Inspection on 24/05/07 for 5 St Margaret`s Gardens

This inspection was carried out on 24th May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

5 St Margaret`s Gardens 21/05/09

5 St Margaret`s Gardens 25/05/06

5 St Margaret`s Gardens 18/10/05

5 St Margaret`s Gardens 09/05/05

5 St Margaret`s Gardens 20/12/04

5 St Margaret`s Gardens 20/07/04

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 09/07/2008.

CARE HOME ADULTS 18-65 St Margaret`s Gardens (5) Melksham Wiltshire SN12 7BT Lead Inspector Malcolm Kippax Unannounced Inspection 24th May 2007 09:30 St Margaret`s Gardens (5) DS0000028372.V342747.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 St Margaret`s Gardens (5) DS0000028372.V342747.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. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margaret`s Gardens (5) Address Melksham Wiltshire SN12 7BT 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) 01225 709691 Ordinary Life Project Association Bernadette Anne Saunders Care Home 4 Category(ies) of Learning disability (4) registration, with number of places St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2006 Brief Description of the Service: 5 St Margarets Gardens is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). 5 St Margarets Gardens is a detached property in a residential area on the outskirts of Melksham. The home fits in well with the neighbouring properties. Service users have their own bedrooms, one of which is on the ground floor with an en-suite bathroom. The other accommodation consists of a lounge, a dining room, kitchen, upstairs bathroom and a separate toilet. There is a large garden at the side of the property. The home’s garage is used as a laundry and storage area. The service users receive support from a manager and a permanent staff team. There is at least one person working in the home throughout the day. Extra staff are deployed at certain times. The current fees are in the range of £797.75 - £973.76 per week. 5 St. Margaret’s Gardens is the service users’ long-term home, for as long as this remains appropriate to their needs and wishes. Information about the service is available in the home’s ‘Statement of Purpose’. Copies of inspection reports are available from the OLPA office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. Inspection reports are also available through the Commission’s website at: www.csci.org.uk St Margaret`s Gardens (5) DS0000028372.V342747.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 24 May 2007 between 9.30 am and 4.30 pm. Evidence was obtained during the visit through: • • • • Time spent with three service users. Meetings with the home’s manager and with a member of staff. Observation and a tour of the home. An examination of records, including the service users’ personal files. The home’s previous main inspection was in May 2006. Another, shorter inspection, involving an ‘Expert by Experience’* took place in November 2006. That was to follow up matters arising from the inspection in May 2006. Some of the findings from the inspection in November 2006 are referred to in this report. Other information has been taken into account as part of this inspection: • • • A pre-inspection questionnaire that was completed by the manager about the running of the home. Surveys that were completed by two of the service users’ relatives. A survey that was completed by one of the service users 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. * ‘Experts by Experience’ are people who use services and are helping C.S.C.I. to inspect homes and Councils. What the service does well: Service users have meetings when they can talk with other people about their needs and personal goals. This helps service users to make decisions about what they want to do in the future. The information is then recorded in individual plans, which ensures that staff know about the things that service users want to do and how they can be helped to achieve these. Service users have enjoyed having days out and started some new college courses as part of their personal goals. Tenants meeting are being held, when service users talk about the things that concern or interest them. They can decide what meals they would like. The mealtimes are flexible to fit in with what they are doing. Service users receive support with attending different activities that meet their needs. Service users have had part-time jobs, which have included helping out in a pub and in a care home for older people. They like the contact that St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 6 they have with people outside the home and being part of the local community. One service user is doing more things in the community after a period of rehabilitation. This person enjoys spending time at home and looking after a pet cat. Service users receive support from staff, which helps them to maintain contact with family and friends. They are reminded about birthdays and sending Christmas cards, but also benefit from discussion about their relationships and the problems that can arise. Service users receive the support that they need with healthcare and with managing their medication. Some of the service users’ activities involve a degree of risk. Staff assess the hazards, which helps service users to do things safely. This includes, for example, advising a service user who rides a bike to wear a helmet and things that will help them to be seen. Assessments are undertaken, so that the service users’ wish to be independent can be respected and managed safely. There are times when service users can do things independently of staff. On the afternoon of the visit, two service users went out by themselves to one of the local shops. The home’s location suits the service users and many of their regular activities are within walking distance. 