Inspection on 13/08/08 for 59 Bury Road

This inspection was carried out on 13th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

59 Bury Road 08/08/07

59 Bury Road 26/06/06

59 Bury Road 08/11/05

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 59 Bury Road Gosport Hampshire PO12 3UE Lead Inspector Laurie Stride Unannounced Inspection 13th August 2008 11:00 59 Bury Road DS0000064247.V368953.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 Bury Road DS0000064247.V368953.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 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 59 Bury Road Address Gosport Hampshire PO12 3UE 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) 02392 587329 www.caremanagementgroup.com Care Management Group Ltd Care Home 6 Category(ies) of Learning disability (0) registration, with number of places 59 Bury Road DS0000064247.V368953.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 - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Learning disability - LD The maximum number of service users who can be accommodated is: 6 8th August 2007 Date of last inspection Brief Description of the Service: This service was registered in May 2005 and is owned by the Care Management Group. The provider has two houses next door to each other in Bury Road and they are registered separately. The house has been refurbished to a good standard and provides a home for up to six people who have a learning disability and/or autism and challenging behaviours. Each person has a single room with en-suite facilities and access to the communal areas. The current range of fees at the home is £1,850.36 to £2,155.31 per week, depending on the assessed needs of individuals. This information was obtained at the time of the inspection visit. Members of the public may wish to obtain more up-to-date information from the care home. 59 Bury Road DS0000064247.V368953.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 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit took place as part of a key inspection of this service. The visit lasted nine hours during which we (the commission) met the people who live in the home and spoke with the home’s deputy manager and three members of staff. As part of the inspection we received completed survey questionnaires from one of the people who use the service, a member of staff and a healthcare professional who visits the service. We also looked at samples of the records kept in the home and undertook a brief tour of the communal areas of the premises. Further evidence used in this report was obtained from the home’s annual quality assurance assessment (AQAA) and the previous inspection report. What the service does well: What has improved since the last inspection? 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 6 The goals and wishes of people who use the service are now being recorded. This is to make sure people are getting the support they need to achieve their goals. 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 Bury Road DS0000064247.V368953.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 Bury Road DS0000064247.V368953.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): Standard 2 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home’s assessment and admissions process has not always protected the people who use the service. EVIDENCE: The previous report identified that care needs assessments had been undertaken for all the people living at the home before a place there was offered, to ensure the home could meet their care needs. The report also commented that people would benefit from the Service User Guide being provided in a more user friendly format. For this visit we had received a survey questionnaire from a person who uses the service, indicating that they had been asked if they wanted to move to this home. They also indicated that they had not received enough information about the home before they moved in so they could decide if it was the right place for them. We saw that the home’s Service User Guide gave clear information about the home, although the home’s annual quality assurance assessment (AQAA) acknowledged that people would benefit from the information being in a more user friendly format. Some of the information in the Guide, such as the complaints procedure, was in need of updating. The deputy manager said that this was work in progress. 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 9 The home’s deputy manager told us that, since our previous visit, one individual had left the service for a period of ten months, after which the person had been re-admitted to the home. The original assessment carried out in 2005 had been suitable at that time, however the person’s needs had changed during the period away from the home and a new assessment had not been carried out by the organisation’s referral and assessment team. A risk assessment written by the person’s care manager in December 2007 was not received by the home until May this year. We were told that the home would not have admitted the person had this and other information been made available. Since the person was re-admitted there had been a number of incidents, involving safeguarding referrals, complaints to the home from neighbours, assault on staff members and the involvement of the police. We were informed that the service had served notice on the individual and the person’s care manager was looking for a suitable placement. The home’s AQAA stated that there are regular reviews of individual’s assessed needs and that the service could do better in relation to the compatibility assessment for prospective service users. During our visit we saw records indicating that people’s care needs were being continually assessed while they were living at the home. A health professional commented in our survey questionnaire that the service could improve through looking at the compatibility of individuals more, before new people move in. The home currently accommodates five individuals with a very wide range of needs and members of staff we spoke to also felt that compatibility assessment was an issue for the service. One staff member said the staff team give “support as best they can and make it work.” Asked what the service could do better, a member of staff said in our survey questionnaire “get the right mix of service users so we can do more things as a house.” During our visit we spoke with the person who had been re-admitted and with members of staff. We also observed staff interacting with and responding to the individual and others in a calm, friendly and professional manner. Staff members understood the person’s needs and worked in line with the guidelines the home had drawn up since the person moved in. The deputy manager said that the assessment and referral team would now be working more closely with the home’s managers, giving them a more active role in making the pre-admission assessments. A joint visit to assess a prospective service user’s needs was planned for the following day. 59 Bury Road DS0000064247.V368953.