Inspection on 10/05/06 for 56-58 Turnbull Close

This inspection was carried out on 10th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

56-58 Turnbull Close 14/06/07

56-58 Turnbull Close 03/11/05

56-58 Turnbull Close 24/05/05

56-58 Turnbull Close 20/12/04

56-58 Turnbull Close 13/07/04

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

CARE HOME ADULTS 18-65 56/58 Turnbull Close 56/58 Turnbull Close Greenhithe Kent DA9 9EB Lead Inspector Lynnette Gajjar Unannounced Inspection 10th May 2006 09:00 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 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 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 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. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 56/58 Turnbull Close Address 56/58 Turnbull Close Greenhithe Kent DA9 9EB 01322 381568 01322 381568 turnbullclose@walsingham.com 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) Walsingham Mr John Henderson Care Home 12 Category(ies) of Learning disability (12) registration, with number of places 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005 Brief Description of the Service: 56/58 Turnbull Close residential home (part of Walsingham which has some forty- two homes in the group across the UK) provides care and accommodation for up to twelve people with physical and learning disabilities. Accommodation is in a bungalow that is divided into two units, each with its own communal areas. All residents have single bedrooms that are individually furnished and equipped with significant support from relatives and supporters. Some service users have motability vehicles. Other organisations (e.g. Yew Tree Centre and Social Education Centres) supplement the homes own transport provision in enabling residents users to attend specialist day centres. The premises have safe landscaped gardens used by service users. Twenty-four hour care is provided (at night there are two support workers on duty, one sleeping and one awake). A registered manager, who has achieved the Registered Managers Award, runs the home with assistance from Walsingham support network. The home is within easy reach (by car) of a range of local amenities and public transport. There are good parking facilities. The homes current fees range from £763.05 to £933.78 per week. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2006 to March 31st 2007. The visit lasted from 09:00am until 15.00pm. The home has 12 people in residence who have lived together for a number of years. The visit was spent talking with two residents who were at the home, with staffs interpretation through their individual communication methods, however communication was limited. Time was spent observing direct interaction and support with staff and residents, talking with three care workers, the senior carer, the registered manager and three relatives who visited briefly during the day. Due to the planned activities other residents had left for the day or were leaving as the inspector arrived. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the resident in the report. Some judgements about quality of life and choices were taken from direct conversation and physical responses with people living in the home as well as direct observation followed by discussion with staff and relatives, evidencing records and care plans held at the home. A tour of the house was undertaken. A number of CSCI “comment cards” (completed questionnaires) were received from 4x relatives/visitors; 3x care managers, 3x Health Care professionals and 2x GP’s. The report also uses information provided by the home via a detailed questionnaire. The fax number on page 4 is incorrect and should read 01322 381852. What the service does well: Residents benefit from a staff team who work well together, promote a happy and familiar support for individual residents. Staff know the individuals well and communicate effectively with them. Residents presented as feeling safe and comfortable at the home. Residents have a happy and fulfilled lifestyle with good two-way relationships and contact with their families. Feedback received included: “(Name if resident) has a much better life in the home than she would at home here with us. She now gets holidays, theatre trips and days out where as she wouldn’t other wise.” “We are happy with the care (name of resident) gets here. No complaints” 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 6 Comment cards again indicated good communication, welcoming support from staff. However it was also reflected in a minority that they did not always feel there was adequate numbers of staff on duty. The premises provide good accommodation, with a variety of disability aids and equipment to meet the needs of residents who have a high dependency than others in every day tasks. Personal health care needs are well supported. Residents are encouraged to maintain regular contact with external agencies and professionals to manage their health care and personal preferences. Feedback was received from professionals working with the home. A GP commented, “I think they offer an excellent and caring service”. Other professional stated, “I have found staff at the home very able to incorporate physiotherapy recommendations and related (e.g. wheelchairs/ sleep systems) areas into client programmes. The staff also facilitate regular attendance to external session i.e. Hydrotherapy.” All 8 professional comment cards reflected good communication and working in partnership by with home, ability to see residents privately, staff demonstrate a clear understanding of resident care needs. None had dealt with complaints regarding the home or accessed previous inspection reports. Residents are benefiting from staff continuing their knowledge and skills through ongoing training in core training required. What has improved since the last inspection? What they could do better: Residents would benefit from staff having clear guidelines and information regarding when to administer PRN medication, storage of medication keys and recording of controlled drugs as recommended by the Royal Pharmaceutical Society. Residents would be safer and more comfortable with the resolution of poor water temperature control, supply and heating systems to the home. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 7 Residents and staff would have a better understanding of what to do in the event of a fire alarms sounding with occasional fire drills being completed and recorded. Residents and representatives would have a clearer understanding of the outcome of a complaint through written response on conclusion of an investigation. Staff can develop further the daily records and diaries by ensuring accurate details of the support and care given, how the residents have felt, been involved etc, to reflect the guidelines and assessed plan of care. Through the refurbishment of the kitchen to meet the needs of physically disabled and those with limited mobility, residents could be encouraged to learn new and maintain basic kitchen and catering skills through their daily routines. This will also promote good infection control and basic food hygiene requirements. Residents would find the home more homely, easier to get around and comfortable through the redecoration and maintenance/repairs being completed in bathrooms and communal hallways. Doorways need to be wide enough for those who self propel their wheelchairs to get around the home safely as recommended by the physiotherapists. 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. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 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 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service Residents and representatives have access to the information needed in making a decision if the home can best meet their needs. Residents are given opportunity to find out and work towards personal aspirations and interests at a pace suitable to them. Residents are protected by a written agreement for living at the home. EVIDENCE: The home has developed a comprehensive guide to the home and facilities and services provided, known as the Statement of Purpose and Service Users guide. These are in the written format and not easily understood by residents. The current residents are heavily dependant on relatives and care managers in supporting them in making a decision as to whether the home can meet their needs. Alternative guides have not been explored such as video or cassette recordings but an option the manager would consider and discuss with the organisation. The key working and person centre planning process is developing slowly to offer clear promotion and support in identifying personal aspirations and meeting individual care needs. A care plan viewed showed person centred approaches, with personal aspirations and goals discussed, including, where 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 10 they would like to like to live, experiencing various holidays and activities, and being happy and healthy. Other aspirations reflected their interests and personalities also. The current residents living in the home have lived here for many years, with the last admission being over two years ago. The home has full procedures and assessments to follow in the event of a vacancy occurring. All files seen detailed a simply presented written and pictorial agreement between the resident and Walsingham Company. Relatives signed those seen. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Care plans, risk assessments and guidelines continue to develop with more detailed information to ensure consistent support by staff to meet the individual health and social care needs of residents and to track care provided. Residents and representatives feel confident staff support them in every day decisions, taking risks, being part off aspects of their lives they feel are important, whilst maintaining their confidence. EVIDENCE: Two individual care plans and records were tracked. Goals and care needs have been expanded to be clear and easy to follow. Staff have begun to implement Person Centred Care documentation, those seen were an ongoing working documents and not fully completed by key workers due to gaps identified. Those seen are regularly monitored with formal reviews planned with their care manager and relatives. Residents are heavily reliant on their relative’s/advocates support and understanding to sign on their behalf. Risk assessments viewed have not been reviewed since 2004. All of the residents 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 12 lead busy lives, which present challenges, risks and the opportunity to make mistakes. Regular house meetings supports residents to make their own views known and all such meetings are recorded in writing. Residents’ individual activities and wishes determine mealtimes, menus, holiday venues, décor and activities. Current daily recordings do not allow accurate reflections of the support, care and individual wellbeing given. Staff have a good understanding of handling of confidential information. They know when and how such information should be ‘passed on’. The inspector observed close, positive interaction between staff and residents, enabling residents to feel genuinely liked and respected. Interaction between residents and staff is good showing genuine respect and appropriate familiarity with each other. The sign language used by a resident about the manager was very clear to the inspector, showing affection but some friendly teasing too. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are given encouragement and support to make choices about aspects of their daily lives, including a range of local social and recreational interests at a pace suitable to them. Residents know those around them will support their rights and personal wishes. Mealtimes feel like a pleasurable experience, offering choice, special diets and social opportunity with friends. EVIDENCE: Good contact and support is promoted with family and friends with some residents visiting their family homes regularly staying for a few days. Two residents were away; another went out for the day during this visit. Good relationships have developed between staff and the families, with open familiarity and relaxed observations made today. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 14 Residents participate in some activities in so far as their level of disabilities permit. Residents live within a fairly rigid structured framework as a set of activities during weekdays between 09.00 am and 04.00 pm has been determined for them [i.e. they are transported to either of 2 day centres (2/3 use Gravesend SEC and 9/10 use Dartford Yew Tree centre)]. A member of staff remained at the home to care for a resident who was not feeling well today. The home has the use of three vehicles for transport; a minibus that can accommodate two wheelchair users, a car that can accommodate one wheelchair user and a smaller car. The 2 main day centres co-operating with the home (Yew Tree and Gravesend SEC) also pick up and return residents each weekday. A resident has a “Motability” vehicle funded from personal mobility allowance. A member of staff is in control of the vehicle (on behalf of the resident) during the week and the resident’s family has responsibility for it at weekends. A record book continues to be used between staff and the Yew Tree Centre and Gravesend SEC showing the types of leisure activities, living/educational skills or difficulties experienced that day. Continued support from staff enables individuals to access local area and amenities including shopping, trips to the coast, meals out, and theatres. Annual holiday for two residents have been planned to Sussex and Norfolk so far, with a further holiday away with family too. Each resident receives a nonreturnable grant of £500 from Walsingham towards this. The kitchen was observed to be clean although in need of refurbishment to make it more resident accessible and address cracked tiling and units to manage good food hygiene and infection control. The kitchen was stocked with fresh produce. Support and guidance has been made regarding diet management for residents particularly where subsidised meals are prescribed to monitor and ensure meeting dietary needs. Adapted cutlery and crockery is available for those requiring such assistance. Residents receive full staff support at mealtimes. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. The health, social and personal care needs of residents are well supported with regular contact with specialists and external professionals. Residents are treated with genuine respect and dignity by care staff. Residents would receive more consistent and safe use of PRN medication through the use of clear-recorded guidelines. EVIDENCE: Through discussion with a staff and records viewed, it is clear that residents are given full support and encouragement to maintain personal contact with practices nurses, GP, community learning disability staff, clinical psychologists, mobility advisors, physiotherapists, and consultants, as well as chiropodist and dentists, to maintain good standards of health and well being. The care home staff, medical and social care staff and families have explored issues of medical consent for treatment where residents do not have the capacity to consent, extensively. This has been seen as a lengthy process by 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 16 some of those involved but clearly work through, in the best interest of the residents’ concerned in promoting better health care. Staff spoken with today evidenced they were aware, of the type and nature of the support required for individual’s personal and intimate care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Good systems are in place to administration of medicines as safely as possible. Only staff who are trained administer medication. MAR sheets seen were detailed, and no gaps identified. Medication was being administered as direct by GP. Recommendations were made to improve current practice in record keeping and guidelines were made. See requirements and recommendations at the end of the report. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Systems are in place to enable those living and those visiting the home to raise concerns or complaints with staff. Records need to formalise the outcome achieve from any investigation. Protection from abuse is promoted through staff training and understanding of actions they may need to take. Not all risk assessments and guidelines have not been sufficiently reviewed and kept up to date to ensure consistent support and care. EVIDENCE: Copies of the complaint procedure are available in the home. Due to the nature of the service and those residents living here, using this system is very limited. It was clear relatives knew whom they would talk to if they were unhappy about something and had done this in the past. All residents would require relative/ advocate to identify concerns and raise them on their behalf. Kent Advocacy Scheme was visiting the home today to look at taking on a more active role for residents at the home. One complaint has been received since the last inspection. This has been resolved according to the manager however there was no formal record of the outcome of investigation or letter to complainant detailing findings and actions taken. Staff who were spoken with showed a good understanding of how to protect and prevent abuse, including reporting under local procedures. There has been one recent Adult Protection Alert that has been fully investigated and 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 18 closed. Staff discussed openly what they had learnt from this in a positive manner. Issues of restraint have been addressed particularly for the use of bedsides and seat belts. Also as detailed earlier in the report restraint is being implemented to support a resident with health care checks required daily. The care home staff, medical and social care staff and families have explored issues of medical consent for treatment where residents do not have the capacity to consent, extensively. This has been seen as a lengthy process by some of those involved but clearly worked through, in the best interest of the residents’ concerned in promoting better health care. All restraint being implemented is set through multi-disciplinary meetings with support of the clinical psychologist, being closely monitored and reviewed. Staff are due to undertake formal training in restraint methods as part of this process. Personal and environmental risk assessments are in place, however those tracked today had not been reviewed since 2004. New risk assessments have been implemented as needed. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Residents live in a comfortable and clean home, with a good range of specialist equipment to meet individual needs. Internal maintenance of the property will enhanced residents lifestyles further following completion of the refurbishment of the kitchens, redecoration of bathrooms, hallway areas. Resident’s safety would be improved by better water heating controls and safe low surface temperature heaters being installed. EVIDENCE: The home continues to be presented to good standard cleanliness. The home is split into two units of six bedrooms with their own bathrooms, toilets, kitchen, and lounge and dining area. There is a nicely maintained garden, with pergola and fishpond. A path suitable for wheelchairs circumnavigates the whole house. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 20 The home is rented from a housing association that are responsible for structural maintenance of the property. Walsingham are responsible for the fixtures and fittings and internal maintenance and repairs. The current kitchens are in need of refurbishment to improve easier, safe access and use by residents with a physical disability (i.e. heights of worktops, cupboards, equipment). Cracking of tiles and broken units do compromise good food hygiene standards and basic infection control management. Also highlighted in bathrooms, where a number of tiles have falling off the walls recently and have not been repaired. The electrical water heating and storage heaters are an ongoing issue for the home. Water temperatures are low. Surveys have been undertaken to explore the installation of gas supply and new systems to improve current supplies. An area of concern to the inspector was that of the storage heaters not being able to be boxed in. These have high surface temperatures, which hold a high risk of burns particularly as identified one residents positions themselves against these regularly. This must be address as a matter of personal safety to the residents. A doorway has been moved and widened in a bathroom in one unit, but there are a number of remaining doorways identified in Physiotherapy assessment that require widening access for wheelchair users. These are heavily damaged by the constant knocks. The manager understands this is being planned but over a period of time and through careful budget planning. All rooms are single, individually decorated, furnished. All have specialist equipment to meet their personal care needs. The home has disability aids including four ceiling track hoists (in bedrooms and bathrooms), a battery powered hoist, standing hoist, ‘Parker’ baths, two shower beds, three specialist reclining chairs and a toilet chair. Care reviews continue to monitor the need for additional adaptations, with physiotherapy support and advice sought. The laundry is undertaken on site with adequate equipment to meet the demands of the service. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service A staff team that receives good training and on-going support and supervision supports residents meeting individual needs. Residents would benefit by stabilizing the staff team through positive recruitment to the vacant positions currently experienced. EVIDENCE: The home has 698 hours of staff support per week; this includes the manager and auxiliary staff. The home is currently running with 228 hours unfilled permanent hours. This is being covered by the use of regular agency staff. The same staff is booked to try to maintain familiarity for residents. Adverts are currently at the job centre to fill these posts. Two feedback received from comment cards did indicate that relatives/professionals did not always feel there was adequate numbers of staff on duty. Staff are currently working towards NVQ Level 2, one staff NVQ level 3, four more staff are undertaking HSC award. A new staff file was tracked evidencing good recruitment processes, checks and formal records. References and CRB disclosures are held at head office. Records indicated these were received and satisfactory before employment started. Good induction programmes are 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 22 followed complying with Skills Sector recommendations. Staff are issued with Id Badges. Staff on duty today evidenced a good understanding of residents care needs through the positive relationships formed between them and residents. Rosters are covered by all staff on 24-hour basis including waking night. The home does employ designated waking night staff and a sleep over support. Staff confirmed they receive regular formal supervision. Auditing records showed 7 supervisions and appraisal in the past 12 months. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents personal preferences support and care needs are encouraged through the registered managers open approach to managing the home and the promotion of a safe home and working environment. Representatives, professionals and staff would feel more involved and listened to through a formal quality review being undertaken by the organisation. EVIDENCE: The registered manager has worked with people with a learning disability and physical disability for many years and has completed the Registered Managers Award NVQ 4. The deputy manager is completing NVQ Level 3 in Promoting Independence and the NVQ Assessors Award. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 24 Relatives and staff expressed a high regard for their management approach to the home. Residents felt the registered manager was approachable from direct observations and interaction today. Staff also felt comfortable to approach and discuss issues with the manager directly. A formal quality review of services has not been completed by the home; to gain feedback on what the home does well and what could be improved from residents who are able, their relatives or other professionals involved in their care. Staff meetings occurred at least monthly with minutes taken for reference. The registered manager demonstrated through discussion, a good understanding of the needs of current residents and current issues they require support in. Monitoring health and safety in the home is to a good standard. Equipment is serviced as required to maintain a safe home and facilities. Fire system testing is undertaken monthly and fire risk assessments approved by the fire officer. Fire drills have not been undertaken or recorded. All food records of temperatures are maintained to a satisfactory standard. Risk assessments continue to develop for individuals and staff activities in the home and care duties, however there is not a system to monitor and ensure these are regularly reviewed (many last reviewed 2004). Staff and the manager evidenced a clear understanding of accident/incident recording and reporting under regulation 37 to the commission. Records on the whole at the home are completed to a satisfactory standard, with minor gaps identified. The manager acknowledged these and will explore monitoring systems and reviewing current practice to assist staff in reflecting care and support given. The Operations Manager undertakes regulation 26 visits. Gaps seen today had already been highlighted in the last visit for action. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X 2 2 X 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13(4) Requirement The registered person shall ensure that unnecessary risks to health and safety of service users are identified and as far as possible eliminated. In that: 1) Risk assessments or safe working practice and service users are assessed, recorded with clear action/ strategies to be taken. 2) Risk assessment are formally reviewed and updated on a regular basis. 3) Records of the details and action taken, by whom, why and where strategies cannot be implemented. To be completed by timescale date. 2 YA20 13(2) The registered person shall make suitable arrangements for the recording and DS0000023873.V291805.R01.S.doc Timescale for action 11/07/06 31/05/06 56/58 Turnbull Close Version 5.1 Page 27 safekeeping of medication. In that complying with the Royal Pharmaceutical Society guide to medication management in Care Homes 2003: 1) The medication key is held separately to any other keys in the home. The manager holds the spare key to each cabinet. 2) Controlled drugs are checked each shift and logged by two staff to the correct total in stock in a Controlled drug logbook. To be completed by timescale date. The registered person shall 11/06/06 supply to the Commission at it request a statement containing a summary of the complaints made during the preceding 12 months and the action that was taken in response. In that: Records of the investigation, action taken and outcome of the complaint are maintained including feedback to the complainant. To be completed by timescale date. The registered person shall having regard to the number and needs of service users ensure that: The physical design and layout of the premises to be used meet the needs of service users. 3 YA22 22(8) 4 YA24 23(2)(a) 11/06/06 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 28 In that: Doorways are widened to meet the needs of current service users equipment used. Improvement plan to be submitted by timescale date (including proposed start and completion dates) 5 YA24 23(2)(b)(d) The registered person shall have regard to the number and needs of service users ensure that the premises to be used are kept in a good state of repair and reasonably decorated internally. In that: 1) Bathrooms tiles are repair or replaced. 2) Hallways and communal areas are redecorate / refurbished. 3) Kitchens are refurbished to meet the needs of current tenants. Improvement plan to be submitted by timescale date (including proposed start and completion dates) The registered person shall having regard to the number and needs of service users ensure that adequate supplies of hot water and heating systems are provided in all parts of the home which are used by service users. In that: 1) Heating of hot water supply be reviewed and action taken to meet minimum standards. 2) Current hot surface storage radiators are 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 29 11/06/06 6 YA24 23(2)(j)(p) 11/06/06 reviewed and action taken to reduce the risk of burns to service users. Improvement plan to be submitted by timescale date (including proposed start and completion dates) 7 YA24Y 23(4)(d) The registered person shall after consultation with the fire authority: To ensure by means of fire drills and practises at suitable intervals, that persons working at the care home and so far as practicable service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life. To be introduced and followed by timescale date. The registered person shall establish and maintain a system for reviewing at appropriate levels and improving the quality of care provided at the home. Then supply the Commission with a report of any review and make the report available to service users. In that: Local quality review is undertaken with families, professionals and other stakeholders to feedback on the good service provided and identify areas for improvements. To be completed by timescale date. 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 30 31/05/06 8 YA39 24 11/12/06 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 YA1 Good Practice Recommendations As a good practice recommendation: Alternative methods of sharing information held in the written service user guide; be explored to ensure residents are not excluded from this and totally reliant on relatives and care managers. It is strongly recommended alternative methods be explored to ensure accurate reflection of the care and support provide is recorded daily. Current records do not show this or are dotted around in different places making it difficult to track and review. As a good practice recommendation that Person centre care plans continue to be developed and fully completed with up to date and accurate information. It was acknowledge this is ongoing by key workers. It is strongly recommended that recruitment to permanent 228 hours staffing be implemented as quickly as safe recruitment procedures will allow. It is strongly recommended that action be progressed within agreed timescales to implement requirements identified in the CSCI report. 2 YA6 3 YA6 4 5 YA33 YA39 56/58 Turnbull Close DS0000023873.V291805.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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