Inspection on 13/09/07 for 59 & 61 Whipton Barton Road

This inspection was carried out on 13th September 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

59 & 61 Whipton Barton Road 29/08/08

59 & 61 Whipton Barton Road 04/07/06

59 & 61 Whipton Barton Road 30/01/06

59 & 61 Whipton Barton Road 06/09/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 59 & 61 Whipton Barton Road 59 & 61 Whipton Barton Road Exeter Devon EX1 3NE Lead Inspector Ms Rachel Fleet Unannounced Inspection 13 & 14 September 2007 8.30 59 & 61 Whipton Barton Road DS0000064093.V344583.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 59 & 61 Whipton Barton Road DS0000064093.V344583.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. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 59 & 61 Whipton Barton Road Address 59 & 61 Whipton Barton Road Exeter Devon EX1 3NE 01392 462512 01392 873233 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) Devon Partnership NHS Trust Mrs Gillian Ann Bond Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability - Code LD 2. The maximum number of service users who can be accommodated is 4. Date of last inspection 4th July 2006 Brief Description of the Service: The home provides personal care for up to four younger adults who have a learning disability. It cannot offer nursing care other than that which local district nurses can provide for. The home was originally two semi-detached modern bungalows, which have been converted into one property with nothing to distinguish it externally as a care home. It is in a residential area of Exeter, close to some local shops. There is on-the-road parking outside the home. There are four single bedrooms, with two lounge/dining rooms, a piano room, two kitchens and two bathrooms. There are gardens to the rear and front of the property, still divided into two from when the bungalows existed separately. Weekly fees at the time of the inspection are £1700 – 3000, with the level depending on individuals’ needs. Fees do not include toiletries, chiropody, hairdressing, or personal clothing, which are at cost price where obtained by the home. Nor do they include hire of the lease car (which all people living at the home are expected to contribute to) and fuel for the car. Inspection reports on the home, by the Commission for Social Care Inspection (CSCI), are available in the home’s office. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as part of our usual inspection programme. There were four people living at the home on this unannounced site visit, which lasted 11 hours over two days. Jill Bond, the manager, had previously returned a CSCI questionnaire about the home, including an assessment of what they do well, and their plans for improvement. We had also sent surveys to 12 health and social care professionals (including GPs, specialist community nurses and care managers) who support the people living at the home, and five were returned. Eighteen staff surveys were sent out, with five returned. Neither of the two surveys sent to relatives of people living at the home were returned. The inspection included ‘case-tracking’ of three people – including people with more complex needs, changing needs, and people who rarely had visitors. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (medication sheets, etc.), talking with staff, and observation of care they received. We spent time with all four people who lived at the home, either individually or whilst they were with their peers or staff. Most of them had limited verbal communication or were unable to understand questions we asked, because of their disabilities. Thus we could not get their views in detail. But we also got the views of others who visit the home (through surveys), spoke with five staff, observed staff interactions with the individuals they cared for, looked around the home, and looked at records. These included records relating to staff, peoples’ personal monies, catering, health and safety, and quality assurance. We also spoke with the manager, and ended the visit by discussing our findings with her. Information gained from all these sources and from communication about the home since the last full inspection (in July 2006) is included in this report. What the service does well: The needs of prospective residents will be fully assessed, and assurance given that the home can meet those needs before people move in, promoting the success of any admission to the home. People are benefiting from accommodation that is kept clean, and which is being improved to meet their individual and collective needs. They are enabled to take part in activities that give them some responsibility. They are listened to, being supported by flexible, caring staff who know them well, and who want to safeguard them. They are helped to be part of the wider community around the home, including keeping in touch with their relatives. There are links with community-based health and social care professionals, which help 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 6 people receive health care and support they need. Their medications are managed well, and they have a healthy diet, which takes into account their individual preferences. What has improved since the last inspection? 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. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 7 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 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service: People have access to information about the home to help them decide where to live, but written information needs reviewing, to ensure people can be clear about what the home currently offers. Systems are in place to ensure prospective residents’ needs are fully assessed, with assurance given that the home can meet those needs, promoting the success of any admission to the home. EVIDENCE: There have not been any new admissions to the home since the last inspection, but the manager described a well thought out admissions procedure. Needs and views of those already living at the home would be taken into account throughout the enquiry and assessment period. Information about prospective residents’ needs would be obtained from their current carer and Care Manager. The manager would meet the person concerned to assess their needs more fully, before inviting them to visit the home. These visits could progress to staying for a meal, or overnight, with existing carers if necessary. The person concerned and supporting professionals would be consulted again before a place at the home was offered. Because of this 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 9 considered approach, the home does not intend to admit people in an emergency or at short notice. The Statement of Purpose and Service User Guide both need updating, in the light of changes that have occurred since last year amongst other things. The manager would also like to produce a version more suited to the needs of people for whom the service is intended. And get the staff to give their views on the Statement of Purpose, helping ensure they too are aware of its contents. Contracts seen confirmed the home could meet the individual’s needs, but did not include arrangements for the lease car, which people paid for as an extra to the fees. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 10 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 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to ensure staff have information that addresses peoples’ current and various individual needs and personal goals, so they can give necessary and enabling, but safe, support. EVIDENCE: Staff provided us with the care plans for each person living at the home. Two people living at the home had also recently completed person-centred records detailing their preferences, likes and dislikes, which were shown to us by the manager. One had been helped to take photos to include in these. One person’s plan was very detailed but had not been reviewed for over six months, so did not reflect recent personal achievements well. Care plans generally had little about individuals’ health needs, as surveys from professionals had pointed out. One person’s care plans did not reflect recent changes to their wellbeing, although staff told us about these and what 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 11 investigations were being done. Information from medical appointments, etc. was kept in a separate file, without any cross-reference between this and care plans. And there were no social care plans to ensure varied and regular opportunities for recreation or fulfilment, and encourage new experiences in a planned way. During our visit, the manager replaced one person’s daily programme, which had gone missing from their file. One staff member said they would like meetings specifically for updating of care plans. Very occasional entries in daily care notes were inappropriate (such as ‘Has been well behaved today’, and ‘Silly talk’). The manager said a new person-centred and easier to read health care plan is to be introduced once staff have had training on their use, in November 2007. She also said a relative had attended the review of someone’s care plan, although their attendance had not been reflected. One person’s care plan included guidance relating to their capacity to give consent. Documentation is to be introduced relating medication with individuals’ right to choice. Someone’s preference for the gender of carers helping with personal care was noted in their care plan. Staff were heard regularly engaging with the people they supported to find out their wishes or to reassure them about decisions they were trying to make. Surveys from staff and professionals said relatively low staffing levels were limiting peoples’ choices (-see later section on Staffing). Some personal risk assessments had not been reviewed for over six months. Staff told us someone did not have a chair in their bedroom for a particular reason, but this information was not included in their care records. Personal monies held for three people were checked, and found to tally with records kept by staff. Two signatures had been obtained to verify transactions recorded. Receipts were available for shopping done with or by staff, where checked at random. One staff survey said it was not always easy to get peoples’ spending money, for clothes shopping, and that peoples’ clothes were beginning to look worn. People looked presentable on our unannounced visit, and personal money records showed some expenditure on clothing items. The manager said limited amounts of cash were kept at the home, so she needed to get more if it was needed for such shopping trips which couldn’t always be done immediately she was asked. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 12 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 – 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have limited opportunities for personal development and fulfilment, which can affect their wellbeing in both the short-term and longer-term. EVIDENCE: A professional commented that whilst people received satisfactory personal care, social needs - including needs for appropriate activities or stimulation were not met, partly because of the diverse needs of people living at the home. One felt individuals needed more planned activities. There was evidence from staff of progress in expanding some peoples’ abilities to try new experiences, although this was not reflected well in care plans. Staff felt people had limited opportunities as individuals for recreation or activity, partly because of staffing levels. Some had recently gone together to Dartmoor for a walk, but this had not met every individual’s needs. Three people said there were transport difficulties due to staffing levels, in some 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 