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): Standards 6, 7 & 9 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service are supported to make their own decisions. Individual’s changing needs, wishes and goals are now better reflected in their care plans. Staff members respond well to individuals’ needs and this would be better supported by more timely provision of training. EVIDENCE: The previous report identified that people who use the service are supported to make their own decisions and participate in all aspects of life at the home. A requirement was made that people’s goals and wishes must be documented and support be given to people to achieve their goals. The home’s annual quality assurance assessment (AQAA) stated the home does well at promoting independence and in effective communication. It told us that guidelines and risk assessments were regularly updated. It also said that the service had improved through the involvement of people who use the service in their care plans and reviews. 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 11 We saw that individual goals with timescales for review had been developed this year. The timescales were not yet reached so it was not possible to fully assess the outcomes for people, but monthly reports of meetings between individuals and their key worker gave an indication of progress in meeting goals, or changes in the person’s plans. One individual had indicated a wish to travel by aeroplane and this was being risked assessed and planned, with the person’s parents’ support and encouragement. Another person had been supported in looking for part-time work and had attended an external course for people seeking to overcome barriers to employment. During our visit we looked at samples of records from three people’s care and support plans, which were mostly held in four main files for each individual. This resulted in some duplication and made tracking of information difficult, although the deputy manager was able to find all the information we asked for. A staff member we spoke to said the care plan system worked for them “once you know where everything is.” Another confirmed this view but both felt that new staff might benefit from more guidance or training prior to working with people who live in the home. We saw that there is a daily file that gives an overview of information and guidelines about individual behaviours and activities, which is intended to give new or bank staff a quick guide to working with people who use the service. The deputy manager had identified a list of staff further training needs, which he said he had notified the organisation about, however the current availability of some training meant that not everyone who would benefit could attend soon. A member of staff who completed our survey questionnaire indicated that they are usually given up-to-date information about the needs of the people they support. They felt they usually have the right support, experience and knowledge to meet the different needs of people who use the service. They also commented that “I personally feel that at our home there are too many different behaviours and sometimes difficult to cope with.” During our visit we observed staff dealing patiently and sensitively with challenging behaviours shown by two of the people who live in the home. A health professional indicated in a questionnaire that staff members usually have the right skills and experience to support individuals’ social and health care needs. Care plans contained guidance for staff in giving support in all aspects of a person’s care, including behavioural profiles, communication and risk assessments. We saw that one individual had written some of the guidelines within their own care plan. Others had signed to say they agreed with their 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 12 plans. The records showed dates when plans were reviewed by the home’s managers and staff sign to say they have read and understood the guidance. All three individuals whose plans we saw had a review of their needs with their care manager this year. Guidance in the care plans was worded in a way that promotes the independence of the individual being supported. A survey questionnaire from a person who uses the service indicated that they always make decisions about what they do each day, and during our visit we observed staff encouraging people to make their own decisions. People living in the home have a wide range of communication skills and needs and we saw staff members responding to and communicating well with each individual. The organisation had recently employed an external assessor to do a communication audit in the home. This rated how well the service supports people in communication across a number of areas. The only area not scoring highly was staff training to assist communication, however the audit report noted that the current staff team are able to communicate well with people who use the service (See also the section in this report on Staffing). 59 Bury Road DS0000064247.V368953.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): Standards 12, 13, 15, 16 & 17 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit from being supported to access a wide range of activities both within the community and the home. They are supported to maintain relationships and are offered a healthy diet. EVIDENCE: The previous report identified that people who use the service participated in activities of their choice and enjoyed the meals provided at the home. The home’s annual quality assurance assessment (AQAA) said that the home does well at involving people in everyday choices and using their daily living skills, keeping up social networks and experiences. The AQAA also told us the home has improved through reduced incidents of challenging behaviour. During this visit we saw that each person who lives in the home has their own schedule of activities that is planned around their needs and preferences. 