Inspection on 26/09/06 for 46a Court Road

This inspection was carried out on 26th September 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

46a Court Road 26/08/08

46a Court Road 01/09/07

46a Court Road 07/01/06

46a Court Road 09/05/05

46a Court Road 22/02/05

46a Court Road 22/07/04

46a Court Road 05/02/04

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 46a Court Road Kingswood South Glos BS15 9QG Lead Inspector Paula Cordell Key Unannounced Inspection 26th September 2006 09:30 46a Court Road DS0000003380.V304663.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.V304663.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.V304663.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 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.V304663.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th January 2006 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.V304663.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The purpose of the site visit was to review the progress to the requirements and recommendations made at the last visit in January 2006 and review the quality of the care provided for the residents living at 46a Court Road. There has been no regulatory role between this and the last site visit. The focus of the site visit was on the general care of a sample group of residents and the environment, including an extensive tour of the premises. This provided a good opportunity to observe residents as well as allowing for informal conversations with individuals and the staff supporting them. Three members of staff were spoken with during the inspection, which included the registered manager. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the residents. These were used as a focus for the site visit along with the pre-inspection questionnaire completed by the home, residents (5) and relatives (2) and the visiting professionals (2) and the monthly provider reports. The site visit was conducted over a period of 7 hours. What the service does well: What has improved since the last inspection? Care plans and risk assessments have been updated to meet the changing needs of the residents including a proactive strategy including triggers that may challenge and how staff can diffuse them. Residents now benefit from staff attending training relevant to their care needs. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 6 The statement of purpose has been updated to reflect the residents the home intends to support. Residents have benefited from all communal areas and some of the bedrooms being decorated. Whilst some of the radiators have been risk assessed and action taken to prevent scalds the bathroom radiator had been overlooked. The home has systems in place for reducing the odour in one of the bedrooms. Residents and staff are now benefiting from regular support via the monthly provider visits in respect of regulation 26. What they could do better: The home must be able to demonstrate that they are meeting the care needs of the resident collectively and individually in relation to the newest individual who has moved to the home. Taking into consideration the age of the other residents, compatibility and the accessibility for the new individual to all parts of the home. As part of this the home must ensure that the staffing is adequate to meet the needs of the individuals. Residents must be protected by ensuring that medication is stored appropriately. Residents would benefit from having the windows regularly cleaned throughout their home. Residents must benefit from a review on the use of the conservatory making it more homely and safe. Residents must be protected by a risk assessment on the bathroom radiator and where potential risks are identified the appropriate remedial work must be undertaken. Flooring in the downstairs bathroom and a specific bedroom must be replaced. Competent staff in the event of a fire must protect residents. Residents should be consulted and consent sought for the contributions made to the running costs of the home’s vehicle. Residents should benefit from a forum where they can actively take part in the running of the home and voice their concerns constructively. Residents to be consulted on the frequency of resident meetings to ensure appropriate. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 7 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. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Whilst there is information to guide residents on whether they wish to live in 46a Court Road there are concerns about the compatibility of the group and the effects this is having on the individuals. EVIDENCE: The home has a statement of purpose and service user guide as seen at the last inspection. This has since been made into a booklet and the manager has agreed to send a copy to the Commission for Social Care Inspection. There was an assessment of need for each resident, which was being kept under review. This included an assessment and a care plan drawn up by the placing authority and other professionals involved in the care of the individual. The home has a clear admission procedure, which includes supporting individuals to visit the home prior to making a decision and a trial period. Many of the individuals living in 46a Court Road have lived there for many years, with the last admission being twelve months ago. Information on file for the most newly admitted person caused some controversy in that an occupational assessment stated that the individual only moved to the home as there was ground floor accommodation and access to 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 10 the garden and the conservatory was limited. Staff stated that the individual prefers to sit in the lounge and only accesses these areas with staff support. Whilst the home was trying to meet the individuals care needs it appears that this is sometimes to the detriment of the other residents. Staff stated that the individual requires more one to one attention both with personal and emotional care needs. Residents have raised