13 cases due to shortage of a driver for the lease car. The manager said all permanent staff are insured to drive the car. However, one person we spoke with was anxious about driving the vehicle because of its size. Some staff said that use of agency staff (who are not insured to drive the car) has affected the ease with which staff can leave the home; and they felt agency staff should not be left on their own at the home, because of the complex needs of people living there. The manager later told us that some agency staff are also insured to drive the car. A two-week period recorded in individuals’ recent daily care notes reflected a limited range of opportunities for fulfilment. Care notes showed some people undertook aspects of housework with staff support – one doing their own washing, vacuuming, cleaning windows, shopping for the next meal. We were also told one person was also paid to help deliver the Trust’s post to its facilities, being driven round by staff to do this. One person enjoyed playing their piano. Some people took themselves out to the back gardens as they wished. The manager hopes to review use of digipad door locks when staffing levels are improved; these currently restrict peoples’ freedom of movement. One person went out locally every day, during this period, supported by two staff. Another went out on eight days - to a supermarket or for food shopping for the home, apart from one trip to Exeter quay. A social care professional visited them once in this time to help them with one of their interests. Another person went out with staff on seven days - to shops, apart from one visit to relatives. They had one visitor (a health professional) in this time. They also went out twice without staff knowing they had gone initially. Staff said people living at the home were not recognised locally. A third went out twice to shops, once for a drive, and had two visitors (one being a health professional). Their care notes regularly said this person had spent their time sitting at the dining table with items they enjoyed handling, as seen during our visit. Staff who looked after this person in their previous care setting said they had more opportunity for exercise there. The person’s mobility had since deteriorated, and for different reasons they needed support from two people if they went out. The person’s opportunities for outings and exercise were therefore limited by staffing levels. The manager felt that some issues could be resolved if staff planned ahead or liaised with other staff better, which is something to be addressed with the staff team or individuals. Care records included important dates (family birthdays, etc.). Daily notes showed people were enabled to ring their family, and visit them, as well as revisit places they used to live (despite a tendency to dislike travel). Menus displayed were balanced over the week. They showed that each person chose the main meal of the day once a month. The main meal was sometimes planned for lunchtime and sometimes for the evening. Choices were available, although the two were sometimes similar in some way – both options using a cheese sauce, or minced meat, for example. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 14 Staff said individuals enjoyed one-to-one cookery sessions, the most recent recipe (for biscuits) being pinned on the board. They said one person made snacks for themselves, as noted from their care plan. One person helped themselves regularly to fruit from the kitchen during our visit. We saw that although two peoples’ care plans said a high fibre diet was to be encouraged, only white bread was available during our visit. Staff said this was an oversight on their recent shopping trip. Surveys and staff meeting minutes showed staff thought the food budget was inadequate – currently £30 per day, including £3 per week per person for cleaning products, to feed the four people living at the home and the staff on duty. The manager said the budget was adequate, being the same as for other homes accommodating as many males. But she felt the cleaning budget element was unrealistic, given that some people needed regular laundering of their clothes, spillages occurred quite often, etc. People were active, and their clothes were not ill-fitting. Staff did not feel they were losing weight. They had not been weighed recently, but the manager said people would be attending annual ‘well man’ clinics in future, when they would have the opportunity to be weighed. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 – 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with health and social care professionals help people receive the health care and support they need, though the home should be more proactive to ensure this is done in a timely way and with regard to peoples’ rights. EVIDENCE: People were offered various options for breakfast. One person got up later in the day during our visit, out of choice. We heard staff used guidance in care plans when communicating with people. A staff member felt the team were very keen to promote the wellbeing of the people they supported. Another thought staff created a family atmosphere, with genuine, warm relationships, with evidence of this during our visit. However, one person said staff had needed reminding not to talk about people in front of others. Care records showed some people had had eye tests, dental checks, regular appointments with medical staff (for both physical and mental health needs), and support from specialist nurses. However, there were no care plans in place to evidence that each person had the same opportunity for regular health checks. One person had attended a multidisciplinary review of their needs in 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 16 June 2007. Action points arising from this were being addressed by the home, although one would not be progressed until November 2007. Some staff were concerned