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 14 These are also presented in a picture board format to assist communication with people where this is required. A survey questionnaire received from one person who uses the service, indicated that the individual can do the things they want to do during the day, evenings and at weekends. Staff members told us that staffing levels were flexible around the activities of people who use the service. We saw that people can go to bed and get up when they like and staff will support people to stick to their commitments. Three of the people who live in the home had opportunities to attend college. As the college was closed for the holiday period, staff members were arranging activities to keep people who usually attend occupied and stimulated. During our visit we observed people who use the service helping with the daily routines, such as making their bed and tidying up in the kitchen. We also saw people going out on various activities with members of staff, for example two people went on a trip to Hayling Island, while another went jogging and swimming. We spoke to another person who said they had been for a walk during the morning and talked enthusiastically about a planned train trip and hot air balloon ride. Apart from walking, they also liked playing the drums, at times that had been agreed with the neighbours. The drums are padded so that they are not too loud. Staff members told us that one person who had gone through an unsettled period had now settled more and there were fewer instances of challenging behaviour that could disrupt activities. Staff members were working on developing more suitable activities for a person who has complex needs. We saw that the service encourages the involvement of family members, for example through attendance at reviews and discussion of individual strengths and needs. We met the relatives of one person who lives in the home. They told us that the service is “ brilliant” and the life of their relative who receives care had been “transformed.” The menu for the day was displayed in the kitchen. Menus are discussed during residents’ meetings and some of the people who live in the home go with staff members to do the grocery shopping. A person who lives in the home told us that they enjoyed helping to prepare meals and that they liked the food. Staff members do daily checks to make sure food is stored, prepared and cooked properly. 59 Bury Road DS0000064247.V368953.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): Standards 18, 19 & 20 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The health care and personal support people receive is based on their individual needs and they are protected by the home’s medication procedures and practices. This would be further enhanced through all staff receiving prompt training relevant to individual’s health needs. EVIDENCE: The previous report identified that individuals’ healthcare needs were being met and that people were protected by the home’s medication practices. The home’s annual quality assurance assessment (AQAA) stated that people have regular access to support and privacy and dignity in the delivery of healthcare. It told us that people who use the service have a choice of who supports them with personal care. Regular checks and audits are made to ensure compliance with the medication policy and procedures. The AQAA says the service could do better in relation to staff training. During this visit we saw that each person had a health action plan. Individual records clearly indicated how the person likes to be supported and showed how 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 16 specific needs are being monitored and addressed. Details of appointments with healthcare professionals were recorded with the outcomes. A health professional commented in our survey questionnaire that the home usually seeks advice and acts upon it to look after peoples’ health care needs. They told us that individuals’ health care needs are met by the home and staff members always respect individuals’ privacy and dignity. There is an organisational training programme and some staff members had received training in relation to individuals’ specific health and support needs, such as epilepsy and autism. The last time epilepsy training took place in the home was July 2007, although the home accommodates an individual who has epilepsy. The deputy manager confirmed that new staff employed since that time had not received the training, although the organisation had been informed of the training need. While there was no evidence to indicate this has had a negative impact on the person’s wellbeing, the organisation needs to make sure that all staff members are prepared with the relevant knowledge, skills and experience to work with people in the service (See also the section in this report on Staffing). We saw a sample of the medication records, which were clear and up-to-date and all current medication in the home was stored appropriately and safely. We advised the deputy manager of recent changes to the regulations about the storage of controlled drugs and that the home needs to obtain a suitable storage facility. This is so that the home is properly equipped in the event that someone is prescribed a controlled drug. The medication policy was signed by the staff to confirm they were following the stated procedures. Records and discussion with staff members showed that staff received training in medication and regularly completed a competency questionnaire to make sure good levels of practice were maintained. We saw that one person had recently had their medication reviewed and staff members were monitoring the outcome. Another person had information about their medication presented in picture symbols, to assist them to understand about the medication. A health professional indicated in our survey that the service always support individuals to administer their own medication or manage it correctly where this is not possible. 59 Bury Road DS0000064247.V368953.