CARE HOME ADULTS 18-65
Sycamore Grove (56) 56 Sycamore Grove Trowbridge Wiltshire BA12 9LR Lead Inspector
Malcolm Kippax Unannounced Inspection 18th April 2007 09:25 Sycamore Grove (56) DS0000028338.V337008.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 Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sycamore Grove (56) Address 56 Sycamore Grove Trowbridge Wiltshire BA12 9LR 01225 763056 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) Ordinary Life Project Association Vacant Care Home 3 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (1) of places Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Only one named female service user over 65 years of age. Date of last inspection 24th October 2006 Brief Description of the Service: 56 Sycamore Grove is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). 56 Sycamore Grove is situated in a residential area of Trowbridge. There are some shops nearby. The home has its own minibus. The property is a detached bungalow. Each service user has their own room. There is a large lounge, which has a dining area. There is always at least one support worker on duty during the day. Extra staff are also employed at certain times. An agency carer provides waking cover during the night. The range of fees is £899.47 - £1028.63 per week. Information about the service is available in a Statement of Purpose for the home. Copies of inspection reports are available from the OLPA head office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. They are also available through the Commission’s website: www.csci.org.uk Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home, which took place on 18 April 2007 at 9.30 am. Service users and staff went out during the morning and a second visit was arranged in order to complete the on-site part of the inspection. This took place on 23 April between 12.15 pm and 6.15 pm. The two service users who live at 56 Sycamore Grove were met with, although verbal communication with both people was very limited. They were given the opportunity to look at a photo-story book, which tells people who use services what is done on inspections and why. One service user spent a short time looking at this with the inspector. The home did not have a manager at the time of this inspection. An OLPA service co-ordinator was visiting the home to provide management support. The inspection focussed on following up the requirements from the previous inspection and on the developments that have taken place since then. Information from the last inspection has been included as evidence in this report. Other information has also been taken into account as part of this inspection: • The OLPA Chief Officer provided the Commission with an Improvement Plan in response to the requirements that were identified at the previous key inspection. Ms S. Escott, the OLPA service co-ordinator, provided information about staffing and the running of the home since the last inspection. • Evidence was obtained during the visits through: • • • • Discussion with two staff members and with Ms Escott. Observation. A tour of the home. Examination of records, including the two service users’ personal files. A meeting with the OLPA Chief Officer took place in January 2007, when the future of the home was discussed. The service users’ care manager has also confirmed the action being taken following the reassessment of a service user’s needs. One service user has moved out of the home since the last inspection. During the visit to the home on 23 April 2007, Ms Escott said that the OLPA Chief Officer had written that day to the service users’ placing authority, giving one month’s notice for the two remaining service users to leave the home. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits.
Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The home continued to be without a manager at the time of this inspection. The manager from another OLPA home was having some input at the time of the last inspection and a start had been made with reviewing the risk Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 7 assessments and care plans. This was not followed by the appointment of a permanent or acting manager. A timescale (by 30 June 2007) has been identified for a suitable manager to be appointed, so that service users can benefit from a well run home. An alternative timescale may be confirmed if the home is temporarily closed or unoccupied before this date. Service users have not benefited from stability in the management of the home. Some significant concerns that were raised at the last inspection have not yet been addressed. Risk assessments are not consistently reviewed within the timescales identified. There is a lack of clear guidance for staff about the support that service users require in particular areas. An OLPA service co-ordinator was visiting the home on a regular basis to provide support. The most immediate matters in need of attention were confirmed with the service co-ordinator during the visit on 23 April. These concerned the guidelines and risk assessment for one service user who was at risk of choking and for another service user who needs support with bathing. This is important in order to ensure that support is provided which meets the service users’ current needs and that there is accurate guidance available to staff. There was a system of ‘Shared Action Planning’ (S.A.P.) for identifying the service users’ personal goals each year and for monitoring their progress with achieving these. This system is not well developed in the home, which means that the benefits for service users have been very limited. The system needs to be completed consistently to ensure that service users make good progress with achieving their goals. The goals should reflect better the service users’ individual lifestyles and interests. An OLPA service co-ordinator reported at the last inspection that it was the intention to introduce a new system of Person Centred Planning, to replace S.A.P. This was not yet evident in the home. The deployment of staff means that there are times of day when service users cannot receive personal care in a way that is consistent with the home’s policy. There is a lack of clear guidance for staff, which could put service users at risk. The training requirements of staff members need to be assessed and fully met to ensure that service users benefit from an appropriately trained staff team The service users could receive better support with the upkeep of the garden. The garden could be tidied up and better maintained in order to make the most of the new features that staff have put in place. The use of the garage could be developed and it has previously been recommended that consideration is given to providing a new facility, which service users could use for recreational and therapeutic activities. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 8 Another recommendation from previous inspections has concerned the OLPA license agreements for service users. These had not been agreed between the appropriate parties. Service users do not have the capacity to understand the contents of the agreements and should receive support from an appropriate person outside the home, to ensure that their rights are protected. The agreements include a statement that a service user may be required to move to a different bedroom in the home. However, no information is given about the circumstances in which this could happen. The agreements should not only be signed by the appropriate parties, but also appear to be fair. They should be updated to ensure that they include all relevant items. The Commission has been told that the home is likely to close or be unoccupied for a period of time in the near future. If this happens, the Commission will need to be assured that the requirements and concerns raised in this report have been addressed, before any new service users move into the home. 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. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 9 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 Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 was not looked at on this occasion. No new service users have move into 56 Sycamore Grove for several years. EVIDENCE: Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including the visits to the home. There is a system is in place for identifying personal goals, although the benefits for service users are very limited because of how the system is used. Staff members encourage service users to make decisions and to participate in the home. However a lack of up to date assessments means that service users are at risk of not receiving the support that they need. EVIDENCE: There was a requirement made at the last inspection that a comprehensive and up to date care and support plan is produced in respect of each service user. In order to show compliance with this requirement, the care and support plans and the related risk assessments needed to be reviewed and updated to reflect the service users’ current needs. This requirement had not been met, as some assessments were not being regularly reviewed. There were also occasions when staff practice was not
Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 12 consistent with the written guidance that has been produced about the service users’ needs. The evidence for this is detailed in the ‘Heath and Personal Support’ section of this report. The service users’ files contained some records of ‘Shared Action Planning’ (S.A.P.). This was the system used by OLPA for identifying the service users’ personal goals each year and for monitoring their progress with achieving these goals. It had been found at the last inspection that the forms were inconsistently completed and that one service user did not have a current Shared Action Plan. There was a lack of information, which meant that it was not clear how achievement was being measured and what stage the service users were at with meeting their goals. An OLPA service co-ordinator reported at the last inspection that it was the intention to introduce a new system of Person Centred Planning, to replace S.A.P. The records were looked at again during the visit on 23 April 2007. The S.A.P. documentation continued to be used. New S.A.P. records, dated 21 April 2007, had been set up for one service user. The other service user’s shared action plan was dated 16 February 2006 and had not been replaced with a more recent plan. Goals were identified which focussed on core values and basic care needs, rather than on developing new experiences and activities. These included for example the monitoring of physical and emotional wellbeing. The S.A.P. forms were not being consistently completed. There was a lack of cross-referencing to other records and information that might be relevant. It had been recommended at the last inspection that the system of Shared Action Planning is completed consistently and that the goals reflect a wider range of individual activities that the service users may wish to experience. The service users were not able to express their views directly in a meeting situation. Instead, staff members had taken the lead and used a ‘Tenants Discussion’ form to record relevant issues concerning the service users. There had been discussions about various matters, including travelling in the minibus, swimming and family relationships. Some general risk assessments involving facilities in the home had been updated at the time of the last inspection. These included for example the safety of service users when using the minibus. It was recommended at the previous inspection that the assessment pro-formas are amended. This recommendation is still applicable, as the forms do not provide clear sections for the recording of the outcome of the reviews. Staff members were observed during the visits to be involving service users in some of the domestic routines, such as helping with the meal arrangements. Service users spent time in different parts of the home. Staff members were Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 13 aware of each service user’s whereabouts and recognised that some areas of the home could be hazardous. Some limitations on choice and freedom of movement had been agreed for reasons of personal safety. For example, there were guidelines in place which stated that one service user needed to be accompanied by a staff member at all times when they used the bathroom. The deployment of staff at particular times of day meant that there was a lack of flexibility and choice as to when service users could receive support with certain activities. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is mainly adequate, but good in respect of the meals. This judgement has been made using available evidence including the visits to the home. Service users are supported with attending some regular activities and with seeing their family. This helps service users to keep in touch with the wider community and to maintain relationships. Opportunities for personal development and new experiences have been limited. This is improving as service users receive more individual support. Service users are provided with a varied menu and the mealtimes are arranged in an individual way. EVIDENCE: 56 Sycamore Grove is situated in a residential area of Trowbridge and is within walking distance of some shops. The home had its own vehicle, which took a wheelchair but was of a relatively old design. Staff members have said that
Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 15 they would prefer to have a different type of vehicle, which would draw less attention to the service users and the support that they need. One service user attended a resource centre for four days a week and had one home based day. The other service user had a more unstructured week with fewer planned activities. Their activities were arranged on a flexible basis, taking into account the service user’s views on the day and the staff support available. Staffing levels reduced to one person working after 6pm, which limited what the service users could do in the evenings. It had been recommended at previous inspections that the opportunity for recreational activities and occupation within the home is reviewed, with consideration given to providing a new facility. This had arisen as the three service users who were then in the home had spent a lot of time in the lounge. This room gave service users a large sitting area with a television and music centre. However there was no space for more individual and practical activities, which could have been beneficial in view of the service users’ incompatibility. The OLPA service co-ordinator who was present at the last inspection had said that they would like to see space in the home used in different ways, although resources were not readily available for this. As reported under ‘Individual Needs and Choices’ and other sections of this report, support for service users during the last year has focussed on meeting physical needs and on ensuring that service users are not at risk when together in the home. ‘Shared Action Planning’ has not been well implemented, which means that service users have not benefited from a system that is designed to support them with achieving new goals. Staff members said that in recent weeks there had been more opportunities for one to one support during the day and that service users were now going out more. During the first visit to the home, one service user went shopping in Bath with a staff member and another person was accompanied on a trip out for a game of skittles and a pub lunch. An ‘Activity Record’ sheet was being kept as a means of monitoring the frequency and variety of activities that the service users were involved in. The record for one service user showed that they went out for walks, watched television and had foot and hand massages in the home. Information about the service users’ family contacts and important people in their lives was recorded in their personal files. Each service user had a close relative who they were in regular contact with. Two relatives came to the home during the visit on 23 April. The service user and their two relatives had a meal together. Staff said that they had prepared the type of meal that they knew the service user would like. The relatives’ visit was not a regular event for the service user. Staff members were keen that the visit should go well and worked hard to make it a positive experience for everyone. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 16 A staff member said that a menu is written each Sunday for the week ahead, when the service users’ likes and dislikes were taken into account. The main meal was normally prepared in the evening and service users chose what to have for lunch each day. The menus showed a varied range of meals, which included roasts, take-aways, curries and other dishes that were known to be popular with the service users. Staff said that one service user in particular enjoyed the curries and other spicy dishes, which they thought were important to provide because of the service user’s cultural background. Guidelines for meal times and assessments about support with eating had been produced. As reported under ‘Personal and Healthcare support’ one of the risk assessments had not been reviewed within the required frequency. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including the visits to the home. Service users are at risk because some areas of support are not being regularly reviewed. There is a lack of clear guidance for staff, which can put service users at risk and result in an inflexible approach in the provision of personal care. Service users receive the support that they need with their medication and with accessing health care services. EVIDENCE: Each service user had a ‘Daily Care Plan’ file. The files contained details of the service users’ personal care needs in areas such as bathing, foot care, eye care and dressing. Needs were highlighted with which service users required one to one support from staff. These included assistance with eating because of a risk of choking, and supervision with toileting and bathing because of the risk to a service user with epilepsy. Timescales had been identified within the service users’ support plans and assessments for when different areas of support needed to be reviewed.
Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 18 Requirements have been made at previous inspections to ensure that the service users’ care and support plan were up to date and comprehensive. Some progress had been made at the last inspection with reorganising the files and updating the contents. However it was reported at the time that timescales for reviewing the care and support needs were not always being met. During the visit on 23 April 2007 it was found that there continued to be areas of need that were not being consistently reviewed and where there was a lack of clear guidance for staff. For example, support for one service user with eating and drinking was not being reviewed monthly, as stated in the plan. This was significant, as the service user’s assessments had identified a risk of choking. The assessment referred to the service user’s epilepsy, although a staff member said that the service user’s posture was also a risk factor. Another assessment had been undertaken concerning the bathroom overhead hoist, which one service user used. The most recent review date was given as January 2006 although there was no record of the outcome of this. A staff member said that normally two staff members would be needed when the hoist was used although there were occasions when one person assisted. A bathing assessment for another service user had been reviewed annually up to 2004, but not since then. There were behavioural guidelines in place for one service user. These had been written in April 2005. A number of review meetings had since taken place in respect of this person, although the guidelines did not refer to these. It was confirmed with the service co-ordinator on 23 April 2007 that the immediate priority was to review all the assessments and guidelines relating to eating and drinking and also those relating to bathing and the use of the hoist. There was guidance in the service users’ care records about the provision of personal support. This was commented on at the last inspection, as the way that staff were deployed had meant that it would not be possible to provide service users with personal care in a way that was consistent with the home’s policy. Much of the guidance on personal care and risk assessments was also contained in an information file that was provided for the agency carers who work in the home. The file still included information relating the service user who had left the home earlier in the year. The service users’ files included medical and health sections, in which staff recorded and reported on appointments with health care professionals, such as dentists and chiropodists. Service users were visiting the chiropodist about Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 19 every six weeks. A staff member said that this was costing each service user £26 a session. One service user’s epilepsy management plan was being discussed with the Community Team for People with Learning Disabilities at the time of the last inspection. Staff continued to keep a record of epileptic activity. Other forms were being completed on a daily basis, for example to monitor a service user’s sleep patterns and their food and fluid intake. The medication arrangements were looked at during the visit on 18 April 2007. Staff members were managing the medication for both service users, who were not able to do this themselves. Medication was kept securely and the records of its administration were up to date. Each service user had a medication profile. Health professionals were involved in reviewing the service users’ medication. There were guidelines for staff concerning the use of medication that was prescribed on a P.R.N. (as required) basis. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visits to the home. The service users have very limited understanding of the complaints procedure and are dependant on others to raise concerns on their behalf. Staff members are aware that service users are at risk and work hard to minimise the opportunity for harmful incidents to arise. EVIDENCE: OLPA had produced a complaints procedure, which included contact details for people outside the home. The service users were dependant on other people to raise concerns on their behalf. In the comment cards received at the last inspection, the service users’ relatives confirmed that they were aware of the home’s complaints procedure. The OLPA service co-ordinator reported that no complaints had been received since the last inspection. It was reported at the last inspection that there was an underlying incompatibility between the three service users, which affected the independence and freedom of movement that they could exercise within the home. There had also been a number of incidents involving a service user’s physical aggression towards other service users and occasionally towards staff. One service user has moved out of the home since the last inspection. The Commission has been notified of two incidents that have arisen between the
Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 21 current service users. A staff member said that it was important to be present with service users when they were together in the lounge, in order to ensure their safety. OLPA has liaised with the Community Team for People with Learning Disabilities in connection with the behavioural issues in the home. The home has had experience of making a referral under the safeguarding adults procedures. Training for staff in abuse awareness was provided ‘in-house’ as part of the OLPA training programme. Staff members had received a copy of the ‘No Secrets’ guidance about abuse and the reporting of allegations. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 22 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visits to the home. The accommodation is generally homely and domestic, although the garden is not well maintained. Service users benefit from the support they receive from staff with keeping the home clean and tidy. EVIDENCE: The home is an ordinary detached bungalow in a residential area. The accommodation was decorated and furnished in a homely and domestic manner. The home had a front and rear garden, with some parking space at the front of the property. At the time of the last inspection a sensory area was being created in one area of the garden. Other features such as wind chimes had been placed around the garden. Staff had said that this was particularly
Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 23 beneficial for one service user. However, parts of the garden were overgrown and in need of better upkeep. It was seen during the visits that the overall condition of the garden has not improved and there had been some wind damage to the boundary fencing panels. The home had a spacious sitting room, with a dining area in one corner. There was one toilet for use by the service users and staff. This was in the bathroom, which has been refurbished during the last year. Decoration of the room had recently been completed. The accommodation generally looked clean and tidy. Laundry was carried out in the kitchen and a procedure had been written about the movement of washing to reduce the risk of cross-infection. Guidance on infection control was included in the home’s file for agency carers. As reported under the ‘Lifestyle’ section, it has previously been recommended that consideration is given to providing a new facility for recreational activities within the home. The home’s garage, which is attached to the property, has been suggested as a possible area to develop for this purpose. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visits to the home. Service users benefit from the attention of individual support workers. The effectiveness of the staff team is reduced by a lack of up to date guidance and the way in which staff are deployed. The training requirements of staff members need to be assessed and fully met to ensure that service users benefit from an appropriately trained staff team. EVIDENCE: A requirement was made at the last inspection that the deployment of staff meets the service users’ assessed needs and is consistent with the home’s written guidance on the provision of personal care. This guidance stated that two people will be on duty when female service users are receiving personal care. The change in occupancy since the last inspection had meant that staff members were in a better position to provide individual support to the two remaining service users. However the written guidance on the provision of personal care had not changed. The staff rotas showed that there continues to
Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 25 be lone working from 6 pm until 9 am the following morning. Staff cover after 8 pm each day was being provided by an agency carer. As reported under the section, ‘Personal and Healthcare Support’ some of the written guidance for staff was either inconsistent or not up to date, which could result in service users not being supported in the way that they need. During the visits, staff members were engaged in a range of domestic tasks, whilst responding to service users and the different events that arose. Staff members showed awareness of when service users might be at risk in the home, such as when being near to doors and other obstacles. On occasions, staff provided practical assistance to ensure that service users were safe. The staff present at the time of the visits had worked with the service users for a number of years and appeared familiar with the way that the service users communicated their feelings. During the visits, staff members were seen to be providing support in a positive and friendly manner. Staff employment records were not looked at on this occasion, as no new staff had been appointed since the last inspection. Training records were looked at for the four permanent staff members. Each had received training, or had training booked, in first aid, manual handling, food safety, drug administration, abuse, health & safety and control of substances hazardous to health (C.O.S.H.H.). Two staff had received training in Shared Action Planning. All staff were booked to receive training in infection control on 26 April 2007 and fire training on 8 May 2007. OLPA had identified other subjects under the heading of ‘skills’ training. These included more specialist areas such as sexuality awareness, epilepsy workshop, supporting communication and mental health. Of these, two support workers had attended the epilepsy workshop, although all these areas of training were relevant for each staff member. A member of staff was undertaking their National Vocational Qualification in care at level 2. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including the visits to the home. The appointment of a permanent manager will be required to ensure that OLPA meets its legal responsibilities and so that service users benefit from a well run home in the future. The management arrangements have not ensured that good standards are maintained in the home. There are concerns about the safety of service users, which have not been addressed since the last inspection. EVIDENCE: The home has been without a manager since the last inspection. The manager from another OLPA service had some input after the previous registered manager left. Their involvement did not continue and a manager has not yet been appointed, either in a permanent position or in an acting capacity. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 27 There was a requirement at the last inspection for the Commission to be informed of the arrangements being made for the appointment of a new manager and a timescale for this. Following receipt of their improvement plan, OLPA’s Chief Officer was written to about the management arrangements. It was confirmed that the Commission would require an application for registration to be made and for a manager to be in post before the end of June 2007. If the home was to close for a period of time then there would need to be a manager in post and approved before the home reopened. There was another requirement for the Commission to be supplied with a report based upon the home’s system for evaluating the quality of the services provided. This needed to include those matters that are referred to under Regulation 24(2) of Care Homes Regulations 2001. The report was not received within the timescale identified (by 31 January 2007). An inconsistent approach to risk assessments has been evident at previous inspections. When the home was last inspected in October 2006, a start had been made with reviewing the assessment and related guidance. This included the home’s fire risk assessment. The storage for C.O.S.H.H. related substances had been reorganised. There was no regular health & safety check being made of the home environment and it was reported that this was going to be started. Health and safety matters were discussed again during the visit on 23 April 2007 and some records looked at. A health & safety check of the home environment had not been started and there were environmental risk assessments that were not being kept under review. For example the risk assessment in respect of hot water temperatures had been reviewed annually up to 2005 but not after this date. A review sheet for the generic risk assessments showed that several areas had been reviewed annually in the past, but not during 2006. There were guidelines for staff that needed to be reviewed or updated. For example, there was guidance about the use of the home’s minibus, which stated that one service user should not travel with the other service user, although the service co-ordinator said that this situation had now changed and the two service users were travelling together. Fire drills were recorded in the home’s fire log book. The required frequency of drills was not clearly stated. At the front of the log book it was stated that drills were every three months, but on the recording form a weekly timescale was identified. The last drill had taken place on 10 October 2006 and a further drill was therefore overdue. Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 1 34 x 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 3 x 1 x 2 x x 1 x Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15 Requirement The assessments and guidelines relating to eating and drinking and to bathing and the use of the hoist must be reviewed. (Requirement from previous inspection met in part: ‘All care and support plans, and related risk assessments must be reviewed, in accordance with the timescales identified and updated to reflect the service users’ current needs’). 2. YA33 18(1) The deployment of staff throughout the day must meet the service users’ assessed needs and be consistent with the home’s written guidance on the provision of personal care. (Requirement from previous inspection met in part) 3. YA35 18(1)(a)(c) The training requirements of staff members must be assessed and fully met to
DS0000028338.V337008.R01.S.doc Timescale for action 30/04/07 31/05/07 31/07/07 Sycamore Grove (56) Version 5.2 Page 30 ensure that service users benefit from an appropriately trained staff team. (An alternative timescale to the one identified may be confirmed if the home is temporarily closed or unoccupied before the end of June 2007) 4. YA37 8 A manager to be in post and an application made for their registration. (An alternative timescale to the one identified may be confirmed if the home is temporarily closed or unoccupied before the end of June 2007). The registered person must supply the Commission with a report based upon the home’s system for evaluating the quality of the services provided at the care home and which includes those matters that are referred to under Regulation 24(2) of Care Homes Regulations 2001. (Requirement from previous inspection not met. An alternative timescale to the one identified may be confirmed if the home is temporarily closed or unoccupied before the end of June 2007) 6 YA42 14(2) Assessments concerning the risk to service users from the environment and the facilities in the home must be kept under review and revised having regard to any changes of circumstances. 30/06/07 30/06/07 5. YA39 24(2) 31/07/07 Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 31 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 YA5 Good Practice Recommendations That a third party is involved in agreeing and signing any terms and conditions statements. (Recommendation from last inspection) That the licence agreements include all items that are specified under Standard 5.2 of National Minimum Standards. (Recommendation from last inspection) That the opportunities for recreational and therapeutic activities within the home are reviewed, with consideration given to the provision of a new facility. (Recommendation outstanding from last inspection) That the risk assessment pro-formas are amended to provide clearer section for the recording of review dates and the outcome of the reviews. (Recommendation outstanding from last inspection) That the system of Shared Action Planning is consistently completed with each service user. (Recommendation outstanding from last inspection) That the service users’ have personal goals which reflect a wider range of individual activities that they may wish to experience. (Recommendation outstanding from last inspection) That the policy on quality assurance is amended to include the arrangements made for annual development and for the production of an improvement plan. (Recommendation outstanding from last inspection) 2. YA5 3. YA12 4. YA9 5. YA6 6. YA6 7. YA39 Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sycamore Grove (56) DS0000028338.V337008.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