people had limited opportunity for exercise. The manager said one person was supposed to go swimming weekly, but the hydrotherapy pool was often closed, or staff had forgotten their swimming things. A health professional said the home appeared to act on their advice, and they had no concerns about medication management. Care records showed that people had their medication regularly reviewed. Medication received for individuals was recorded on their medication administration sheets. The manager confirmed no controlled drugs were in use. There was clear guidance for staff on giving of medication that was not prescribed for regular use but only given in certain circumstances. We saw that such medication was only given occasionally. Care plans also included what staff should do if people declined to take their medication when first offered it. The manager showed us a new easy-read document for people living at the home, on how to make choices about medicines – something a professionals’ survey had said the home needed to work on. This will be completed with individuals once staff have had relevant training in November 2007. An incident form was seen relating to a drug error – the manager had taken appropriate action, and was continuing to monitor staff practice. We saw one handwritten entry on medication sheets, where, to add a new medication, another had been crossed out; the entry was not signed or dated. A small number of signatures had not been recorded to evidence medication had been given. The manager said she would follow these matters up with staff concerned, to ensure correct practice in future. A Homely Remedies policy was available, but needed updating and bringing to the attention of peoples’ GPs, which the manager agreed to do. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place for ensuring complaints, concerns and opinions are heard or reported, although these need development to ensure such information is used to improve the service people receive and to safeguard them. EVIDENCE: The people living at the home approached staff freely during our visit, appearing at ease with them. We heard staff asking peoples’ opinions, and checking their understanding of the responses they got. Staff surveys showed concern for the welfare of those they looked after, with records showing staff were vigilant regarding non-verbal signs of discontent or dissatisfaction. Professionals reported they generally got a satisfactory response to concerns they raised, although sometimes they had to chase up matters. Staff were unaware of the availability of a form for them to record complaints on, which was kept in the office. The complaints procedure was displayed but was quite high on the wall. It named individuals who could be contacted by complainants, but did not include their contact details, and was not very reader-friendly. The manager is hoping to produce a format more suited to the needs of people living at the home. We have not received any complaints about the home since our last inspection. The manager said safeguarding was part of mandatory update days, which one staff had just attended. One staff survey said they and others had not had such updates recently. A policy on reporting of abuse defined abusive practice; 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 18 it didn’t include how staff might report concerns, but the manager said staff had read the Alerter’s Guide (which includes such information). Staff spoken with were aware of their responsibilities, and of whom other than the manager they could report concerns to. Records showed four of 19 staff were due to attend their annual update on safe holding, which the manager said also included safeguarding. Since the last inspection, there has been one allegation of verbal abuse, which is being investigated under safeguarding procedures. We are waiting to be informed of the outcome. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from having clean accommodation that is being developed to meet their individual and collective needs, although ongoing and planned improvements to the environment will make it more homely. EVIDENCE: One professional felt there was a homely, caring environment. Two people were keen to show us their own bedroom – showing us their music collections, pictures, etc. Bedrooms had been personalised, reflecting individuals’ interests, and some had direct access to the gardens. Staff would like a more comfortable settee in the lounge used by people with bedrooms in that area. A piano room is being used for document storage (see Standard 41 in final section of report) and is not homely, although there are plans to change it into a multipurpose room where visitors can be entertained more privately, etc. Some corridor carpets were showing signs of wear. A bath’s wooden base was rotting, but the manager said this was already scheduled for attention and 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 20 agreed the carpets would be added to the renewals programme. Staff said minor repairs were dealt with quite promptly. Staff are responsible for the upkeep of the gardens and had made one area with seating very attractive with flower boxes. Staff said people living at the home had grown vegetables in the summer, with homegrown tomatoes seen. An activities shed had been built recently in one garden. There is a showerhead over the bath, and some grab rails around it. An aid has been obtained for one person who has difficulty getting in and out of the bath. The home looked clean and was free of malodours. One staff acts as link person for infection control, a role that other staff felt was very useful and helpful to the home. Disposable aprons were being obtained as a result of their advice. There are two laundry rooms, separate from food preparation areas, where washing machines have recommended programmes for proper cleaning of laundry. There was no hand soap or hand drying facilities in one laundry area, which the manager said she would address. Paper towel holders have been ordered, for provision throughout the home. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 - 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there is some attention to staff training and development, staffing arrangements do not currently ensure that people’ needs can be met. Recruitment practices are not robust enough yet to fully protect people living at the home from unsuitable staff. EVIDENCE: There were four staff at the home when we arrived – two supporting one person in one part of the home and two supporting three people in the other part. Three staff had worked there for at least nine months, but knew the people living at the home for much longer, having supported them at their previous homes. They clearly knew them well. A fourth was an agency staff who had worked at the home several times before. Care staff are also responsible for making meals and other housekeeping duties. Professionals commented that staff engaged positively with people they supported, as seen during our visit, and with the professionals. Some felt most permanent staff were highly skilled, but agency staff were not familiar with 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 22 people and communication problems had been observed. Surveys from professionals and staff suggested there were relative staff shortages, because of the diverse needs of people living at the home, and the use of agency or bank staff, who are not as familiar with the home so not able to completely fulfil the roles of permanent staff. Digital door locks were fitted on external doors, partly because one person sometimes leaves the home without staff knowing, and a door between the bungalows. The manager intends that these will only be used at night (when there are fewest staff on duty), but is waiting until staff vacancies have been filled. The manager said there were three staff vacancies that could not be filled permanently until a reorganisation had been completed within Devon Partnership NHS Trust. She said she had also requested additional staffing because of the nighttime needs of people living at the home. The manager said action was being taken to address high sickness rates mentioned in surveys. People spoken with said the situation was improving, although there were still some long-term absences. Rotas for recent weeks showed some consistency in agency staff supplied (most from the NHS staff agency), the manager saying two had worked with people living at the home in their previous care setting. One part-time staff said there was good communication so they felt they were kept well informed, despite not working regularly at the home. A professional suggested the home needs systems for communication of what is happening daily – which the manager felt was something to be addressed with individual staff members, since systems were in place. The manager confirmed no new staff had been employed since the last inspection. Most staff had been transferred from other Trust homes, so had not been through recruitment processes. Personnel files for Trust staff we saw did not include original CRB disclosures, but had information to evidence they had been obtained. This did not show enhanced checks were obtained, but Trust staff confirmed they always request these. Our guidance says that moving from one care position to another within the same employer, without a break in service, will not require a new police check provided that the previous check included a Protection of Vulnerable Adult (POVA) check. However, for some of these staff, their previous police check pre-dated the implementation of the POVA scheme on 26 July 2004, so a new police check should have been carried out for these people. We were told some staff had had to apply for their jobs, since they worked in slightly different roles previously. We saw that police checks for two such staff had been obtained seven months prior to their submitting an application to work at the home. Neither application form included any employment history. Of two references obtained for one person, one was incomplete and one was returned after the person’s start date. The manager was able to describe 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 23 appropriate processes that would meet regulatory requirements, for future recruitment of staff. Of 19 staff, five have a recognised care qualification and six are undertaking one. Two of the latter are taking a course particularly intended for those looking after people with a Learning Disability (i.e. LDAF Level3). Some staff said they have asked for training on epilepsy, to avoid having to ring for an ambulance in certain circumstances. A professional felt staff need training on equality and holistic needs, to provide more person-centred care. Training records we looked at for four staff showed they had not had any training or updating on topics relevant to the needs of people living at the home, to ensure they could communicate using Makaton as indicated in one care plan, for example. The manager said the Trust had stopped providing training for financial reasons, except for that deemed mandatory or essential for job roles, but the situation was about to change. Also, a nurse specialist was working with the home was to provide training in coming weeks, related to the needs of individuals living at the home. There was no overview of training attended, for quick identification of those who had attended training on a particular topic and when. The manager told us systems generally relied on notification from Trust training organisers that particular staff were due to attend an update, and on staff bringing in evidence of attendance. Staff surveys said they had not had formal, recorded supervision, when training needs, etc. might be discussed regarding the service the home offers. Records for four staff showed they had last had supervision in December 2006 or January 2007, which some individuals confirmed, although one was due to have supervision again during our visit. The manager said she is restarting such sessions and has met with five staff in the current month. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 24 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, 41 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements for assuring the quality and safety of this service need to be developed and fully implemented, so that people can be assured they will receive a safe, high standard of service. EVIDENCE: The manager, Gill Bond, was registered with us in April 2007, having worked in similar care settings previously as the registered manager of another Devon Partnership NHS Trust home. She qualified originally as a nurse for people with Learning Disabilities, and is a member of the Good Practice committee for the Trust. She is undertaking a management qualification, hoping to achieve this by December 2007. Some staff felt they had enough support to do their job, although they had relatively little contact with the manager (particularly without regular supervision or staff meetings); two staff felt they could achieve 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 25 more with the people they looked after if they were more supported by the manager. The manager said she has spent much time integrating five preexisting staff teams that have been brought together at this home, and has only just begun to benefit from the appointment of a deputy manager. She has worked some weekend shifts and said she is always ‘on call’ for phone advice, when not at the home. Staff meetings are now held every two months, as decided at a staff meeting held in May 2007. There are some systems for reviewing individuals’ care, and monthly monitoring visits by the Trust’s representative. One person had made written suggestions for improvement, and we saw these were being addressed over time – the provision of the activity shed, for example. But, as a professional reflected, there are no formal systems in place to check on the quality and suitability of the service provided that include people living at the home, their families and other supporters (such as other visiting professionals). Some policies had not been recently reviewed to ensure they were appropriate for the current service - some referring to ‘nurses’ when people are not employed in that capacity at the home, for example. People living at the home were being given opportunities to contribute to their personal records. However, information about them was being kept in the piano room. There are plans to archive these, but at present they are not kept securely or in a way that ensures confidentiality. Difficulties in determining staff training are included elsewhere in this report. The manager said she was unable to provide all the information requested before and during the site visit, not having access to it. Environmental risk assessments had been reviewed in June 2007. We saw electrical items had had safety checks in February 2007. However, electric cookers had not been risk assessed, where cooking surfaces remain hot after being switched off. The manager said the cookers were to be replaced. Bath hot water temperatures were not checked routinely to ensure thermostatic controls were still effective, and there was no evidence of the safety of gas appliances. One person on duty had recently undertaken a first aid course, although there was no system to ensure there was an identified first aider on duty each shift. A certificate was seen showing the fixed bath hoists had been serviced in June 2007. There are no mobile hoists at the home. Staff felt they generally had the equipment they needed to do their job. The manager was not aware of ‘Safer food, better business’ guidance. It was not clear which staff had appropriate food hygiene training, though two said they had. The manager thought it was part of mandatory update days, but a staff who had recently attended such a day said it was not. The manager agreed to ask the Environmental Health Department for information and clarification of training expected in such a service. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 26 Some fire safety checks were not recorded at recommended intervals, although guidance available to staff included appropriate frequencies for such checks. The fire risk assessment was last reviewed in 2005. Some staff have not had recent fire training, one saying it was given once a year. The manager said a fire safety questionnaire is used in addition to external training, but it was not clear from records if all staff had had six-monthly training/updating. We have made requirements about aspects of fire safety in the last two inspection reports. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 27 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 1 2 3 3 X 4 X 5 2 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 2 X 2 2 X 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 6 Requirement You must (a) keep under review and, where appropriate, revise the Statement of purpose and the Service users guide; and (b) notify the Commission and people living at the home of any such revision within 28 days. Timescale for action 30/11/07 2 YA6 15 30/11/07 (1) Unless it is impracticable to carry out such consultation, you must, after consultation with the individual or their representative, prepare a written plan as to how the person’s health and welfare needs are to be met. (2) (b-d) You must keep the care plan under review. Where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the individual or their representative, revise the care plan; and notify the person of any such revision. This relates to inclusion of health & social needs in care plans, and ensuring they are reviewed every six months, or sooner if care needs change. 