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): Standards 22 & 23 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service are confident that their views are listened to and acted upon and they are protected by the home’s policies and procedures. EVIDENCE: The previous report commented that the views of people who use the service were listened to and acted upon. The home’s annual quality assurance assessment (AQAA) stated that there have been improvements, such as more training given in safeguarding adults. It also told us there are plans for further improvement through every staff member to receive annual refresher in safeguarding adults. We were also informed that a ‘buddy’ system had been developed for those who follow the whistle-blowing policy. There is a complaints procedure on display in the home and people who use the service are supported to communicate using their preferred method. A person who lives in the home told us they are happy here and if they had any concerns they would speak to the manager or deputy manager. Another person who completed a survey questionnaire indicated that they know how to make a complaint and who to speak to if they are unhappy. They also told us that staff members always listen and act on what they are told. A health professional said the care home has usually responded appropriately if they or a person using the service have raised any concerns about their care. A 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 18 member of staff who returned a survey form indicated that they know what to do if someone has concerns about the home. The AQAA stated that the home had received five complaints in the last twelve months, all of which were resolved within twenty-eight days. We saw that records had been kept of these and the actions taken by the service. We advised the deputy manager that the home looks at the way concerns are currently being recorded, so that there is always a clear audit trail of the actions taken to address concerns and of the outcome. The deputy manager agreed to do this. In the last twelve months there had been three referrals made under the local authority safeguarding adults’ procedures. These related to incidents that had been reported by staff at the home, who acted in accordance with the whistle blowing procedures. The home had put safeguarding plans in place and we saw evidence that these were being followed. We saw records indicating that most staff had received training in safeguarding matters and staff members discuss the procedures in supervisions and at team meetings. We spoke with two members of staff who were clear about the reporting procedure if they suspected any form of abuse was taking place. We saw that some staff members had been given training in the prevention and management of challenging behaviour. The deputy manager had a list of ten staff members who still needed to do the training, which is an updated form of the training previously given to all staff. Staff members we spoke to said the new training teaches more about communication and de-escalation of situations. They also said there had been a decrease in the number of instances of challenging behaviour in the home. The home holds small amounts of money for people who use the service, which are kept in individual containers in a safe place. We observed staff supporting people to access their money. Receipts and records are kept for all transactions. There is a second in-house account where money is kept for items such as leisure activities. The organisation had recently issued an updated policy, which makes it clear what individual’s personal money is for. 59 Bury Road DS0000064247.V368953.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): Standards 24 & 30 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service benefit from living in a homely, clean and comfortable environment. EVIDENCE: The home is a large semi detached property situated in a residential area of Gosport, within walking distance of the shops and the seafront. The property next door is also a care home owned by the same organisation. Accommodation is provided on three floors. People who use the service each have a single room with en-suite facilities and have access to the lounge with dining area. One of the people who live in the home had chosen to move to a ground floor bedroom when this became available, as this was more suited to their needs and preferences. A quiet room was in the process of being converted into a sensory area. The kitchen is domestic in style and laundry equipment is available in a small room off the lounge. A small staff office is 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 20 located on the ground floor. The garden to the rear of the property has a seating area and colourful artwork is displayed on the fencing. A person who likes to play the drums has a shed at the bottom of the garden that houses the drums, which are padded to prevent them being played loudly and upsetting the neighbours. The plaster and paintwork in parts of the hallway and stairs are showing signs of wear and tear and would benefit from redecoration. The home’s annual quality assurance assessment (AQAA) told us that the service could do better in relation to timely maintenance responses and more maintenance personnel have been employed. Sufficient bathroom and toilet facilities are provided and those seen looked clean and in good order. The home has infection control policies in place and during our visit the premises were clean throughout. A person living in the home, who completed a survey questionnaire, said the home is always fresh and clean. 59 Bury Road DS0000064247.V368953.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): Standards 32, 34 & 35 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service would benefit from a more proactive approach to training from the organisation. The home’s recruitment practices continue to protect people. EVIDENCE: The previous report identified that people who use the service were protected by the robust procedures used for the recruitment of staff. The home’s annual quality assurance assessment (AQAA) stated that all staff recruitment checks were carried out and we confirmed this through looking at a sample of staff records, including new staff. The staff members’ files contained evidence of Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks, two written references, completed application forms with employment histories. Records also included information about staff probation and induction periods. A member of staff who returned a survey form confirmed that their employer carried out checks, such as CRB and references, before they started work. 