concerns and openly voiced their dislike for the individual. The occupational therapist in addition to the environment noted, “existing residents are all over the age of 65 years and may have difficulty to accommodate needs alongside those of an older group. Staff confirmed this and anxieties had been heightened recently by an increase in falls for the individual and the demands that this has put on the staff team which has compromised the care for the other residents living in the home. The home must request that a reassessment of needs is completed by the placing authority to ensure that 46a remains a suitable placement/home for the individual taking into consideration the compatibility and the age difference of the other residents. It was evident from reading another resident’s care records that the new resident was having a detrimental affect on an individual’s mental health from reading the consultant psychiatrists report. The manager stated that the home, to ensure viability, had to look beyond providing care to residents who were getting older and stated that whilst there are some difficulties these are being addressed. Residents had copies of their terms and conditions of occupancy these were signed and dated by the resident and the home’s manager. The terms and conditions included the expectations of the home on shared living and the role and responsibilities of the provider. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. 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 the service. Resident’s plans were person centred and evidenced that residents were consulted and supported to take risks as part of an independent lifestyle. EVIDENCE: Care plans were in place for each individual. Information recorded was person centred and contained valuable information to support the individuals living in 46a Court Road. This included things that were essential or important to the individual. The home has been supported by an Essential Lifestyle facilitator to assist with the documentation for one individual. It was evident that this was seen as positive and provided the resident with an independent advocate. It was evident that the care plans were continually evolving and being adapted to ensure that it reflected the changing needs of the individuals. Care was being reviewed at monthly intervals and residents were invited to participate. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 12 Residents were encouraged to assist with writing up their daily events and took great pride in this level of involvement whether this be that they wrote them or staff read them to them so they knew what was being written. This is good practice and demonstrated resident involvement. Comprehensive risk assessments were in place to ensure that individuals remain safe. It was evident that these did not curtail individuals from being independent. The home has responded to a requirement to ensure that the newest resident’s risk assessments reflect her current environment. The manager was able to demonstrate that all risk assessments are systematically reviewed to ensure that they are current and reflect the changing needs of the residents. Risk assessments had been signed by staff to say that they had read them. Care plans included information about behaviours that challenge and the home has sought support from external professionals in supporting both the resident and the staff. There is clear documentation on how the individual is supported including the triggers. Staff have received training on supporting individuals that challenge which explores positive ways of responding to individuals. This fits well with the person centred approach that has been adopted in the home. Four residents stated that they were happy with the support from staff and that they were always treated in a respectful manner. This was confirmed in the questionnaire sent prior to the site visit to residents. Staff spoken with during the site visit were knowledgeable of all the residents needs. Observations made at the time showed that residents and staff relationships were positive and inclusive. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. 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 the service. Residents are supported to lead active and fulfilling lifestyles. Residents were encouraged to make full use of the community including the maintenance of friendships. Residents have available to them a healthy and varied diet. EVIDENCE: From reading care information including daily diaries and speaking with residents and staff there was a great commitment to ensure that residents make full use of the local community. Residents stated that they are supported to go out most days with staff support. One of the residents accesses the community independently. In addition residents have some structured activities including work placements, the farm, college and day centres. Staff described how they were meeting the needs of the residents in relation to activities ensuring that they were appropriate. It was evident that this was person centred and age was not 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 14 a barrier to the activities that were in place and were varied to suit the individual. The manager stated that there has been a change in organising activities where residents are supported to do more activities as individuals. Group outings are still organised occasionally however, the new resident prefers not to go out, as a large group, which means one member of staff, has to stay back and this has occasionally upset the other residents. Whilst on balance the manager felt that this was a positive move to ensuring that activities were tailored to the individual, there was acknowledgment how this was impacting on the other residents. It was evident that residents were encouraged to make choices and make decisions and these were respected. The home has a vehicle to enable residents to access the community. Residents contribute part of their disability living allowance to the cost of the vehicle and pay for