies living in the home it was evident they were happy with the support offered. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 15 Good records were maintained relating to personal care detailing what care was provided and who supported the individual. It was evident that individuals were encouraged to be as independent as possible. Evidence was provided that individuals have access to a GP, dentist, opticians and other health professionals. One concern was raised that one person had not been to a dentist since March 07. Staff stated that they did like going to the dentist and there were some physical difficulties, however, this was not recorded in the person’s essential lifestyle plan or their health action plan. Where individuals are prone to falling there are risk assessments and safe working practices in place. Accident records are maintained and the Commission for Social Care Inspection are kept informed of all incidents that affect the wellbeing of the people living in the home. Staff have received training in first aid and manual handling in response to a requirement at the last visit. The home has demonstrated compliance. From records and talking to staff it was evident that they are proactive in talking to the doctor about medical concerns with good documentation in place to support this. However concerns were raised relating to a person who had recently been discharged from hospital and it was not clear that their medication had been increased until the manager was available and provided evidence in the form of a discharge letter. Three staff were unaware of the increase and the reasons why. Concerns were raised with the manager that this increase did not follow what a specialist had advised a month previous and could put the individual at risk in relation to their health. The manager has agreed to contact all concerned to clarify whether the increase in the medication is appropriate and better record medication changes. Confirmation was received by the manager that this was resolved shortly after the visit in the form of a letter. The home generally has robust medication procedures and practices on the administration of medication including a comprehensive induction and training package for staff. However, from talking with staff and messages in the communication book and the incident above it is evident that the communication relating to medication changes could be better communicated to staff through daily handovers and records. From reviewing the medication system it was evident that three of the individuals were on one system and one on another. From talking with staff it was evident that they would be happier for all individuals to be on the same monitored dosage system. The manager stated that this system was inherited when the person moved to the home and that there was a concern that if changed to the other system there would be insufficient room in the medication cabinet. This was two years ago and it would be recommended that all individuals be on the same system ensuring a consistent approach. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 16 One person self-medicates and there was no risk assessment supporting the decision process or that they have been assessed as able to do this. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 17 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. Individuals can be confident that their concerns would be listened to and acted upon. Good systems are in place to ensure individuals are protected. EVIDENCE: The home has a complaints procedure, which clearly describes how a complaint is responded to. The Annual Quality Assurance Assessment completed by the home demonstrated that there have been no complaints since the last inspection. Evidence at previous visits is that complaints are responded to appropriately involving senior management in line with the home’s policy. The policies and procedures relating to the Protection of Vulnerable Adults were in place as seen at the last inspection. Staff spoken with during this visit had a good knowledge of what constitutes abuse and how an allegation of abuse must be responded to however what was lacking was the knowledge of the role of Social Services in safeguarding adults. It would be recommended that the manager update staff on the role of social services in safeguarding adults. Staff stated that safeguarding is discussed both through inductions and the Trust organises compulsory training for all staff. It was very clear that staff would report all incidents of abuse to senior management. Since the last visit two staff have completed safeguarding training and evidence was provided that a referral has been made for the 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 18 remainder of the staff team to attend an update in this area. The home has demonstrated compliance to a previous requirement. The home has robust procedures on the finances of the home and that belonging to individuals receiving a service. These procedures were translated into practice. Checks are completed on finances on a daily basis by staff and monthly during the provider visits in respect of regulation 26. Two staff signatures and a receipt supported all expenditure. Individuals where possible had signed the record of financial transactions. Risk assessments were seen detailing the level of support individuals required in respect of their finances. Individuals had varying control in relation to their finances, which was based on the assessment and the abilities of the person. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 46a court Road provides a safe and homely place for the individuals to live, which is presently meeting their needs. EVIDENCE: 46a Court Road is in a residential area close to local amenities and in keeping with the local neighbourhood. The focus on this inspection was the communal areas. The home has responded to a requirement to ensure that the steps leading to the conservatory from the garden are made safe. The home has demonstrated compliance. Individuals have a lounge, which doubles up as the dining room and a conservatory looking onto a secure and enclosed garden. All areas seen were clean and free from odour. The communal areas were furnished with domestic 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 20 style furniture with plants, pictures and ornaments assisting in making it homely for the occupants. At the last inspection it was noted that there was a slight odour in the lounge. Whilst the carpet has not been replaced staff stated that it is regularly cleaned to reduce odours. The home was free from odour and it was evident that the level of cleaning undertaken and improvements to the management of continence has assisted with this. Staff stated that one of the individuals living in the home has the responsibility of tending to the garden with staff support. Since the last visit the bathroom has been redecorated and a new bath hoist has been purchased. In addition it was noted that the call bell was now accessible to individuals in the bathroom. The home has demonstrated compliance to a previous requirement. Bedrooms seen at the last visit were personalised and homely and reflected the taste of the individual. Keys are available for the occupants. A member of staff stated that rooms are only entered with the express permission of the individual. It was noted that three of the individuals chose to lock their bedroom when they went out. These rooms were not viewed on this occasion. One person said they had been out to buy new furniture including a chest of drawers, wardrobe and a new bed. The Trust had paid for the furniture and it was evident that the individual was happy with their room. The individual had expressed the need for replacement of the furniture through a house meeting and it was evident that the staff had supported this. The home has access to a team of maintenance contractors with a good response to repairs. The manager stated that the home is planning to have replacement windows to the first floor and the guttering with the facia boards being painted a budget has been set aside for this to be completed. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient and competent staff support the individuals in the home. Whilst there is evidence that the team is not fully cohesive this is being actively addressed by the manager. EVIDENCE: 46 Court Road is staffed 24 hours a day in the main house with the bungalow being staffed in accordance with the individual’s assessment and care plan (40 hours). There are two separate duty rotas one for the main house and one for the supported living bungalow, which is situated to the rear of the property. The rotas provided evidence that the home is staffed in accordance with the assessed needs of the individuals and the statement of purpose. There are two staff working in the home during the day and one member of staff providing sleep in cover in the event of an emergency. Recruitment information was not viewed on this occasion. There have been no new staff since the last inspection when the manager was able to demonstrate that a robust recruitment process had been undertaken for the staff employed. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 22 Two members of staff stated that the home has a shortfall of staff due to longterm sickness and one member of staff has recently left. Bank staff is covering this shortfall. From conversations with staff, the manager and documentation it was evident that bank staff that are familiar to the home is covering this. Reassurances were given by the manager that this was being addressed with staff increasing their contractual hours and one member of staff hopefully returning to work shortly. It was evident from records and conversations with staff that there were good support mechanisms in place including regular staff meetings and daily handovers and supervisions. However, there are concerns on the quality of the handovers in relation to medication changes as none of the staff were aware of the increase in medication for one person and from reading the communication book it was evident that there were other examples. From reviewing staff training records it was evident that the home has demonstrated compliance to a previous requirement relating to training. It was noted that staff have completed their statutory training including manual handling, first aid, food hygiene and health and safety. In addition staff have attended a team-building day, epilepsy training and further training was planned on the mental capacity act. The manager has now devised an overview of training attended. There was some confusion that individual staff training records were not up to date but the manager has agreed to rectify this. Staff complete the Learning Disability Award Framework as part of their induction. This was not viewed on this occasion as all staff had been working in the home in excess of twelve months. The annual quality assurance assessment completed by the provider provided evidence that the home has exceeded the target for 50 of the staff team to have an NVQ in care. Seven of the eight staff have completed an NVQ in care. This is commendable. Staff had clear guidelines on their roles as key worker and each member of staff had been delegated a specific role in the home. This is good practice. Staff spoken with during this site visit had a good understanding of the care needs of the people receiving a care service. From conversations with some of the staff it was evident that the team was not fully cohesive with a male/female staff divide. The manager acknowledges that there are some issues but this is being explored through team meetings and team building days. A further team-building day has been arranged for September 08 with an external facilitator. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 23 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals benefit from a service that is well managed ensuring good involvement. Individual’s safety is paramount. EVIDENCE: Mr Chris Horgan is the registered manager. He has worked for the trust for many years supporting individuals with a learning disability. He is a registered nurse. Relationships observed between people who use the service, the staff and the manager demonstrated that these were positive. People who use the service spoke highly of the manager and the staff team. Staff stated that the manager has an open door and hands on approach to the care and management of the home. One member of staff stated, “The manager ensures that the care is 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 25 good, does not always deal with the little things but does deal with what really matters”. The manager stated that there are small conflicts between the team but each team member is here for the people living in the home. The manager stated the team dynamics and skill mix is always being reviewed and regularly discussed with the representative of the Trust during monthly visits. Policies and procedures are in place to ensure the health and safety of the people who use the service and staff members. These form part of the induction. The home has good systems for monitoring the quality of the care provided to the individuals living at 46 Court Road. These included monthly key worker meetings with people who use the service, house meetings, supervisions, staff meetings and a quality assurance tool, which encompasses the Care Homes National Minimum Standards. The latter was not fully explored on this occasion. The manager submitted a copy of the annual quality assurance assessment as requested by the Commission for Social Care Inspection. This identified areas where the home has improved and areas that the home could do better. Regulation 26 monthly provider checks were taking place and copies of the report were sent to the Commission for Social Care Inspection along with any notification of incidents that affect the wellbeing of the individuals living at 46 Court Road in respect of Regulation 37. There were systems in place for ensuring that the home was a safe place to live and work. All records relating to fire, including ongoing training for permanent staff, were up to date and in order. The home has demonstrated compliance to a requirement to ensure that all staff attend a drill in six-month period as recommended by the fire officer. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 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 3 X 3 X 3 X X 3 X 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 27 Yes 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 YA5 Regulation 5 (2) (a) Requirement Expand contracts for people who use the service to include information relating to Regulation 5a, which includes a full breakdown of fees and who is responsible for paying them. For people who use the service to have a copy of their contract and this to be signed by the individual where possible and other appropriate persons. The contract must include what is included in the fees and any additional costs. (Outstanding since 04/07/08) Where individuals self medicate ensure there is a risk assessment to support this. Ensure all medication changes are clearly recorded and communicated to the staff team effectively. Timescale for action 26/10/08 2. 3. YA20 YA20 13 (2) 13 (2) 26/09/08 26/08/08 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 28 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 YA20 Good Practice Recommendations Review the monitored dosage system for one person in respect of their medication so that there is only one system in place. 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 46a Court Road DS0000003380.V365386.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!