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 22 The previous report also highlighted a requirement for all staff members to receive the training they require to fully support people, including food hygiene, protection of vulnerable adults, communication skills and autism. The home’s AQAA stated that there is a consistent and trained/competent staff team, but the service could do better through more specialist training. The home has a four-week staff rota, which showed the individuals responsible for various tasks and is flexible around service user activities. Staff members told us that the current staffing levels were enough to meet the individual needs of the people who use the service. The home has not used agency staff since September 2007, regular staff members cover some additional shifts when needed and this provides good continuity for the people using the service. During this visit we saw updated records indicating that, while training provision had improved in the time since the last inspection, the slow rollout of the organisations’ training programme resulted in staff not all being able to access training and updates when these are due. The deputy manager had identified a list of further individual training needs and six staff members were booked to attend training on autism the day after our visit. Most of the staff team had received training in safeguarding. Food hygiene training had been held earlier in the month for some of the staff who required it. Staff members are now being given training in the prevention and management of challenging behaviour (PMCB), which is gradually replacing the Dignified Management of Conflict (DIGMAN) training that all staff had previously done. Staff members told us that the PMCB training teaches more about communication and deescalation techniques than the previous training. The last time epilepsy training was provided was July 2007, which means that any new staff working in the home since that time had not received this. The deputy manager had identified that ten members of staff needed this training, eleven staff would benefit from training in sign language and six staff needed training in autism, which also includes guidance about communication. A new requirement has been made in relation to staff receiving specialist training relevant to supporting people who use the service. The organisation needs to make sure that the training in the programme is delivered in a timely fashion. Comments from a member of staff indicated that induction covered mostly everything they needed to know to do the job when they started. They also confirmed that they receive training which is relevant to their role, helps them understand and meet the individual needs of people who use the service and 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 23 keep up to date with new ways of working. Staff members we spoke with during the visit also told us that the training they had received was useful in helping them to meet the needs of people who live in the home. Currently there are five staff members, out of fifteen who work in the home, who have a National Vocational Qualification (NVQ) level 2 or 3 or equivalent and there are six other staff members who are working towards NVQ2. There was a record of supervisions the deputy had arranged with individual staff members for the month of August. 59 Bury Road DS0000064247.V368953.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): Standards 37, 39 & 42 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is generally well run and management practices promote the wellbeing and best interests of the people who use the service. This will be better supported by the manager becoming registered and through more prompt delivery of the organisations’ training programme. EVIDENCE: The previous report highlighted that since the home registered with the commission in June 2005 no one has registered as manager of the home. The home’s annual quality assurance assessment (AQAA) told us that the home’s manager is applying for registration. Following our visit we spoke with the regional director, who confirmed that the manager’s application to register had been sent. The AQAA states the service does well at maintaining good relationships with other agencies and families and there are regular health and 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 25 safety checks. The AQAA also says that the home could do better at fully implementing the quality assurance system and that an Improvement and Development Plan is to be drafted for the next twelve months. The home’s manager has been in post since 1st November 2007 and was on leave at the time of our visit. The deputy manager told us that the manager is on shift in a ‘hands-on’ capacity every other weekend, apart from which she performs the management role. The manager has started the NVQ level 4 Registered Manager Award. Staff members we spoke with expressed confidence in the management approach and said that the managers were approachable. The deputy manager said he feels that the service does well at respecting people’s individuality, especially with regard to the wide range of needs the home currently caters for. A health professional said in our survey “on the whole I am satisfied with the service.” Asked what the care service does well, the health professional told us “they’re empathetic and caring – the manager is good at leading her team.” We saw that the organisation obtains the views of people who use the service, relatives and health professionals on an annual basis through surveys. Quarterly forum meetings are also held which give people involved in the care homes an opportunity to meet and discuss the quality of care provided. There are in-house resident meetings and staff team meetings. We saw evidence that the organisation carries out monthly quality assurance inspections of the home and the deputy manager said there is an organisational improvement strategy in place for 2008. Since the last inspection there had been improvements in record keeping in relation to fire safety. We saw records of up-to-date fire drills with the evacuation times, fire alarm tests, emergency lights and equipment checks. There is a fire risk assessment for the building. The fire officer inspected the premises in January 2008 and the home had taken action in relation to improving the evacuation times. Most staff had undertaken fire safety training and the deputy manager said that the remaining four staff members would be booked on the course next. Two fire doors, while both functioning, have been without magnetic closers for a long time and the organisation should address this. As mentioned in the preceding sections of this report, the home would be better supported by a quicker rollout of the organisations’ training programme. The local food authority inspector had rated the home as excellent in March 2008, in relation to safe working practices with food. 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 Regulation 18(1) Requirement All staff members working in the home must receive prompt training relevant to supporting people who use the service, including specialist training such as epilepsy and autism. Timescale for action 13/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 59 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Bury Road DS0000064247.V368953.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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