Inspection on 29/08/08 for 59 & 61 Whipton Barton Road

This inspection was carried out on 29th August 2008.

CSCI found this care home to be providing an Adequate service.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

59 & 61 Whipton Barton Road 13/09/07

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 12/11/2008.

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 29 August 2008 10:25 59 & 61 Whipton Barton Road DS0000064093.V368409.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.V368409.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.V368409.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) Premier Living (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.V368409.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: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 4. Date of last inspection 13th September 2007 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. In total, 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. Coded locks prevent free movement between the two halves of the home. Weekly fees at the time of the inspection are £1500 - 3000, with the level depending on individuals’ needs. Fees do not routinely include toiletries, chiropody, hairdressing, personal clothing, holidays, entrance fees and the cost of some meals on outings. Nor do they include hire of the home’s transport, a lease car (which all people living at the home are expected to contribute to), and fuel. Inspection reports on the home, by the Commission for Social Care Inspection (CSCI), are available in the home’s office. Or they can be viewed, downloaded or requested through our website. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place as part of our usual inspection programme. The home’s rating has not changed since our last inspection, but some improvements were noted. Before our visit, we had sent surveys to the home for them to give to the four people living at the home and to eight staff. We received three back, all from staff. We received back three of six surveys we sent to community social or healthcare professionals supporting people at the home. Our unannounced visit to the home took place over seven hours on a weekday. We spent time with three people who lived at the home, and met the fourth person briefly. All the residents were men. We could not get peoples’ views in detail because of communication difficulties, but two were able to answer some of our questions. We found out what it was like living at the home from them, as well as by talking with staff (including two agency carers), and looking around the home. We ‘case-tracked’ three people, which meant we looked in more depth at their care. They included someone with changing needs, someone with communication difficulties, someone who had few visitors, and someone with more complex needs. We did this by reading their care records and related information (medication records, personal monies records, etc.). We met them, observed some of the care and attention given to them, spoke to staff about their care and other related matters, and looked at the accommodation in relation to their needs. We checked staff recruitment and training files, and records relating to health and safety (such as accident and maintenance records). We ended the inspection by discussing our findings with Mr Daniel Fitzgerald, the deputy manager, who assisted us in the absence of the manager. A CSCI questionnaire (the Annual Quality Assurance Assessment, or ‘AQAA’), sent to the home ahead of our site visit, was returned after the 28-day timescale for return of AQAAs. This was in part due to the manager having some leave during the time period set. It was therefore not seen before our visit. The AQAA included the home’s assessment of what they do well and any plans for improvement, as well as information about the people living at the home, staffing, policies in place, and maintenance of facilities. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 6 Information included in this report is from all these sources, and from communication with or about the service since our last inspection. What the service does well: What has improved since the last inspection? People can get clear information about what the home currently offers to help them decide where to live, since written information had been amended. People living at home have better opportunities for personal development and fulfilment, promoting their quality of life. Their opinions and the opinions of the various people who support them are being sought, with a view to improving the quality of the service received by people living at home. The home’s improved recruitment practices protect them from unsuitable staff. Arrangements have been made to ensure first aid treatment is available should people need it. There are new carpets and other new fittings, with more refurbishment planned. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 7 Files and other paperwork are stored away appropriately, protecting peoples’ personal information and making their accommodation more homely. Formal staff supervision meetings have begun. 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.V368409.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is good. People have access to information about the home to help them decide where to live. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have not been any new admissions to the home since the last inspection. The deputy manager confirmed the home’s admissions procedure was, in theory, still as thorough as described in our last report. However, because the suitability of the accommodation and the service was currently under review, he did not expect that the home would admit anyone until the review had been concluded next year. And because of the home’s considered approach to admissions, it would not admit people in an emergency or at short notice. Information for prospective residents - the Statement of Purpose - needed minor updating, but gave clear information about the service offered. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 10 We were told that the home’s written contract/statement of terms and conditions now included details about the lease car arrangements and associated costs, as recommended at our last inspection. 59 & 61 Whipton Barton Road DS0000064093.V368409.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 & 9. Quality in this outcome area is adequate. Although there have been improvements, staff do not yet have sufficient current information about each individual’s diverse needs, personal goals or risks to their welfare. People living at the home may not, therefore, get necessary, person-centred, enabling and safe support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff had commented in surveys that care plans had not been kept up-to-date nor were they always accessible, but added that this was beginning to be addressed. They also said communication was usually good, and that handovers between staff and shifts had improved. We looked at care plans and associated records for the three people we were case-tracking. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 12 We found one person had a comprehensive care plan based on thorough assessment of their needs. This guided staff about communicating with the person as well as how they communicated, their medication, mental health needs, etc. Aims and goals were included for each need. The format had been adapted to better suit the individual’s needs. Aspects were cross-referenced to other information elsewhere in the person’s care records. The care plan had been achieved through input from communitybased professionals, who were working with the individual as well as with staff at the home to ensure this person’s needs were properly identified and an appropriate care plan subsequently developed. However, the care records we were given for two other person did not include an updated care plan based on review of their current needs. The AQAA said health care plans had been completed for everyone at the home; one was not found for one individual we case-tracked, although it was positive to see a health needs assessment had been carried out. There was no guidance in their existing care plan on how they might be helped with a particular sight problem - regarding appropriate lighting for the condition, etc. Some relevant personal risk assessments had not been reviewed for over six months. Someone’s preference for the gender of carers helping with personal care was noted in their care plan. One person’s care plan included guidance relating to their capacity to give consent. But, as noted in one professional’s survey, peoples’ capacity to make decisions or ability to advocate for themselves was not fully reflected through some care plans. For example, in relation to taking medication. People living at the home all needed help to manage their finances. The deputy manager told us that the local authority staff are to become their appointees, taking over from senior staff at the home who currently act in this role. In two people’s care records, there was clear guidance for staff on management of identified risks, following multidisciplinary involvement in risk assessment and subsequent decisions in some cases. All aspects of needs had been considered (emotional, sexual, etc.). We saw one environmental risk assessment that took account of the different abilities and needs of those living at the home, adjusting management of the risk according to the individual concerned. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 – 17. Quality in this outcome area is good. Opportunities for personal development and fulfilment have improved, promoting peoples’ wellbeing and quality of life, although they do not have equal opportunities for involvement in the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person we spoke with confirmed they used the garden, including for a barbeque held in the summer for everyone living at the home. Daily care notes for another person said they had recently been picking tomatoes they had grown in the greenhouse. During our visit, one person was freely able to spend time singing and playing music in the piano room. Another was assisted to listen to particular music, 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 14 which we saw was included in their care plan. Both clearly enjoyed these opportunities. Staff told us that some people living at the home keep a diary that they write in, and they are enabled to write cards on special occasions (to family, etc.). Daily care notes showed some people were enabled to phone relatives regularly. Availability of a cordless phone meant people could talk in private, if they wished. The AQAA said the home did not have a written policy for contact with family and friends. We have since discussed with the manager why such a policy would be useful. We saw that one person had been to a matinee, attended music therapy and was able to attend a church on Sundays when they chose to. Another person attended a day centre, and occasionally went swimming. Although they paid for it themselves (rather than the home paying, as the National Minimum Standards recommend), someone had been on a holiday, accompanied by a staff member from the home. During our visit, someone helped write the home’s shopping list before going out with staff to the shops. Developing this person’s activities in the community was a slow process, but we noticed the progress made since our last visit. One person was encouraged to do their own laundry, which we saw was part of their care plan. Others were to help with gardening, and cleaning their bedrooms. The AQAA stated that no changes had been made to promote equality and diversity because the home had already addressed this. However, we noted some individuals had a more limited range of opportunities for fulfilment than their peers, as also identified at our last inspection. One person’s daily records showed that most of their recent outings were to help deliver post to the provider’s various facilities, for which they were paid. When they had not done this, because of a shortage of drivers for the home’s vehicle we were told, they had not been enabled to have other outings instead. Menus displayed were balanced over the week, with choices shown for some mealtimes. The main meal was usually planned for the evening. Fresh produce and a range of condiments were seen in the kitchens. Someone had been given their own copy of the menu, which they were encouraged to refer to when we asked them about their meals for the day. During our visit, staff also discussed with people what they wanted for their next meal, going shopping for the ingredients with one person. Care records showed some people helped staff at mealtimes in various ways. 59 & 61 Whipton Barton Road DS0000064093.V368409.