Inspection on 07/12/06 for 535 High Lane

This inspection was carried out on 7th December 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

535 High Lane 04/12/07

535 High Lane 14/12/05

535 High Lane 18/05/05

535 High Lane 11/01/05

535 High Lane 01/10/04

535 High Lane 28/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 535 High Lane Burslem Stoke-on-trent Staffordshire ST6 7AE Lead Inspector Irene Wilkes Key Unannounced Inspection 7 December 2006 09:30 535 High Lane DS0000008214.V323824.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 535 High Lane DS0000008214.V323824.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 Older People and 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. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 535 High Lane Address Burslem Stoke-on-trent Staffordshire ST6 7AE 01782 862134 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) Choices Housing Association Limited Mr Barry Joseph Flanagan Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. PD, 2 LD(E) Date of last inspection Brief Description of the Service: 535 High lane is a home for 8 people with a learning disability managed by Choices Housing Association. The service users may also have a physical disability and 2 people may be over the age of 65 years. The home is currently full, with 3 ladies and 5 gentlemen living there. 1 of the men is over the age of 65 years. The house is divided into two separate flats, with one on the ground floor and one on the first floor. Each flat has four single bedrooms, with an assisted bath, lounge and dining and kitchen facilities. There is one laundry situated on the ground floor, and this has shared access with the service users living in the upstairs flat. The grounds are neat and tidy, with a parking area to the side, and lawned areas around the property for the service users to enjoy. The home overlooks the local hospital grounds to one side. There is good access at High Lane to local shops, pubs and churches and the hospital. The home is very accessible by road and public transport, being on a main bus route. Burslem is only a few minutes drive away, with all the usual facilities of a small town. The costs of the service range from £325 to £508 per week. These costs were provided to the commission on the day of the inspection. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a day in December 2006 and was undertaken by 1 inspector. All of the service users who were at home during the visit were spoken with, and 3 of their records were examined in detail. All 8 of the service users had previously returned survey forms to the commission that asked their views about the quality of their care, and this information was used to inform the outcome of the inspection. 5 relatives had returned comment cards and these responses also informed the inspection. 2 staff were interviewed and a third member of staff assisted the inspection by providing information that was required and responding to questions. The manager had previously returned a pre inspection questionnaire and the information that was provided in this document was also examined. In addition to speaking to service users and staff, various records linked to care practices, medication, staff recruitment, training and staffing levels, and responses to health and safety requirements were examined. A tour of the home was also made. What the service does well: The staff at High Lane show the utmost respect to the service users and they are totally geared to meeting their needs in the way that each individual wishes. One of the service users put it well by saying: ‘I like it here. Its my home.’ The home keeps good records about the needs of each person and a large part of these records are shown in pictures and photographs as well as written so that the service users can better understand them. The staff meet with them every month to see what progress has been made towards achieving the plans, such as finding work or visiting particular places. The staff also keep good records about the support that people need on a daily basis. These records are always very clear. One person living at the home has a serious illness. The home has responded in an excellent way to make sure that he has all of the aids and equipment and support from relevant health professionals that he needs. They also make sure 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 6 that there is an additional member of staff on duty in the flat that he lives in, so that someone is always available should he need some extra input from staff. The manager and staff want everyone living at the home to be content with their lives. The service users were very clear that they know who to complain to should anything be wrong, and they feel comfortable in raising any concerns. The needs of some people at High Lane are such that they can be verbally or physically aggressive. All of the staff are trained to manage this behaviour appropriately. There was clear evidence that staff try to calm people down by talking to them or diverting them to other activities, and physical restraint is only used as a last resort. There were full records available about the circumstances surrounding an incident whenever restraint is used. High Lane is a very nice home to live in. There is lots of room and the chairs and beds and bathrooms are all very comfortable. It’s brightly decorated as well, so people living there enjoy their home. What has improved since the last inspection? High Lane is a good home and there are never many things of concern when the home is visited. Issues raised at the last inspection have been addressed. These are: A new service user had been admitted to the home. An assessment of his needs had been undertaken at his previous placement, but he had not been given the opportunity to visit High Lane before moving in. This also meant that the other service users did not have any chance to say if they were happy for the new person to join them. This is important as well as it is their home. There have been no new service users since that visit, but the manager has given an assurance that in the future he would ensure that any prospective new service users would make visits to the home prior to a decision being made about them moving in. At the last visit the home had 2 staff vacancies and the staff were working additional shifts to cover these hours. On the day of the visit there was only 1 staff available on each floor. Given the needs of the service users a requirement was made that the staffing levels should be reviewed. At this visit there were 2 staff on duty in the downstairs flat, and 1 upstairs. The additional staff member downstairs is mainly to support the needs of the service user who is ill. A requirement has not been made about staffing because there is now a full complement of staff. Nevertheless, the home has been recommended to keep the staffing levels under regular review. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 7 The home keeps good records generally, but at the last inspection some records had not been dated and signed so that it was not always clear which records were the current ones. This had improved at this visit and all records that were sampled were appropriately dated and signed. 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. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home will undertake an assessment of needs for any prospective new service user planning to move to the home. EVIDENCE: There has been no new service users admitted to the home since the last inspection. The last inspection found that whilst a new service user had been visited and an assessment of his needs had been undertaken at his then current placement, he had not had the opportunity to visit High Lane to see if his needs could be met in that environment, or to find out if he liked it or was compatible with the other service users. This was discussed at the time of that 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 10 inspection with the manager of the home and he said that he would ensure that in the future these issues would be addressed. The Commission is confident that a full assessment of needs will be undertaken for any future prospective service user. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The records that the home keeps about each person are excellent and these, together with discussions with service users show that each person is supported to maintain control over their own life. EVIDENCE: The files of 3 service users were looked at and the service users also spoke to the inspector. The files showed that good person centred planning continues at the home. These plans were in a format and language that the service users could 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 12 understand. The plans had been reviewed earlier in the year, and then progress against the outcomes had been monitored since then on a monthly basis. Each file also showed a comprehensive 24-hour plan of care, and individual care plans for such areas as the management of violence and aggression and for another person, self-harm. The plans had been reviewed on a monthly basis. One of the service users, who is over 65 has been diagnosed as having a terminal illness and his file showed that a complete review of his care plan had taken place. There was an additional care programme in place for pain with clear information about how the service user was being supported to manage this. There were full records about how his illness was impacting on other areas of his life and how this was being managed. The home is applauded for the very comprehensive information available. Service user’s rights are promoted at High Lane. Each person is supported to make decisions that affect their lives. For example, the service user who is ill had consented to receiving a course of chemotherapy treatment but had since decided to withdraw from this. There was clear evidence that the manager had spent some considerable time with him to explain again why the treatment had been recommended and the consequences of not having it, but armed with this information the service user had still refused. Records were available for all important decisions for each service user. Where restraint was used as a last resort in the management of violence and aggression there were very clear records, with an audit trail, to show that this had been undertaken appropriately in the person’s best interests and consistent with the purpose of the service and the home’s duties and responsibilities under law. The home pays good attention to assessing the individual risks for each person to enable them to take a level of risk as part of an independent lifestyle, but working with them to minimise the risk as far as possible. A range of risk assessments were in place, such as accessing the community alone, undertaking various activities, and smoking, and for each there was a risk management strategy in place. Revised protocols had been agreed with 2 of the service users about smoking as a high risk of causing a fire had been identified. The service users spoken with confirmed that staff talked to them about their care plans and about individual risks; they had real confidence in the staff, particularly their key workers, and were able to express in their own way that they discussed all aspects of their lives with them. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 14 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy an independent lifestyle based around their own interests and wishes, and they take part in appropriate activities both within the home and in the wider community. EVIDENCE: 1 of the service users talked to the inspector about her job that she has with Choices. This is to help clean the outside windows at 2 other of Choices homes. She said that she was really pleased about this as it helped her to buy more clothes that she loves. There was evidence in the 3 files sampled that the service users are supported to seek out work where they wish this. Although to date this had been unsuccessful there was evidence that other avenues were being explored. Some service users were out on the day of the inspection but returned towards the end of the visit and said that they had been to day services that they enjoyed. Another service user file showed that he attend 2 different centres for people with a disability in the evenings and he confirmed that he met his friends there, played pool, listened to music and generally had a good time. There was evidence that according to their own preferences people go shopping in the city centre, access the local shop and visit different pubs for a meal or drink and to socialise. The service user who is ill used to access the community independently, visiting cafes and local shops and the pub. Whilst he now needs support from the staff his records showed that he still goes out almost every day in a wheelchair with a member of staff, even if this is only to the local shop or the WRVS shop at the hospital that is close by. Although he didn’t feel like talking too much, the service user confirmed