petrol based on usage. Documentation provided evidence that this was transparent and equitable based on usage. This would be enhanced if resident’s consent was sought on these contributions, or where a resident is not able to consent to confirm with the placing authority that this expenditure is appropriate. Residents confirmed that they maintain contact with family and friends and visitors are made welcome. A resident described how their key worker (named member of staff) supported them to visit a relative. This is commendable considering the journey involved. Residents are supported to attend the local church should they wish. It was evident that good relationships had been built with and it was an important part of one individuals lifestyle with regular attendance. All residents are supported to have an annual holiday, and this was tailored to the individual and their preferences. The menu plans were examined. Residents were observed making their own choices regarding lunch and confirmed their input with the main meals. Meals were varied and balanced. Residents had participated in the shopping and on their return assisted in putting the food away. There was a good stock of fresh and convenience food including a well-stocked fruit bowl in the lounge area. Staff had attended a course in food hygiene and systems were in place to ensure that residents were protected in the preparation and the cooking of food. Records of fridge and freezer temperatures were recorded daily. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Resident’s personal and health care needs are being met. Whilst there are safe systems in place for the administration of medication this was being compromised due to medication not being stored in accordance to the Royal Pharmaceutical Guidelines. EVIDENCE: Care plans clearly documented the personal and health care needs of the residents. Again this was resident focused. Systems for monitoring an individual’s wellbeing were in place and concerns about health were quickly addressed. Residents had access to other health professionals including a GP, opticians, chiropody, dentist and the community learning disability team. Staff have attended training in first aid and manual handling. The home has developed a comprehensive planner for training to ensure that periodic updates are undertaken. Where residents are prone to falls risk assessments and safe working practices are in place. However, this could be compromised by the environment as discussed later in this report. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 16 The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the residents in respect of regulation 37. Accident records were being maintained and cross-referenced with the diary of events for residents. Appropriate action was seen to be taken. Staff were sensitive to the needs of an individual and acted appropriately when dealing with a fall and a seizure during the site visit. Appropriate manual handling equipment is in place to assist the staff. Care plans and risk assessments included information on their use giving staff clear guidance. The home has robust procedures and practices on the administration of medication, including a comprehensive induction and training package for staff. However serious concerns were raised relating to storage of the medication, excess medication was stored in a kitchen cupboard and on the top of the medication cupboard and eye drops were kept in the fridge and were not held securely. An immediate requirement was left with the manager to address this shortfall. 46a Court Road DS0000003380.V304663.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 at least once during a 12 month period. 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 the service. Residents can be confident that the staff will listen to their concerns and act appropriately. Residents can be assured that there are robust policies and procedures, which ensure their protection. EVIDENCE: The home has a complaints procedure, which clearly describes how a complaint is responded to. The home has had two complaints since the last inspection and it was evident that these were responded to appropriately involving senior management in line with the home’s policy. From these complaints it was evident that residents are supported to voice their concerns. The policies and procedures relating to the Protection of Vulnerable Adults were in place as seen at the last inspection. Staff spoken with during the site visit had a good knowledge of what constitutes abuse and how an allegation of abuse must be responded to. Staff stated that this is discussed both through inductions and the Trust organises compulsory training for all staff. Training records for staff confirmed this. The home has responded to a previous requirement to ensure that staff have training on supporting residents that challenge. It was evident that staff were aware of the triggers and were responsive to the residents needs in reducing anxieties and incidents of verbal aggression. Care plans described how residents should be supported in the event of an incident, which was respectful of the individual and person centred. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 18 The home has robust procedures on the finances of the home and that belonging to residents. These procedures were translated into practice. Staff were observed completing checks on the finances on the return from the shopping trip including the involvement of the resident. Two staff signatures and a receipt supported all expenditure. 46a Court Road DS0000003380.V304663.