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 29 3 YA33 18(1) You must, with regard to the Statement of purpose and the number and needs of people living at the home (a) ensure that at all times suitably qualified & experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of people living there; (b) ensure that the employment of any persons on a temporary basis at the care home will not prevent people from receiving such continuity of care as is reasonable to meet their needs. This relates to adequacy of staff numbers to meet social needs as well as other needs, taking into account the presence of agency or bank staff. 30/11/07 4 YA33 18(1) (c) (i) You must, with regard to the Statement of purpose and the number and needs of people living at the home ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. This relates to staff training & regular updating on health & safety matters as well as topics relating to the needs of individuals living at the home. 31/12/07 5 YA34 19 (1)(b) You must not employ a person to 30/10/07 work at the care home unless you have obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. This includes two satisfactory written references; a full 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 30 employment history, with a satisfactory written explanation of any gaps in employment; and an enhanced criminal record certificate that includes a check against the POVA list. 6 YA39 24 (1)& (2) You must ensure that the quality of the service provided is monitored. Previous timescale of 31/07/06 not met This must take the views of people living at the home and their representatives into account, in deciding (i) what services to offer to them, and (ii) the manner in which such services are to be provided. 7 YA42 23 (4) You must, after consultation with the local fire and rescue authority — (c v) make adequate arrangements for reviewing fire precautions, and testing fire equipment, at suitable intervals; (d) make arrangements for staff to receive suitable training in fire prevention; and (e) ensure, by means of fire drills and practices at suitable intervals, that staff and, so far as practicable, people living at the home, are aware of the procedure to follow in case of fire, including the procedure for saving life. 31/10/07 31/12/07 8 YA42 13(4) (Previous timescales of 15/02/06 & 15/07/06 not met) You must ensure that— 31/10/07 (a) all parts of the home to which people have access are so far as reasonably practicable free DS0000064093.V344583.R01.S.doc Version 5.2 Page 31 59 & 61 Whipton Barton Road from hazards to their safety; (b) any activities in which they participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This includes considering risks from electric cookers and from hot water; risks to food safety; risks from gas appliances; arrangements for first aid. 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 You should include in the written contract/statement of terms and conditions between the home and the service user, the fees charged, what they cover, and the cost of facilities or services not covered by fees – including the lease car and fuel costs. You should ensure that limitations on facilities, choice or human rights to prevent self-harm or self-neglect, or abuse or harm to others, are documented, to evidence they are made only in the person’s best interest, consistent with the purpose of the service and the home’s duties and responsibilities under law. You should ensure that personal risk assessments are reviewed, as part of care plan reviews. You should ensure that people living at the home have access to, and choose from a range of, appropriate leisure activities, with activities arranged by the home run by trained staff with appropriate professional support and advice. 2 YA7 3 4 YA9 YA14 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 32 5 YA16 You should ensure the daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in individuals’ care plans and Contract – with regard to restrictions created by staffing levels and digipad door locks. You should ensure that the healthcare needs of people living at the home are assessed, recognized, and that there are procedures in place to address them. You should ensure that there is a clear and effective complaints procedure, which staff are aware of, in appropriate language and formats, with reassurance that people will not be victimized for making a complaint, so that people know how and to whom to complain. You should ensure that there is a staff training and development programme which ensures staff fulfill the aims of the home and meet the changing needs of people living at the home - with a training needs assessment carried out for the staff team as a whole, to inform future planning, with training / development linked to the home’s aims and to peoples’ needs & care plans. You should ensure that staff have regular, recorded supervision meetings at least six times a year with their senior/manager, in addition to regular contact on day-today practice (pro-rata for part-time staff), including support and professional guidance, as well as identification of training and development needs. The registered manager should obtain the Registered Managers Award to help ensure she is qualified and competent to run the home and to meet its stated purpose, so people living at the home benefit from a well run home. You should ensure that records required by regulation are maintained, up to date, in good order, and kept securely. (This should include providing clear evidence of staff training and supervision, recording of maintenance and safety checks, as well as proper storage of personal information) 6 YA19 7 YA22 8 YA35 9 YA36 10 YA37 11 YA41 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 59 & 61 Whipton Barton Road DS0000064093.V344583.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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