that this pleased him and made him feel better. All of the service users had returned comment cards about their satisfaction with the service. All were positive, and 1 person who had been supported by staff to complete the form said ‘‘X says he likes living at High Lane – its his home.’ 4 people had said that they ‘always’ make decisions about what to do each day, 3 people said that they ‘usually’ did, and 1 person said they ‘sometimes’ made decisions. Service users who were at home were asked about their daily lives and decision making, but all those spoken with indicated, as far as it was possible to gather, that they made their own decisions each day. The 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 15 home is asked to check out with each person if they are happy with their level of involvement. Although no relatives visited during the inspection, 8 comment cards had been returned and all were positive about the service. Questionnaires had been returned to the home as part of their quality assurance procedures (discussed further under the section on conduct and management of the home) and these also indicated that relatives are made welcome in the home and are actively encouraged to play a part in activities in the home and in daily routines. One said ‘We as a family have always found High Lane staff very approachable both on the phone and in person. The comfort is always there to be seen and our relative always appears happy and well cared for’. The service users who were asked confirmed that their relatives visited and they either went to their bedroom or sat in the lounge or the kitchen as they chose at that particular time. Throughout the visit the service users made their own decisions about the pattern of their day. At various times different people went to their rooms, sat in the lounge watching the television or wandered into the kitchen and sat chatting with other service users and staff, made a drink or helped with lunch. They all said that they pleased themselves about what they did, what time they got up in a morning and what time they went to bed, and they were obviously very relaxed with staff. There was a lot of laughter, and it was noted that at all times the focus of the staff was on the service users and not each other. If staff did need to go into a service user’s room for something they were observed to knock and wait for a response before doing so. The menu plans were seen and there was good recording of what was on offer at each meal, including where alternative choices had been made. The staff said that a nutritionist had visited the week before at the request of the manager and she had confirmed that the service users were receiving a healthy diet. Each flat is self-contained and the service users in each unit choose their meals. Both flats have a large eat in kitchen and service users were heard making their own choices for lunch and some were actively assisting in food preparation and/or setting the table. The service user who is ill has lost his appetite, but staff gently encouraged him to eat by offering a range of choices and a small portion. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity and privacy are put into practice. EVIDENCE: The service users at High lane are supported to make their own choices about how staff assist them in personal care. Care plans/ risk assessments were in place to show how independence is promoted for bathing/showering within a well thought through risk assessment framework. The 24-hour plans of care also contained detailed information about each person’s preferences in personal support. These also showed that the home know about each person’s 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 17 preferences in relation to times for getting up/going to bed and bathing. There were moving and handling risk assessments in place that were comprehensive. There is a mixed gender team of staff at the home. Each service user has 2 key workers so that there is some continuity when shifts change or at holiday times. Preferences are met as far as possible for a key worker of the same gender where this is preferred. The service users spoken with clearly had a good rapport with all of the staff team, but in particular they valued the input of their key worker. A staff member was asked about the needs of a resident who she supported as key worker and she had a clear understanding of her needs and preferences. The home had responded very promptly to the needs of the service user with a terminal illness. They had liaised with the Occupational Therapist and he has a wheelchair, a specialist chair, a backrest and a new mattress. A hospital type bed is on order. This is not required currently but as there is a waiting list the home, supported by the occupational therapist have had the foresight to request one in advance. It was very pleasing to note the excellent way in which the home have involved other professionals, such as the hospice community nurses, district nursing team and occupational therapist to help support the service user in the best way possible. The health needs of all of the service users are additionally well met. A document called the ‘OK Health Check’ is completed with each service user on an annual basis, and from this any necessary health appointments and routine 6 monthly or annual appointments, as well as any specialist input is updated in the health records. A member of staff said that each service user had a ‘Health Action Plan’ but that these were locked away in the confidential files. These documents are the property of the service user and it is recommended that they keep their action plan in their bedrooms where this is appropriate. The home is proactive in gathering information for service users to get up to date information about health and other issues. Titles seen include ‘Overcoming Low Self Esteem’ ‘Sexuality and Women with Learning Difficulties’ and DVD’s that included ‘You, Your Body and Sex’ and ‘My Life Story.’ On the day of the visit the key worker of the person who is ill came on duty early to take him to a GP appointment. The health records showed that they had persevered in getting an earlier appointment than the surgery were wishing to provide. There was evidence in the other 2 service user files sampled that timely responses are made to any health issues for all of the service users. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 18 None of the service users at the home currently self medicate. Evidence of their consent to staff administering medication was not seen in their individual files or in the medication file, save for initial consent to chemotherapy by one service user. The home is required to obtain the consent of each service user for the administration of medication and retain this evidence in their individual file. Medication is provided by the pharmacy in individual dosette boxes. Procedures for the storage and recording of all medication given were looked at by sampling and were satisfactory in each case seen. Each MAR (Medication Administration Record) that was sampled had been completed appropriately and there were no gaps in recording. It was confirmed that care staff receive medication training. A care worker confirmed that medication procedures are discussed in staff meetings and that the manager observed staff administering medication in the course of their duties. The staff training records showed that the majority of staff had also received external training in medication. The manager is recommended to assure himself that the professional advice document prepared by the Commission – ‘Professional Advice: Training Care Workers to safely administer medicines in care homes’ is implemented at High Lane. There are no controlled drugs currently used in the home. However evidence was seen that when they had been used on a recent occasion that appropriate and safe procedures had been followed. This included a return to the pharmacy of the controlled drugs that were no longer required. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns. They are protected from abuse and have their rights protected. EVIDENCE: The home has an appropriate Complaints Procedure. A new leaflet geared to the communication needs of the service users has recently been introduced by the organisation. Each person has their own copy of the leaflet held in their individual file that they have full access to. A copy of the leaflet was also on display in the home. 3 service users were asked what they would do if they were not happy with anything. 1 said that he would speak to the manager and the other 2 said that they would tell their key worker first. They said that their key worker would make sure that what they were not happy with would be looked at. A Complaints and Comments Book is kept by the home and examination of this showed that 1 complaint had been received since the last visit. The complaint had been made by a service user about the behaviour of another service user 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 20 towards him. The outcome of the complaint stated that staff should be vigilant in observing the service user to pre-empt any inappropriate behaviour. The comments book also held a letter from the family of one of the service users that complimented the home on the excellent care provided. Some of the service users at High lane present with physical and/or verbal aggression, and 1 is prone to self-harm. The record of incidents and the use of restraint were examined. These showed a clear audit trail linked back to individual care plans and there was good information available to show how verbal de-escalation was tried and that restraint was used as a last resort in all instances. It was discussed with a member of staff that the incidents of outbursts of aggression had increased for 1 service user, and incidents of self-injurious behaviour for another. For the former service user it was considered that this may be linked to pain, and a care plan for control of pain had been introduced that appeared to be taking effect. For the other service user a new pro-active intervention plan had been introduced. It was considered that that the selfharm may be linked to frustrations around communication and specialist advice was being sought to see if this could help. The member of staff was very knowledgeable about the service user needs and the need for the home to support the service users and to protect their rights and best interests at all times. Training records also showed that all staff had received training in the management of potential and actual violence and aggression. The home has robust procedures for responding to suspicion or evidence of abuse or neglect. They have the appropriate local multi-agency procedures in place for the protection of vulnerable adults, and a copy of the Department of health document called ‘No Secrets.’ A member of staff was questioned about her understanding of her responsibilities should she witness or suspect any form of abuse and she clear understood these. She confirmed that she had received training in the understanding of the different forms that abuse could take. It was also confirmed that training around abuse is covered in induction. There have been no allegations of abuse at the home. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. High lane provides a comfortable home for the service users, but aspects of fire safety must be improved. EVIDENCE: High lane provides a comfortable home for the service users with sufficient communal space to meet their needs. The 2 flats are self-contained with a comfortable lounge and large eat-in kitchen. Rooms are comfortable, bright, 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 22 airy, clean and odour free, and provide suitable lighting, heating and ventilation. The grounds are tidy and safe and accessible to the service users. One service user said ‘I like it her. I live here, its my home and its good.’ The home has a planned maintenance and renewal programme for the buildings and contents. An outside security light has been fitted since the last inspection. New regulations for fire safety in care homes came into effect in October 2006. The slow response by the manager and the responsible individual towards meeting the recommendations made by the fire officer when he visited in July 2006 to advise the home in readiness for October is discussed more fully in a later section of this report, under ‘Conduct and management of the home.’ At the inspection it was seen that a number of the recommendations of the fire officer have now been met although some remain outstanding, and a staff member advised that a date for other work was awaited from contractors and/or the head office of Choices. The manager was not on duty at the inspection to provide any further detail. The fire officer is due to make a return visit very soon to see if the fire safety work has been completed to his satisfaction. It is a requirement of this report that the home ensure the safety of service users in relation to fire following the professional advice provided by the fire service. There is only 1 laundry on the ground floor. However, there are appropriate arrangements in place to ensure that the use of this is appropriately managed. The laundry floor is fitted with impermeable material and the walls are easily cleanable. Policies and procedures are in place and are followed to control the spread of infection, including the provision of protective clothing and suitable hand-washing provision. The home is very clean throughout. The procedures were discussed further in the light of information from the pre inspection questionnaire that 2, occasionally 3 service users, are incontinent. The commission is satisfied that suitable procedures are in place. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a well-trained staff team, but attention to aspects of record keeping about staff working in the home must be addressed. EVIDENCE: Excellent relationships were observed between the service users and the staff on duty. Throughout the visit in both flats they were seen and heard doing tasks together or chatting over a drink. The service users were very relaxed with the staff and said that they are their friends. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 24 The staff team is experienced. The 2 newest members of staff have transferred to High Lane from another home and have considerable experience of working with people with a learning disability. All staff have had MAPA (Management of Actual and Potential Aggression) training, and some staff have received additional origins of behaviour or behaviour management training. 5 staff have had training in understanding sexuality and inter personal relationships. The needs of some of the individual service users were discussed with a member of staff and she had a good knowledge of their needs and specific conditions. 60 of the care staff are trained to NVQ 2 or above, and others are either nearing completion of their course or planning to start the course. In addition to the manager, there are 2 qualified nurses. On arrival at the visit there were 2 staff on duty working in the downstairs flat, with 2 service users at home, and 1 staff member upstairs with 3 service users. Staffing ratios were discussed and the rotas seen, and it was found that these are the basic staffing ratios across the day and evening, with a waking night staff from 10pm. At least 2 staff are always available downstairs due to the illness of a service user. Staff on duty also said that on particular days there was more staff on duty to cover additional activities being undertaken by the service users. All of the staff questioned said that they considered that the staffing levels are adequate to meet the needs of the service users and to conduct the service safely. A relative returned a comment card to the commission stating that she gets concerned as she hears staff say that they are short staffed. 5 returned relatives satisfaction survey forms that the home had sent out were seen and one of these referred to some lack of social activities but stated ‘….but I understand that the shortage of staff restricts that.’ Reference is made earlier in the report about service users comments regarding decision-making. These comments may have a link to staffing levels. The manager is recommended to keep the staffing levels under regular review. Through discussion it was found that 2 additional staff should have been on duty at High Lane on that day, but they had been called away to help staff another home. This had been happening over a few weeks, as the other Choices home is short staffed. The staff on duty assured the commission that the transfer of these staff had not affected any service user’s activities at High Lane that day. No one could confirm or otherwise that this had been the case on every occasion that rota’d staff had been required to work elsewhere. The commission considers that the staff team at the home are employed to work there for the benefit of the service users at High Lane and they should be deployed there accordingly. The manager is recommended to consider the impact on the service users at High Lane of transferring members of staff to 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 25 other Choices homes. The commission will also discuss this issue at the next meeting with Choices. The manager should assure himself that the night staffing arrangement of 1 waking night staff is sufficient to maintain the health and safety of the service users, to include safety should there be a fire. There was evidence that staff meetings take place. There were agendas and minutes of the meeting duly recorded in the records. The last recorded meeting was shown as September 2006. The manager is reminded that staff meetings should take place at a minimum of 6 per year. All of the service users can verbally communicate to an extent. 1 service user signs the odd word in Makaton and a staff member confirmed that all of the staff could sign and understand these words. Neither the manager or a deputy manager were on duty and the staff files were locked away. Whilst the confidentiality of such records is required, the regulations also require that staff records are at all times available for inspection in the care home by the commission. As the commission now undertakes mainly unannounced inspections the home is required to develop a system to enable access to the records by the commission at any time. This is a requirement of this report. Through discussion with a deputy manager on the day following the inspection the details required to be inspected in the staff files were discussed. A return visit was not made to the service but on this occasion as an exception the commission accepted a verbal response over the telephone to the records in place for 3 pre-selected staff. The above discussion evidenced that because 2 of these staff had transferred from another Choices home the information in their files was incomplete. This included information lacking of an application form, 2 written references, and CRB (Criminal Records Bureau) in 1 case. The manager is required to retain all of the information contained in Schedule 4 ‘Other records to be kept in a care home’ (National Minimum Standards for Younger Adults.’ The file of the third member of staff contained the appropriate information, except that the worker had commenced in the home before either a CRB or a POVA First (Protection of Vulnerable Adults) clearance had been obtained. The staff member had worked supernumery until CRB clearance had been obtained. The staff member has been working at the home for 12 months. This issue has been identified at another Choices home very recently and the requirements 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 26 that at least a POVA First must be obtained have been discussed with Choices personnel department. They have indicated that they will comply with obtaining a POVA First for all future recruitment. Another requirement is therefore not being made, but the manager is reminded that no one should work in the home unless a POVA First at least has been obtained. Choices organisation train their staff to a high standard. Evidence was seen that induction is completed by all new staff, that staff use Learning Disability Award Framework accredited training to provide underpinning knowledge for NVQ 2, and that mandatory training was up to date for all staff. In addition the organisation provides a range of additional courses to help meet the individual needs of the service users. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is generally of a high standard but the slow response to the fire officer’s recommendations is disappointing. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 28 EVIDENCE: The home is led by a manager who is a qualified nurse and also has several years experience as a manager of a care home with Choices organisation. He has completed his NVQ 4 in management. The manager has a clear job description which sets out his responsibilities, and he also undertakes regular training to maintain /update his knowledge and skills and competence to run the home. Mention has been made in an earlier section of the report of the slow response of the manager and the responsible individual to the recommendations made by the fire officer following his visit in July 2006. This was to prepare the home for compliance with the new fire regulations that came into effect in October 2006. The recommendations included some physical improvements to the building for fire safety, and the undertaking of individual risk assessments presenting to the service users. It has been of concern to the commission that the organisation had required several prompts before commencing the work. This work is now in progress. The manager must also understand that as the registered manager he also has legal responsibilities to address those areas of the fire officer’s report that lie within his control, and this includes a responsibility to provide any information that the fire officer or the commission asks for in a timely way. However, in all other aspects the home is very well run, to the credit of the manager and the staff team. The needs of the service users are well met, and the staff report that they have good leadership from a manager who is very open and supportive. The home has effective quality assurance systems in place. The views of the service users are sought via individual reviews, and relatives’ satisfaction surveys are sent out. 5 survey forms were seen and they were positive overall about the service that is provided. The home further addresses quality by producing an annual quality report and development plan for the home. This sets out a systematic process of planning, action and review of outcomes. The report is provided to the commission. A principal officer from Choices organisation visits the home on a monthly, unannounced basis and a report on the visit is supplied to the commission. Some maintenance and other mandatory records were looked at and these showed that maintenance of the fire system, cleaning logs, food temperature storage etc. were up to date and appropriate. COSHH (Control of Substances 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 29 Hazardous to Health) storage and data sheets were satisfactory. Fire bell tests and fire drills were up to date. There were safe practices operating for moving and handling of both people and objects. The manager had provided evidence via the pre inspection questionnaire that other maintenance checks such as electrical tests, gas, water temperature and hoists and adaptations required maintenance were up to date. There were no apparent hazards seen at the time of the visit, save for the outstanding work to improve fire safety shown below. Evidence was seen in the care plans that individual risk assessments are reviewed on a regular basis. The home is now responding to the recommendations made in the fire officer’s report of July 2006. An earlier section of the report includes a requirement to complete this work with some urgency. Compliance will be monitored directly by the fire service but the commission will also expect to be kept informed of progress. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 4 36 X CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 3 40 X 41 X 42 3 43 X 4 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 21 535 High Lane Score 3 4 3 X DS0000008214.V323824.R01.S.doc Version 5.2 Page 31 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 12(2)(3) 13(2), 15(2), 23(4) Requirement Timescale for action 07/01/07 2. YA24 3. YA34 17(2) 19 Schedules 2 and 4 17(3) 4. YA34 Obtain consent for the administration of medication by staff for each service user and retain this signed consent in their records. Implement the fire officer’s 22/12/06 recommendations contained in his report of July 2006 in full, and liaise with the officer regarding the same. Maintain all of the information 07/01/07 required in relation to staff records as outlined in the regulations and schedules shown for all staff All of the records relating to staff 07/01/07 working at the home must be available at all times for inspection in the care home for examination by any person authorised by the commission to enter and inspect the care home. 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 YA33 3 YA33 4 5 YA33 Consider the impact on the service users at High lane when decisions are made about transferring members of the staff team to work temporarily in another home The manager should assure himself that the provision of 1 waking night staff is sufficient to ensure the health and safety of all the service users and staff member. Refer to Standard YA16 YA19 Good Practice Recommendations Discuss with service users their satisfaction with the level of their involvement in day to day decision making Arrange for the service users, as appropriate, to retain their own Health Action Plan Keep the staffing levels under regular review 535 High Lane DS0000008214.V323824.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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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