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. People generally receive health care and support they need and want, often through involvement of other professionals, although inadequate care planning for some creates a risk they may not receive fully person-centred care. Their medication is managed on their behalf with sufficient care, although some small improvements would make systems more robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people we asked confirmed that staff were kind to them, and helped them look after themselves. Care records had lists of individuals’ preferences, and their likes/dislikes in all areas of their lives, which was then linked to care plans - how to reassure or relax the person, or how to encourage them with certain activities, for example. Asked, ‘Does the service support individuals to live the life they choose?’ one professional, who supported only one person at the home, said ‘Always’. Two 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 16 others said ‘usually’ or ‘sometimes’, saying environmental factors affected relationships and how people were able to live together in the home. A communication from a professional we read in care notes said that their patient received high quality care at the home. Surveys from all three professionals said the service usually or always met peoples’ diverse needs, although again, one thought the environment was not helpful. Care records showed community-based professionals - such as occupational therapists – had also been involved in supporting individuals. Minutes of staff meetings showed that these were used to discuss individuals’ care needs, how to improve the support they got, changes to their medication with subsequent monitoring required, etc. General information was available for staff on the more diverse health conditions people had, seen at our last visit. Staff told us they had had relatively little updating to ensure they could meet peoples’ current or changing needs (see section on ‘Staffing’). Two agency staff on duty during our visit said they had worked at the home before, and had been encouraged to read peoples’ care plans. One explained to us how a second clock in the lounge was used, which we saw from someone’s care plan was to help the person progress through tasks and events during the day. However, we noted there was less interaction between these staff and residents than between permanent staff and residents. We discussed this with the deputy manager, querying why agency staff were working together, with permanent staff working together in another part of the home. Some staff told us this was not uncommon; they felt it was disadvantageous for certain people living at the home, affecting continuity of their care. The deputy manager told us certain people had been told who would be supporting them that day, for their own reassurance, before any agency staff were booked. A change of carer would then be too disruptive for them. Care plans included some very specific guidance for staff – such as how to respond to someone who repeated questions or showed certain behaviours. We saw staff using some of these strategies during our visit. Records showed people were generally supported to get routine health checks, such as dental appointments, or ‘well man’ checks. One person with deteriorating mobility was being followed up by various health professionals. Specialist healthcare needs were met through referral by the home for multidisciplinary input and specialist services. Professionals’ surveys said they thought that individuals’ health care needs were usually met by the care service. However, whilst one survey from a professional said the home acted on advice they sought, another said the 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 17 home did not always act on advice they were given, with agreed actions not always followed through. Professionals’ surveys said the home ‘usually’ or ‘always’ supported individuals with their medication, or managed it correctly for them if they couldn’t look after it. We saw agency staff did not give out medication. Care records showed that people had their medication reviewed regularly; one person’s health care plan had information about the support they needed with medication. One professional told us there had been multidisciplinary discussion about peoples’ medications, to ensure it was used in peoples’ best interests, although staff needed to consider further peoples’ consent to take medication and recording of this. We saw guidance in individuals’ care records clarifying when medication prescribed for use only in certain circumstances should be given. Reasons for giving such medication had been recorded, on each occasion, by staff. Medication received into the home were recorded on medication administration sheets from the supplying pharmacist, with signatures to show when medication had been given to individuals. The deputy manager said he would ensure systems for verification were used in future, when we found one handwritten direction on an administration record had not been signed or dated. The one controlled drug we saw at the home did not need specialist storage or recording in a controlled drug register, although the latter is a good practice recommendation. Only one medication (a short course) required storage in a fridge; it was being kept amongst food items. The deputy manager agreed to ensure proper storage for any refrigerated medication. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. Systems are in place to ensure formal complaints are addressed, to improve the service people get. Various measures are in place to prevent people being harmed but staffs’ knowledge of local safeguarding procedures, reducing the level of protection people have. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff surveys said they knew what to do if someone living at the home or their family/friends had concerns about the home. Those we asked were clear that they would report complaints to senior staff, in person or in writing if they were absent. Everyone currently living at the home would need support to make a formal complaint or to achieve a satisfactory outcome to any concerns they expressed. The people living at the home approached staff freely during our visit, appearing at ease with them. We heard some staff asking peoples’ opinions, and checking their understanding of the responses they got. Peoples’ expressed choices were noted in daily care records, and were respected by staff during our visit. On our visit, the home’s complaints procedure was not freely available since it was being updated and reproduced. It has since been sent to us. Some 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 19 amendments are needed, which we discussed with the manager, but it gives people the information they need to make a complaint. There was general information, in an ‘easy read’ as well as standard format, on how to make a complaint through the Patient Advice and Liaison Service (PALS) run by the local NHS Trust. The AQAA said the home had not received any complaints, and we have not received any complaints about the home since our last inspection. Two professionals said the home had responded appropriately if concerns had been raised about peoples’ care. A third said the home had responded appropriately only ‘sometimes’, needing prompting, and not always acknowledging the seriousness of the concerns or the impact on individuals. The need for more timely or proactive action, generally, is discussed in the final section of this report under ‘Conduct & Management of the home’. One staff member told us they had not had a safeguarding update in the last year. They could define abusive practices and said they would report any concerns, but were unclear about the local authority’s safeguarding procedures. The deputy manager was not aware of aspects of these procedures but showed us contact details - displayed in the office - for Community Learning Disability staff who had safeguarding responsibilities. The manager has since confirmed no-one at the home has had the local authority safeguarding training. We checked the personal monies accounts kept by the home for the three people we were case-tracking. Two staff had signed transactions to verify them, relevant receipts were available, and cash held matched the totals shown on each account. Statements were also available for individuals’ bank accounts; these could be cross-referenced with records kept when staff took and returned individuals’ debit cards, when withdrawing money on their behalf. We discussed with the deputy manager whether the home should be contributing to the cost of bed linen and pillows we saw had been bought with individuals’ own money. As a registered service, the home is expected to provide such items for residents, although individuals buy their own if they wish to personalise their bedroom, etc. Clarification was to be sought from senior managers. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. People benefit from accommodation that is being made more homely as well as more suited to their individual and collective needs. Lack of attention a crossinfection risk could affect peoples’ wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people showed us their bedrooms – showing us their photos, pictures, new bedding and curtains, etc. One confirmed the room kept warm enough for them. Bedrooms had been personalised, reflecting individuals’ interests. Some had direct access to the gardens. We noted there were no chairs in bedrooms, but did not see the reason for this reflected in individuals’ care records, as noted at our last inspection (addressed under Standard 7). 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 21 There are showerheads over the baths, and some grab rails to help people when getting in/out of the bath. One bathroom looked warmer and more welcoming than the other. Toilets and bathrooms had privacy locks. We saw improvements since our last visit, in that the piano room has been made more homely, with the home’s paperwork removed and seating provided. And new corridor carpets had been fitted. Furniture was domestic in nature and appeared to be in a good state of repair. Staff said minor repairs were dealt with quite promptly. One cooker was not working properly, which they said was to be replaced; quotes were being obtained for kitchen units, where some were showing signs of use. An area at the front of the home looked very attractive, with garden furniture and flower boxes. People are unable to use this independently because it is not secure, but have free access to the back gardens. One professional was concerned about the living conditions for the three people living in one half of the home, given their diverse and individual needs. People sometimes went into the other half of the home, although this was restricted by their ability to use a coded lock. Bedrooms were not furnished in a way that encouraged them to spend time in their own rooms. Although one person was at an appointment for much of our visit, we saw all three using the compact lounge-diner at times. The activity shed - requiring people to go outside to get to it - was set up last year to give people more day space, for time away from their peers if they wished. The piano room had been made more inviting, and was used by one person for long periods during our visit. The AQAA said staff addressed the problem by being more proactive in giving people opportunities to spend time apart, and the possibility of alternative accommodation was being considered. The home looked clean, and was free of malodours. Staff told us a colleague acts as link person for infection control, a role that the staff felt was very useful and helpful to the home. They said disposable gloves and aprons are always available for use if required, to prevent the risk of infection. 