5 St. Margaret’s Gardens looks like an ordinary home in a residential neighbourhood. The service users’ individual accommodation is meeting their needs and there is good communal space. Staff members provide good support with keeping the house clean and well maintained, so that service users live in homely and attractive surroundings. There is a staff team who know the service users well. This has helped good relationships to be established. Service users benefit from staff who receive regular training and feel supported in the home, which helps staff members to feel confident about their work. Staff members have meetings to discuss the service users’ welfare and keep up to date with changes in their needs. The home’s manager has experience and relevant qualifications, so that service users benefit from a well run home. What has improved since the last inspection? More details are being recorded in some areas, such as the ‘home alone’ arrangements, which provides better information about the service users’ progress. On entering the home it looked clean and well maintained. The hall and lounge had been redecorated. The furnishings and pictures co-ordinated well with the décor. New furniture had been bought for the lounge and the radiator covers had been painted. The overall look was very modern, which the service users said they liked. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 7 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. St Margaret`s Gardens (5) DS0000028372.V342747.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 St Margaret`s Gardens (5) DS0000028372.V342747.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1. Quality in this outcome area is adequate. This judgement has been made using available evidence including the visit to the home. The written guidance about the home does not provide people with all the required information. Standard 2 was not looked at during this inspection. The home had no vacancies. There had been no changes in occupancy since October 2005, when Standard 2 was assessed and met. EVIDENCE: The home’s Statement of Purpose was looked at. This included details for the home’s manager, who it was stated is registered with Social Services. The manager is actually registered with the Commission for Social Care Inspection. Mr Gant, the OLPA Chief Officer, was named as the service provider, although it is the name of the organisation that needs to be given. The Statement of Purpose included some references to the N.C.S.C. (National Care Standards Commission). The N.C.S.C. ceased to function after April 2004 and was replaced as the regulatory body by the Commission for Social Care Inspection. The Statement of Purpose also included the names of the current St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 10 service users, which is not appropriate as the document could be seen by people outside the home. It was stated that the home’s objective is ‘to enable people with learning disabilities to live within ordinary housing’. The Statement of Purpose could include more information about the range of needs that the home intends to meet. There was a lack of information in the home about the charges that are made for particular items and how service users are expected to contribute. The arrangements in place for charging and paying for additional services need to be included in the service user’s guide. See next section ‘Individual Needs and Choices’. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users are asked about their personal goals and supported with doing new things. Service users are encouraged to be independent and to participate in activities that involve a degree of risk. EVIDENCE: Meetings had taken place during 2006 when service users had talked about their needs and goals for the year ahead. Service users had invited people from outside the home to the meetings. In some cases, outside agencies had contributed with reports, which helped to give information about the service users’ occupation and the progress they were making. The meetings formed part of ‘Shared Action Planning’ (S.A.P.), although Ms Saunders said that the system was now known as ‘Person Centred Planning’ (P.C.P.). One service user had attended their P.C.P. meeting in May 2007 and St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 12 meetings for two other service users were due to take place in the following month. Service users had individual files, which contained their current S.A.P. records. Some of the goals were ‘one-off’ events, such as being able to go to a pantomime, visiting an animal sanctuary and receiving support with sending Christmas cards. Others concerned the service users’ long-term occupation and changes in routines. One service user said that they were attending a new college course that they enjoyed. Three service users were at home on the day of the visit. At the start of the visit, two of the service users were having breakfast before needing to go out for appointments. Another service user was not yet up, but came down later and made their own breakfast. Service users chose what to do at other times during the day. Two service users decided to go out by themselves in the afternoon to a local shop. It was reported at the last key inspection that it was intended to assess the ability of two service users to spend time alone in the home. During the visit to the home in November 2006 it was seen that these assessments had been carried out. It was recommended at the time that further information was recorded about the ‘home alone’ arrangements. It was seen during the visit on 24 May 2007 that records had since been kept of the time that service users had spent ‘home alone’. The length of time for ‘home alone’ had been reviewed at a staff meeting in April 2007. Ms Saunders said that the home alone assessment was due to be