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although residents live in a homely environment there are serious concerns about the safety of the residents in relation to falls and the clutter in the shared areas. EVIDENCE: 46a Court Road is in a residential area close to local amenities and in keeping with the local neighbourhood. Since the last visit the home has benefited from some redecoration work including the hallway, stairs and landing, the bathroom and the lounge. The home has demonstrated that they have met the requirements from the last site visit including the replacement of the bath panel. Concerns were raised with staff during the inspection about the cluttered conservatory, which seems to be storage for surplus furniture and wheelchairs and could pose a risk to residents if they fall. In addition it was noted that the bathroom radiator has no protective covering and could pose a further risk if someone fell. Staff stated that other radiators in the home have been risk 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 20 assessed in response to a previous requirement made by the Commission for Social Care Inspection and where a risk has been identified protective coverings have been installed. However it was felt that the bathroom radiator had been overlooked. In light that an individual fell in this area during the site visit this must be risk assessed and the appropriate action must be taken to ensure the safety of the residents. Staff stated that whilst the home does not have a new hoist in response to the last requirement it has been fully serviced and a new strap is now in place. The home has demonstrated compliance to a previous requirement. The bathroom was in the process of being decorated and staff stated that attention would be paid to make this more homely as it felt very barren on the day of the inspection. It was noted at the last site visit that the flooring in the bathroom was badly stained by the toilet pan and where the hoist has been moved the lino was missing. This must be addressed. Bedrooms seen 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. This is good practice. A resident was consulted on the day of the site visit by staff to ensure they were happy for the inspector to enter their bedroom. It was noted in one bedroom that the flooring was half lino and half carpet. This could pose a risk as the person was prone to falling and must be risk assessed taking into account the needs of the individual, and appropriate action taken. Storage is an issue for the home, as already mentioned the conservatory was where wheelchairs were stored and had a mix match of furniture and requires attention to make this area more inviting and homely. In addition it was noted that there was a large supply of continence aids stored on the upstairs landing. Whilst it is appreciated that storage is a problem due considerations must be taken to the risk of falls through tripping and the risk of fire and that this detracts from the homely environment. Residents have access to a secure garden to the rear of the property. Staff stated that an external contractor in response to the requirement from the previous site visit has completed some of the garden work. However, the lawn was in need of some attention. No further requirement will be made at this inspection. Staff were observed cleaning areas of the home. There was heavy build up of lime scale around the tap and sink of one bedroom, which looked unsightly. This was addressed on the day of the site visit. The windows must benefit from a deep clean. The home has access to a team of maintenance contractors with a good response to repairs. 46a Court Road DS0000003380.V304663.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,45 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A competent and skilled workforce, who are committed to providing individualised packages of care, support residents. Whilst the home is staffed adequately if the situation in relation to one individual continues then a full staff review must taken place to ensure that residents care needs are being met collectively and individually. EVIDENCE: Staff spoken with during this inspection stated that whilst the home is adequately staffed during the day there were concerns about the evening and night cover due to the risks of one individual falling and two staff are usually required to assist. It was noted that on some evenings the home was only staffed with one member of staff after 8pm until 7am or 10 am the following day. Risk assessments were in place describing how staff should support the individual. The manager stated that staff are anxious due to a recent fall for one individual which caused a fracture and this has made assisting more complex however this is soon to be resolved. It was evident that the home had put in safe systems, which had included consultation with the resident for example; the late shift assists with personal care before they finish their duty. However 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 22 the resident was not happy with having to go to bed at 8pm and would prefer to sit in the lounge and it was noted that the individual was still in bed in the morning as there was only one member of staff and the other had gone shopping. Reassurances were given that this was only temporary and would be resolved by the end of the week. If this is to continue then the home must review the staffing to ensure meeting the care needs and the aspirations of the individual and the group collectively. Assurances were received on the 23rd October 2006 that this has been resolved with the individual now fully healed from the fracture and staff are more confident in supporting the individual. The rota provided evidence that the home was staffed by a minimum of two staff during the day and one member of staff providing sleep in cover at night, in the event of an emergency. In addition two staff provided consistent cover to the individual living in a selfcontained bungalow at the rear of the property throughout the day and then the main house staff supported in the evenings and on the weekends. Recruitment information was not seen on this occasion, however the inspector is aware that this is now being kept in the home in accordance with the legislation as previously this was kept in the main office for Milestones and Aspects. There are policies and procedures in place to ensure that a thorough recruitment process takes place. 