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 either laundry area, which was something the manager said she would address at our last visit. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 22 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 & 35. Quality in this outcome area is adequate. Whilst some improvements are evident, staffing arrangements do not yet ensure that people’ current and changing needs will be met consistently and safely. Recruitment practices protect people living at the home from unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived, there were care two staff on duty who had known the people living at the home for several years. Two agency carers were also on duty, both of who had worked at the home before. The deputy manager had taken one of the people who lived at the home to an appointment, with both returning later in the morning. We were told this was the usual weekday staffing, with four staff at week-ends (since senior staff worked in a supernumerary capacity at week-ends). Two staff worked overnight. The home’s staff that we spoke with were clearly interested in their work and committed to the people they supported. They appeared to have good 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 23 relationships with them and with each other. Surveys from staff indicated the staff team was more settled and more positive than at our last inspection. Care staff carry out housekeeping duties – cooking, cleaning, gardening, decorating, etc. – with some people living at the home sometimes helping. A professional suggested the home could improve by increasing ‘staffing levels to enable clients to get out and about more often.’ This was reflected in staff surveys, with one also saying the use of agency staff affected continuity of care. Others felt some individuals should have the same opportunities for oneto-one attention as their peers had. We noted from care records that some people went out less regularly than others. Staff told us there was some constancy in the agency staff supplied to the home. But they felt it unfair that the agency staff were usually allocated to look after certain people within the home, creating more inconsistency in the lives of these people compared to others. Rotas for the week showed 17 shifts covered by 8 agency staff, all looking after this group. The deputy explained that this was because of particular needs of some individuals, who were thus supported by the home’s own staff as much as possible. Only one staff member had joined the home since our last inspection, transferring from another of the provider’s services. Their recruitment file contained required information, including timely police checks, to ensure they were fit to work in this care setting. This was an improvement since our last inspection. The staff member had a recognised care qualification. We were told it was hoped two more staff would soon be joining the home. The AQAA pointed out that any new staff are transferred from other services owned by the provider, rather than through more open recruitment processes. One staff member commented that training opportunities had improved in the last year, with all staff being involved. We found several staff had had training to increase awareness of the experiences of people living at a care home, considering issues such as privacy and choice. There was little evidence, from staff or records, of other person-centred training in the last year, although some staff had undertaken epilepsy awareness updates. When asked if they had the right experience and knowledge to meet the needs of people at the home, two said they would like the opportunity to learn more. The AQAA did not give us information on how many staff had a recognised care qualification. The manager has since told us that of 20 care staff, seven have a care qualification (NVQ Level 3 in Care) at a higher level than that recommended, with two staff currently undertaking it. Some agency staff employed have the qualification, although exact numbers were not known. Two staff surveys said the manager sometimes met with them to give them support and discuss how they were working (- a third did not answer this 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 24 question). One added this could be improved further. We recommended at our last inspection that staff should have regular supervision. Staff files showed senior staff had recently begun a programme of one-to-one formal, recorded supervision sessions with individual staff, when training needs could be discussed, etc. Staff meetings were held in alternate months - an improvement since our last inspection. Minutes showed a range of topics were discussed. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate. Although improvements are evident at the home, it is not yet managed proactively enough to ensure it is run in peoples’ best interests to promote their long-term health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s manager, Gill Bond, was registered with us in April 2007, having previously been the registered manager of another, similar care home owned by the same provider. She qualified originally as a nurse for people with Learning Disabilities. She has just begun a management course, which she intended to achieve last year but now hopes to complete by next summer. 