reviewed again. It was stated in the records that one service user had requested to be able to spend time without staff present and that this would enhance dignity and help to develop their independence skills During the visit in November 2006, the Expert by Experience had met the two service users concerned and spoken to another service user who said that they did not want to go out of the house on their own, only with staff. A service user had told the Expert by Experience that they could get up and go to bed when they liked. The service user had also said that they only knew one house rule, which was that there was no smoking in the home. It was recommended at the inspection in November 2006 that a more coordinated approach is taken in the recording of the service users’ care, for example by cross-referencing the service users’ individual plans and the risk assessments. Some progress had been made with this. The risk assessments in one service user’s record had been filed with their support plans. Ms Saunders said that the files were being reorganised to ensure a consistent approach. Staff had discussed the hazards that were associated with the service users’ activities. Risk assessments forms had been completed, which showed the St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 13 safety measures that had been agreed. Some of these covered tasks in the home, such as making drinks and the use of the kettle. An assessment had been carried out in October 2006 concerning service users going out after dark. No date had been identified for reviewing this and for some other assessments. In some cases, an assessment was dated as having been reviewed, but there was no indication of the outcome of the review. Service users met together at tenants meetings. The minutes showed that service users have ideas about what they want to do and make decisions, such as where they would like to go on holiday. At the last meeting on 8 May 2007, service users had said that they like the new furniture and decoration in the lounge. In their survey, one relative felt that the home always met the needs of their relative in the home and the different needs of service users in general. Another relative felt that this was usually the case. Ms Saunders did not feel that there were any significant issues concerning the diversity of the current service users and their individual needs. Ms Saunders said that it was important for her and the staff to be aware of their own values and recognise how these could influence their support for service users if not careful. It was recommended at the last inspection that there is discussion with individual service users to establish their level of understanding of the money that they receive. Ms Saunders said that she felt that service users did have an understanding of their day to day money, although some further discussion could be beneficial. Staff supported service users with looking after their money in the home and records were kept of transactions on individual account sheets. This included obtaining receipts or completing a numbered voucher. Service users had their own building society accounts. There was discussion during the visit about various financial contributions that service users made, for example towards holidays, the television license and transport. As reported under Standard 1, details of these charges and contributions need to be fully included in the written information that is produced about the home. Service users could have keys to their own rooms and there had been discussions about service users having keys to the front door. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 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 take part in different activities that reflect their interests and abilities. Service users receive support, so that they can keep in touch with their family and with the wider community. Their rights and responsibilities are recognised in their daily lives. Service users enjoy their meals. The mealtimes are flexible to meet individual needs. EVIDENCE: One service user was out at a resource centre on the day of the visit and they returned home later in the afternoon. This was their main occupation on four days a week. Other service users had a more varied week, which included activities that were arranged on the day and others, such as work placements St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 15 and college courses, which were attended at set times. One service user had more free time after losing a job that they had in a nearby pub. They had enjoyed this work, which was within walking distance of the home. They said that staff were helping with trying to find another job in the local area and an outside employment agency was involved. Another service user had a job helping out at a care home for older people. One service user was starting to do more things after a period of rehabilitation. They were going to college once a week to do a course on pottery. Service users were able to receive some one to one support from staff when having a home-based day during the week. Service users had friends outside the home who they saw on a regular basis. The service user who completed a survey confirmed that their privacy was respected. One service user said that they liked having their own pet cat, which they looked after themselves. Details of the service users’ family contacts were included in their individual files. There was guidance for staff about the visiting arrangements and how good communication could be maintained. Of the two relatives who completed surveys, one felt that the home always met the needs of their relative in the home and supported them to live the life that they choose. The other relative felt that the home usually did these things. One relative commented that support was