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. Staff training was in place and covered a wide range of topics relevant to the care of the individual residents. There was a good rolling programme of health and safety training for all staff. Staff complete the Learning Disability Award Framework as part of their induction. Since the last site visit staff have attended manual handling training, epilepsy and challenging behaviour training. Further training is planned for a staff member to attend training in diabetes and team training on autism. The home has demonstrated compliance to a previous requirement. The pre-inspection questionnaire provided evidence that the home has exceeded the target for 50 of the staff team to have an NVQ in care with 85 of the care team having completed. 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 residents. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from a home that is managed openly and where staff have clear lines of accountability. Whilst safe systems are in place to ensure the safety of residents, this could be compromised due to the lack of fire drills for staff. 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. Staff evidently had regular meetings, which provided evidence of an open approach where staff were kept informed of changes in the home. Staff meetings clearly described the changing care needs of individuals, changes to staffing, environmental issues and other matters relating to running of a care home. In addition new and existing policies were discussed. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 24 Relationships observed between residents, the staff and the manager demonstrated that these were positive. Residents 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. Staff stated that meetings were arranged for residents every two weeks, however the minutes of the meetings could not be found except for meetings in February 2004, March 2006 and May 2006. Residents must be consulted on the frequency of the meetings and a record maintained. This would be good practice for residents to have a forum to discuss the changes in the home and the dynamics of the group. The home is in the process of implementing a quality audit, which seeks the views of relatives, visiting professionals and the residents. The plan is for this to commence in October 2006 and shall be reviewed and monitored at the next site visit. In addition the home completes a variety of audits on the environment, care planning processes, supervisions, team meetings and safe systems of working including the monthly provider visits in respect of regulation 26. The Commission for Social Care Inspection are receiving copies of these reports in response to a requirement from the last site visit. Policies and procedures are in place to ensure the health and safety of the residents and staff members. These form part of the induction. Health and safety during this site visit focused on fire. All records seen were up to date including routine checks on the equipment and ensuring the staff receive adequate training in accordance with the fire officer’s recommendations. However, less apparent was the involvement of staff in fire drills every six months. Three members of staff had not attended a fire drill once in a twelve-month period. An immediate requirement was left with the home to address the shortfall. Generally the feedback about the organisation was positive and provides comprehensive training enabling staff to deliver a high standard of individualised care. Clear financial and accounting policies are in place and these are discussed with the service development manager at frequent intervals. The home is audited by the Trust’s financial department at frequent intervals. It was evident that the home was trying to be pro-active by ensuring that it remains financially viable by reviewing the resident group and broadening the age group of the individuals living in the home. However, this should not be to the detriment of the residents presently accommodated. 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 2 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 3 3 2 x 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 14 (1) (a) Requirement To ensure the home can meet the assessed care needs of the newest resident taking into consideration age of other residents, compatibility and accessibility to all parts of the home. An urgent review to be completed with Social Services. To ensure the staffing is appropriate for the newest resident as part of one above. The home must store medication in accordance to the Royal Pharmaceutical guidelines. To clean all windows. To review the use of the conservatory and make more homely and safe. To replace lino in bathroom. To review and risk assess the downstairs bedroom flooring. To risk assess the radiator in the bathroom in relation to providing a cover to prevent residents at risk of falls being scalded. (outstanding since 23/01/06) All staff must attend a fire drill once in a six-month period. Timescale for action 02/12/06 2. 3. 4. 5. 6. 7. 8. YA33 YA20 YA30 YA28 YA27 YA26 YA27 18 (1) (a) 13 (2) 23 (2) (d) 23 (2) (b) 23 (2) (b) 23 (2) (b) 23 (2) (b) 02/12/06 05/10/06 02/10/06 02/10/06 02/12/06 02/12/06 02/10/06 9. YA42 23 (4) (e) 02/10/06 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA23 YA24 YA38 Good Practice Recommendations For residents to be consulted and consent sought for the contributions made to the vehicle. Provide a secure shed for storage for the wheelchairs and other clutter that is in the conservatory. To provide a forum for residents to actively take part in the running of the home and voice their concerns constructively. Residents to be consulted on the frequency of resident meetings to ensure appropriate. To look at storage solutions in the home for continence aids. 4. YA24 46a Court Road DS0000003380.V304663.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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.V304663.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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