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 26 The AQAA was returned after the stated deadline, the manager having been on leave. Written responses did not always relate to the information requested, but it gave us most of the information required. Service users’ views were reflected as part of the home’s evidence that it was doing well in some aspects of home life. Matters discussed our last inspection – reflected already in this report - hadn’t been dealt with in a timely way, including two requirements. A community professional thought that the home was slow to address concerns raised about care, and slow to carry out agreed actions. But surveys, with our visit to the home, also showed much improvement had been made in certain areas, with a much more positive atmosphere evident. Fewer requirements have been made on this occasion. The provider’s representative had just carried out a monthly monitoring visit as is required. We were told that the future of the home was being reviewed, so its suitability for individuals living there and the service they received was being assessed. Meetings had thus been held to get the views of peoples’ families and community-based professionals. An action plan for improving the quality of the service, both in the short-term or longer-term, was still to be produced. There were some systems for improving individuals’ care through discussion at care plan reviews and staff meetings. Individuals’ risk assessments indicated a first aider was to be on duty at all times. Training records and duty rotas showed that this was achieved during the week we visited - another improvement since our last inspection. Of the training records we looked at, two staff had not had updates on safe working practices (manual handling, infection control, fire safety, food hygiene, etc.) in the last year. Senior staff were not aware of ‘Safer food, better business’, food safety guidance that we discussed at our last inspection. The agency staff told us they had been shown fire safety procedures, as we saw was done with a new agency staff member later in the day. We noted electrical items had been checked recently for safe functioning, as stated in the AQAA. The last home’s AQAA said wiring circuits were checked for safety in 2007. Servicing of gas appliance was overdue, although this was being addressed. There was no evidence that electric cookers had been risk assessed, where cooking rings remain hot after use without appearing so, or of checks to ensure bath thermostatic controls were still effective. These matters were raised at our last inspection. The manager has since been provided evidence of risk management strategies for the cookers; she told us that visiting maintenance staff who tested water temperatures did not leave records at the home. 59 & 61 Whipton Barton Road DS0000064093.V368409.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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X 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 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X 59 & 61 Whipton Barton Road DS0000064093.V368409.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 YA6 Regulation 15(1) & (2) Requirement (1) You must, after consultation with each person living at the home or their representative wherever possible, prepare a written plan as to how each person’s health and welfare needs are to be met. (2) You must review each person’s care plan, and revise it where appropriate, after consultation with the individual or their representative wherever possible, notifying the person of any changes, Including how each person’s health & social needs are to be met, reviewing care plans if care needs change or at a recommended minimum interval of 6 months. Original timescale of 30/11/07 not fully met. 2 YA23 13(6) You must make arrangements, through training staff or other measures, to fully safeguard people living at the home from abuse or harm, Including ensuring that all staff 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 29 Timescale for action 30/11/08 31/12/08 know the local authority’s safeguarding procedures for reporting allegations of abuse. 3 YA42 18(1)(c)(i) You must, with regard to the Statement of purpose and the needs of the people living at the home, ensure that staff receive training appropriate to the work they are to do, Particularly training & regular updating on safe working practices (food hygiene, fire safety, etc.). 4 YA42 13(4) You must ensure that (a) All parts of the home to which people living there have access are, so far as reasonably practicable, free from hazards to their safety; (b) Any activities they participate in are, so far as reasonably practicable, free from avoidable risks; and (c) Unnecessary risks to their health or safety are identified and eliminated as much as possible, Providing evidence that timely action has been taken regarding the above, including of routine servicing & maintenance checks identified in the report & AQAA. Original timescale of 31/10/07 not fully met. 31/10/08 31/12/08 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 30 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 YA7 Good Practice Recommendations You should ensure that limitations on facilities, choice or human rights are documented, showing how individual choices have been made or why others have made decisions, to evidence this is 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 each person’s personal risk assessments are regularly reviewed, including as part of their care plan reviews. Each person living at the home should be fully supported to become part of, and participate in, the local community taking their assessed diverse needs into account to achieve this. Schedule 3 controlled drugs (such as midazolam) should be recorded in a controlled drug register. There should be proper hand washing facilities in laundry areas, since staff may be handling soiled/infected items for washing. 50 of care staff including agency staff should have achieved a care NVQ at least to Level 2. You should ensure that there is a staff training and development programme which ensures staff can fulfil the aims of the home and meet the changing needs of people living at the home. 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. 2 3 YA9 YA13 4 5 6 7 YA20 YA30 YA32 YA35 8 YA37 59 & 61 Whipton Barton Road DS0000064093.V368409.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V368409.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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