provided as much as funds allow. Both confirmed that the home always helped their relatives in the home to keep in touch with them. Service users said that they felt that they can be private in their own rooms and that staff knocked on the bedroom doors before entering. Service users spoke about the things that they did in the home. They did their own laundry, as far as possible. Staff usually made the evening meal and service users were more independent with the other meals. Service users were asked during the visit what they would like for the evening meal. There was a written menu for the week although it included a statement that it was a guide only and alternative meals could be offered. Service users said that they liked the meals. Details of the meals actually prepared were recorded in the service users’ individual diaries. There were bowls of fruit in the lounge which people could help themselves to. One service user had a small fridge in their room where they kept fizzy drinks. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including the visit to the home. Service users receive the support that they need with their personal and health care needs. Service users are protected by the home’s procedures for dealing with medicines. EVIDENCE: Service users had their own rooms where they could carry out their personal care in private. One service user had a ground floor room with an en-suite bathroom. Information was recorded in the service users’ individual files about their usual routines and health care matters. Personal care needs were described in individual plans. The plans were in different formats. One in a newer format provided better information about how people’s needs were to be met and the overall objective in providing support to meet a particular area of need. It was agreed with Ms Saunders that a single, consistent approach would be beneficial. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 17 Support for three service users with personal care was mainly in the form of prompting, rather than ‘hands-on’ assistance. Service users mentioned help with finding jobs and doing things in the home when asked about the support that they received from staff One service user required a greater degree of practical support with their personal care than the others. There was written guidance for staff about this, which included a statement that was titled ‘Important things to remember for consistency’. This service user’s support plan included a section on mouth care and a section on skin care had been added in April 2007. Each service user was registered with their own doctor at one of four different surgeries. A staff member said that the service users received a good service and that dealing with a number of different surgeries was not a problem. Details of appointments with GPs and other healthcare professionals were recorded on forms in the service users’ files. One service user had an appointment with the GP on the morning of the visit and was supported with this by a staff member. In their survey, one relative felt that the home always gave the support and care that they expected. The other relative felt that this was usually the case. In response to the question, ‘What do you feel the care home does well’, one relative commented that they are ‘satisfied with all care needs’. The other person commented that the home ‘provides care and support to people in their care’. Medication was stored safely. Staff members administered the medication, as this was not something that service users were assessed as being able to do themselves. A stock record of medication was being kept and the records of administration were up to date. These were contained in a file that contained medication profiles, consent forms and drug information cards. ‘As required’ medication was limited to some homely remedies. There was guidance for staff about their conditions for use. Drug administration was included as a subject in the OLPA training programme, which is provided ‘in-house’. There was no specialist input into the training that staff receive about medication and drug use. This has been recommended at previous inspections. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 18 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 encouraged to express their views and have the information they need about making a complaint. Staff have an awareness of abuse, which helps to protect service users. EVIDENCE: When asked, service users mentioned various people including the staff who they could talk to if they had a problem with something. Service users had the opportunity to discuss concerns together in the regular tenants meetings. An OLPA complaints procedure included contact details for different agencies. There was a complaints log in the home. No complaints had been made during the last year. The service user who completed a survey confirmed that they felt safe in the home and knew who to speak to if unhappy about something. In their surveys, both relatives confirmed that they knew how to make a complaint if they needed to. One person confirmed that the home had always responded appropriately if a concern had been raised; the other person felt that this had usually been the case. One survey included the comment ‘we have never had to raise concerns, but if we did we know that everything would be done’. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 19 Abuse awareness was included in the OLPA training programme for support workers. The subject was covered in a short statement in the home’s policy and procedure file, which makes reference to ‘No Secrets’ and to a guidance document on the protection of vulnerable adults from abuse in Swindon & Wiltshire. Staff confirmed the training that they had received and that they had been given a copy of the ‘No Secrets’ booklet, which gives guidance about abuse and what to do if abuse is suspected. The home has had recent experience of an adult protection investigation and a service user has received support from the manager and staff in connection with this. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 20 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 home’s location and the accommodation are meeting the service users’ needs. Service users like the redecoration and refurbishment that have taken place during the last year. The communal areas have been given a modern and fresh appearance. EVIDENCE: 5 St. Margaret’s Gardens is in a residential area and close to a main road that goes through Melksham town centre. The home is close to some shops and has been well placed for service users being able to get to the different jobs that they have had. There was a good-sized garden along one side of the home. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 21 On entering the home it looked clean and well maintained. The hall and lounge had been redecorated. The furnishings and pictures co-ordinated well with the décor. New furniture had been bought for the lounge and the radiator covers had been painted. The overall look was very modern, which the service users said they liked. The service user who completed a survey also stated that they liked the new decoration and the garden. In their survey, one relative commented that the house had improved considerably in the past six months regarding cleanliness and redecoration. The lounge was comfortably furnished and had a television and video player. There was a separate dining room, which provided an additional communal space for quieter activities. Each service user had their own room, which they could personalise and decorate as they wished. At the visit in November 2006, the Expert by Experience had commented that one service user had a lot of personal items in their room that belonged to another service user and which took up a lot of room. It was recommended at the time that this situation was kept under review, to ensure that this is an appropriate arrangement that meets the needs and wishes of both service users. It was seen during the visit on May 24 2007 that the service user’s room had been reorganised and the other person’s belongings were no longer there. Service users said that they like their own rooms. During the visit, service users spent time between their own rooms and the lounge. They chatted with staff in the dining room and in the kitchen when the evening meal was being prepared. Laundry was carried out in the attached garage, which was also used as a storage area. Much of the space was taken up with items that were shortly to be taken to a car boot sale. The home had collected these as part of a fund raising exercise. One service user was shortly to have their bedroom redecorated. The room had been cleared of most items and the service user said that they had chosen the colour that they wanted. During the visit, a maintenance person from OLPA came to look at the job. Another of the bedrooms seen was quite dusty high up and the service user may need more support or encouragement with cleanliness in the room. Downstairs, the rooms looked well maintained and decorated. As reported at previous inspections, the bathroom was in poor condition and in need of St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 22 refurbishment in order to bring it up to the good standard that was evident in the other areas. There was discussion with Ms Saunders and staff about security in the home. A security chain on the front door had been removed some time ago, although Ms Saunders confirmed that this would be reinstated. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users are supported by competent staff who they know well. Staff members receive the training that is expected for working in a care setting. Service users are protected by the way in which the staff have been recruited. EVIDENCE: Four of the six care staff had achieved their National Vocational Qualification (NVQ). The staff team included support workers who had worked in the home for several years. The most recently appointed staff member had started in August 2005. This person’s recruitment records were looked at during a previous inspection of the home, when it was found that the required checks had been undertaken. All staff had been police checked. There had been no use of agency or bank staff in an eight week period prior to the visit. Regular staff meetings were being held with minutes kept. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 24 In their surveys, both relatives responded positively to the questions about staffing. One person commented ‘good training always given’. Staff were provided with an in-house programme of training. This covered OLPA’s mandatory subjects such as health and safety, first aid, food safety, fire training, abuse awareness, manual handling, person centred planning, medication and infection control. A staff member confirmed that they had received training in these areas. The OLPA training programme has developed with the inclusion of some skills related subjects such as communication and mental health awareness. Learning Disability Award Framework (LDAF) is available to new staff. It has previously been recommended that the training programme is developed to include the greater involvement of outside professionals and agencies. This would be useful, for example in the areas of medication and abuse awareness. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 25 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 well run home. They are benefiting from improvements in the home and developments that are taking place concerning quality assurance. There are systems in place that help to safeguard the service users’ safety. EVIDENCE: Ms Saunders is an experienced manager who is also the registered manager of another similar sized home run by OLPA. This joint role was relatively new. Ms Saunders said that the arrangement was working well and that she was able to spend sufficient time in each home. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 26 Ms Saunders had been working in the other home at the start of the visit on 24 May 2007, but came to 5 St. Margaret’s Gardens shortly afterwards. Ms Saunders has achieved the Registered Managers Award and NVQ at level 4 in care. A staff member said that they felt well supported in the home and that the staff meetings were a good time to discuss things. There was an OLPA policy on quality assurance, which referred to a number of internal and external devices by which the service is monitored. The policy did not show how these devices contribute to a cycle of planning-action-review, involving timescales and the production of improvement / action plan. OLPA had 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. The manager was developing a system of quality assurance that was relevant to the home. There was a ‘Quality Assurance file’, which included meeting minutes, monthly reports and a development plan for 2006. The plan gave a review of the action that had been taken in 2005, which included staff achieving their NVQ, improvements to the garden and the kitchen, and service users going on several day trips. Objectives in the Development Plan for 2006 included further work on the kitchen, house redecoration and giving service users the opportunity to have a holiday and days away. It was not clear from the plan how the views of service users and other people had been taken into account. Ms Saunders said that the ideas about redecoration had come out of a tenants meeting. A timescale for the completion of the next development plan was discussed with Ms Saunders, who confirmed that this would be produced by the end of July 2007. Information about health and safety, including the maintenance and servicing of equipment and the checking of the fire precaution systems was received from the home in a pre-inspection questionnaire. The fire alarms were being tested each week. A check of the home’s fire log book showed that staff members had received fire instruction on 16 May 2007 and a drill had been held on 21 May 2007. Assessments had been undertaken in respect of environmental and other hazards that may present a risk to service users and / staff. Individual risk assessment records were included in the service users’ personal files. Some of St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 27 these served as reminders about personal safety, with advice, for example about wearing a helmet and a reflective band when out cycling. There was an assessment about lone working by staff. Health and safety matters were being discussed at the staff meetings. Fire precautions had been discussed at a recent tenants meeting. A fire risk assessment was undertaken in June 2006. At the last inspection, Ms Saunders was recommended to look at new guidance that has been produced on the carrying out of fire safety risk assessments in residential care premises. Ms Saunders had not yet done this, but said that she did intend to. Ms Saunders confirmed that the fire risk assessment was to be reviewed before the end of June 2007. Control of Substances Hazardous to Heath (COSHH) information was kept on file and readily available to staff. The home was using the ‘Safer food - better business’ system for the monitoring of standards in the kitchen. The daily sheets were being completed as part of this system. Advice had been given to staff at a recent staff meeting about the safe storage of food. St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 28 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 2 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 3 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 St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 6 Requirement That the home’s Statement of Purpose and service user’s guide are kept under review and revised. The service user’s guide must include those items as specified under Regulation 5(1) of the Care Homes Regulations 2001, which includes the arrangements in place for charging and paying for any additional services. Timescale for action 31/07/07 2 YA1 5(1) 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations That dates are recorded for when the risk assessments are to be reviewed and that the outcomes of reviews are consistently recorded. DS0000028372.V342747.R01.S.doc Version 5.2 Page 30 St Margaret`s Gardens (5) 2. YA7 That there is discussion with individual service users to establish their level of understanding of the money they receive. This recommendation made at the previous inspection. As reported, further information needs to be recorded and available to service users about the arrangements in place for charging and paying for any additional services. That the home’s plan for staff training is expanded to include more specialist areas of training, involving outside agencies. This will help ensure that service users benefit from staff members who have attended a wider range of training types and courses. That the policy on quality assurance is expanded to include the arrangements made for annual development and consultation with the service users and other parties. That guidance on carrying out fire safety risk assessments in residential care premises (available from the website: www.firesafetyguides.communities.gov.uk ) is obtained and used as a resource in the home. (Recommendation made at a previous inspection). 3. YA35 4. YA39 5. YA42 St Margaret`s Gardens (5) DS0000028372.V342747.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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