Inspection on 04/01/07 for 61 Adkin Way

This inspection was carried out on 4th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

61 Adkin Way 13/06/06

61 Adkin Way 21/11/05

61 Adkin Way 04/07/05

61 Adkin Way 05/01/05

61 Adkin Way 12/08/04

61 Adkin Way 09/02/04

61 Adkin Way 02/02/04

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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 08/07/2008.

CARE HOME ADULTS 18-65 61 Adkin Way Wantage Oxfordshire OX12 9HN Lead Inspector Stephen Webb Unannounced Inspection 4th January 2007 10:45 61 Adkin Way DS0000013060.V326137.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 61 Adkin Way DS0000013060.V326137.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. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 61 Adkin Way Address Wantage Oxfordshire OX12 9HN 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) 01235 762279 adkin.way@unitedresponse.org.uk None United Response Emma Williamson Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: 61 Adkin Way is registered to provide 24-hour residential care and support for up to four people with a learning disability. It is a detached house with a garden and is similar in style to the neighbouring properties. It is domestic rather than institutional in character. At the time of this inspection the home was providing long-term accommodation and support for four people, with Autism, who have lived there since it was first registered. The home is managed by United Response, an organisation with experience of working with people with a learning disability, although the premises are owned by a housing association. Service users are registered with a local GP practice and have access to specialist services as required. At the time of inspection, the fees for this service were £2043.30 per week. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.45am until 7.15pm on 4th of January 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with two of the residents, one relative (on the telephone), the manager and brief conversation with two staff members. Written feedback was also obtained from the family of three of the residents, a care manager and a healthcare professional. The inspector examined the majority of the premises, and ate lunch with residents, as well as making informal observations of interactions between staff and residents at various points during the inspection. The residents are being encouraged to have more involvement in the day-today operation of the home in terms of household routines, and to make daily choices and decisions for themselves with support and prompting by staff. What the service does well: The information available to a prospective resident and their family would help enable them to decide whether Adkin Way was appropriate for the person’s needs, and the current assessment and preadmission planning system would be effective in identifying whether the individual’s needs could be met. Indications are that the new care planning system contains the information needed to plan for the support needs of a resident, and incorporates their wishes and preferences. Residents are being encouraged to take an increasing role in their day-to-day lives, decision making and household routines, including planning menus and shopping for and preparing meals. An appropriate menu is offered, with choices available. The health needs of residents are addressed well and appropriate records are maintained. The home has an appropriate system in place for managing residents’ medication, as none have been risk assessed as being able to manage this for themselves. Systems and training are in place to protect residents from abuse, including for the protection of their funds. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 7 The remaining care plans need to be converted to the new format, and the resident’s individual communication profiles also need to be updated. Although residents and their relatives indicated that they were happier their views would be heard by the current manager and responded to appropriately, no written record of complaints was in place. A written record of complaints must be established. The décor of the first floor and bedrooms remains to be brought up to a satisfactory standard. It is reported these areas are due to be addressed. The plan to provide en suite bathrooms to two of the bedrooms is very positive. There is an ongoing need to recruit additional permanent staff and in the interim, the number of different agency staff should be reduced to further improve the continuity and consistency of care to residents. The records available in the unit to substantiate the vetting process undertaken on prospective staff, remain insufficient to satisfactorily confirm the process, and must be improved. Future quality assurance surveys should seek the views of all relevant parties and the outcomes should be communicated to the participants via a summary report. The quality and content of Regulation 26 monitoring reports should be improved as stated. The unit’s fire risk assessment should be reviewed, and accident recording should be improved by the inclusion of records of any accidents to residents, within their individual case record. 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. 61 Adkin Way DS0000013060.V326137.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 61 Adkin Way DS0000013060.V326137.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): Standards 1 and 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available to prospective service users/their representatives would assist them in making an informed decision about the suitability of the service for their needs. The home has an appropriate system in place for the preadmission assessment of a prospective resident’s needs and aspirations, including visits and a planned transition. EVIDENCE: The home has an appropriate Statement of Purpose, which had recently been updated, though it would benefit from the inclusion of additional detail regarding the complaints procedure and should have the date of review added to indicate when it was last updated. There is also an organisational leaflet about the service, though the manager is planning to provide a more personalised version. The service user guide includes some pictures and symbols and is available also in a more accessible version with greater use of images and less text. It was reported that this information was read and explained to each individually. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 10 The manager indicated that the last inspection report was available to residents or their representatives to read in the office, and that relatives had been informed of its availability on-line. All three of the parents who completed inspection comment cards, indicated they were aware they had access to the home’s inspection report, though two noted that this would only be available if they asked for it. It would be good practice to provide this information in a notice in the entrance hall, with the statement of purpose and service user guide. All four of the residents had lived at the home since it opened eight years ago and the original preadmission assessment documents were not readily available on their current files. However, more up to date information on the residents’ current needs and aspirations was available, within their individual care plans and records. In the absence of a recent admission to the service, the inspector examined the current pre-admission assessment procedure present within the organisational policies and procedures, as would be applied now to any new referral, and these were found to be appropriate. The procedure included undertaking a preadmission assessment to a defined format in addition to whatever information is obtained via the care management assessment. This is good practice to ensure that all relevant information is available when considering a referral. A prospective resident, and their representatives would be provided with appropriate information about the home and invited to visit Adkin Way as part of a planned introduction and transition, once the decision had been taken that their needs could be met by the service. 61 Adkin Way DS0000013060.V326137.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): Standards 6, 7, 9 and 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new care planning and recording systems being introduced across the care records provide evidence that the needs, goals, personal choices and preferences of residents are taken account of in planning their care. The completion of these new formats must be a priority for the service. There was evidence of increasing resident involvement in decision-making and choices in their daily lives, though it is acknowledged there remains room for further development in this area. A new risk assessment format had been introduced, which offers a more coordinated approach to risk assessment, and was being used to support creative developments in the area of risk-taking. An individual daily diary system has been introduced, following a previous inspection requirement to replace the inappropriate collective daily records within the handover log, which now addresses resident confidentiality appropriately. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 12 EVIDENCE: Since the last inspection the manager has undertaken a revision of the service users’ care plans and care records system. Two of the files have been converted into this new format and two are in process, with information being rationalised and converted to the new format, which will then be consistent across all of the files. One completed file was examined together with one still in progress, for comparison. The file is based on a person-centred planning system and included a detailed personal support assessment, (dated 29/8/06), healthcare records, communication profile (an older document, but reportedly in the process of review), a relationship map, an activities plan in an adapted format with accompanying symbols to improve accessibility. Detailed, numbered, individual guidelines were in place to a standard format, for relevant times of day and daily events/activities such as mealtimes, where there are significant issues or the need for specific guidelines. The format also includes signature sheets for staff, to acknowledge they have read and understood the separate elements, and evaluation sheets to review and record progress, though the latter were yet to be used for the first time. This format was a significant improvement over the previous care records and care plans, with a consistent format and style enabling easier identification of key information and improved accountability by staff having to countersign, which has helped to improve consistency and continuity of approach in day-today practice. There was evidence of cross-referencing between the individual guidance where appropriate and the format was flexible enough to incorporate the diversity within the group. Specific and detailed behaviour management plans were in place where required. Individual care records also included a personal details front-sheet, a weekly budget sheet, a copy of the residents’ charter, utilising “Change Picture bank” images, and an adapted copy of the complaints leaflet. Some further work was needed to complete these new documents and formats and the completion of the remaining care plan documents must be prioritised. A new risk management plan format was also being introduced which contains the relevant individual risk assessments for an individual within a coordinated document. The manager demonstrated a good understanding of the nature and purpose of risk assessment and seeks to further broaden the life experiences and opportunities of residents within the context of the new system. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 13 Residents now have an individual diary, within which daily notes are made of significant events, visitors, activities, etc. in place of the previous inappropriate collective record. A sample of entries therein, were examined and found to be detailed and appropriate. (The remainder of Standard 10 was not examined). A copy of the most recent review on the resident was found within both of the tracked care files, and both had taken place in November 2006. Feedback from the relates of three of the residents indicated satisfaction with the care provided, with two noting specifically that there had been significant improvement in care practice, consistency and communication in more recent months, especially since the appointment of the current manager. This was also echoed in the feedback from an external healthcare professional and a care manager. Regular reference is made to the identified likes, dislikes, preferences, needs and wishes of residents, throughout the new care and support documents. The focus of these was very much on appropriate support and prompting of the individual to undertake as much as possible for themselves and to develop their existing skills and abilities. During the inspection staff were observed to actively offer and encourage residents to make choices for themselves and to become involved in aspects of the daily routine, though it is acknowledged there remains room for development in these areas. There was evidence of improved use of different formats and approaches to enable increased resident involvement. The development of favourite recipe files, for each resident, is an example of this, where staff are working towards having photographs of each of these meals to support the recipe and instructions. Again this is still a work in progress, but it is evidence of positive developments in the service. The residents now choose the menu a week at a time, (rather than there being a rolling menu), selecting meals which they wish to take some part in preparing with staff, and they are also more involved in shopping for food, and choose other household tasks to undertake as part of their daily routine. The manager is seeking a distance learning training to broaden the use of Makaton by staff, to support one of the residents and the possible benefits of the “Picture Exchange Communication System” and other communication aids should be explored with the speech and language therapist. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are now better supported, to access activities and events in the local community as well as in the home, and are known within the locality. Further development in this area is still ongoing with the context of a new risk assessment system. Where possible, residents are actively supported to maintain relationships and contact with family, and an advocate is being sought for one resident who has no family. Residents are being encouraged to take a greater role in the day-to-day living tasks in the house and to improve their skills in a variety of areas, including a developing focus on healthy living. They are taking an increasing part in menu planning, shopping and meal preparation with staff support. An appropriate menu is offered, the evening meals being planned by residents a week at a time with staff support, and appropriate alternatives are always made available. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 15 EVIDENCE: The manager acknowledged that they were still developing access to activities and the community in general, but she identified a number of areas where this was improving, and that residents were now often getting out into the community twice a day, and are well known, and sometimes greeted by name, when out in the locality. Residents recently attended a “Dickensian evening“ in Wantage and have watched “music in the park” events. Ongoing negotiations were observed with one resident who wanted to go for a walk with a particular staff member, as they were coming on duty later that day. Feedback from two residents indicated they could access the community, including trips to the pub, day services, shopping and walks. One of the professionals who completed an inspection comment card, also confirmed that residents seemed now to be more involved in day-to-day activities. Keyworkers are being encouraged to increase the options for residents to access the community. One is now supported to attend local football matches, and one attends a weekly computer course. Another is involved in gardening at a local day centre club. Three of the residents have no identified spiritual support needs, but one is supported to attend church when he wishes to. Staff have access to art and craft equipment in the home as well as these activities being part of day service provision. One resident also has an organ and a guitar. Service users had been on two holidays in the past year, though one resident has a series of day outings instead, as they cannot, at present, manage the major routine change associated with staying away from home. One resident showed the inspector the photographs from a previous holiday as well as pointing out the montage of pictures of the home’s last Halloween party, which included staff and residents’ family members. The service holds parents’ evenings, though the manager is working to increase the level of family involvement in these and generally, through encouraging residents to keep in regular touch with their family, with support from their keyworker. Residents are supported to write letters to their family, using a computer programme to produce appropriate symbols to complement the text, to keep them informed of what activities residents are engaged in. Relatives have also been involved in supporting some activities within the home, including the redecoration of one resident’s bedroom. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 16 Family are also invited to seasonal events such as the Halloween party already mentioned, and summer barbecues. Three of the residents go home to family at weekends on a regular basis, one has an ex-staff member who has regular social contact and is also seeking to become his advocate. As already noted, the service is improving with respect to the level of involvement of residents in daily routines, and they are encouraged to participate in areas that they enjoy. This includes being encouraged to take more part in their own self-care, as well as shopping for and preparing meals, laying and clearing tables, doing their laundry, household cleaning etc. as well as having greater involvement in planning the menus. Residents now plan the menus a week at a time and individual files of favourite recipes are being compiled, with instructions and photographs to support residents’ involvement in preparing their favourite meals for the group. An appropriate level of flexibility is retained with various choices being available at breakfast and lunch, and alternatives being offered, if an individual does not like the main evening meal. There was some focus on healthy eating and this will be addressed further as part of the plan to develop health action plans for residents. Places have also been negotiated, for residents who wish to attend, on an upcoming “healthy lifestyle” course, which includes aspects of healthy eating. The dining room provides a pleasant environment for communal meals, which are the norm, but staff showed appropriate flexibility in enabling alternative arrangements when the communal situation did not meet one resident’s needs, at one point during the inspection. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The wishes and needs of residents around personal care are now included within care planning records, together with details of the need for support and prompting, where required. Feedback from external professionals and relatives indicates improvements in staff approach and consistency. There is a need to review and update the individual communication profiles. There is evidence that the physical and emotional healthcare needs of residents are now addressed effectively. None of the residents is felt able to self-administer their medication, but the home has an effective system in place to manage medication on their behalf. EVIDENCE: The new care planning formats provide indications of residents’ individual preferences as well as identifying the areas where support is needed. The new personal support assessments are also informative in this regard. The emphasis is on staff supporting and encouraging resident to do as much as 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 18 possible for themselves. The need for prompts is clearly indicated where required. Evidence of this approach was seen in practice during the inspection. Where guidelines are required to address aspects of behaviour, these are included, to promote consistency and continuity of approach. In one case a review document by an external professional cited improvements in staff implementation of behaviour management plans as the reason for recent behavioural improvements. Feedback from relatives and one of the professional respondents to the inspection comment cards also refers to recent improvements in basic care practice and consistency of approach, and to the residents now being more settled and relaxed. Staff input was described as more proactive. The manager had addressed previous concerns regarding consistency and continuity of care in a variety of ways, one of which was to undertake a “Reinduction” day for all of the staff in the team to ensure that everyone understood their role. Support has previously been sought from a speech and language therapist and the manager is seeking a distance learning Makaton training package to improve staff awareness in the use of Makaton, particularly to improve support to one resident. Other communication systems are also utilised. The individual communication profiles help to identify the communication repertoire of each resident, though they date from 2001 and should be reviewed and updated. It is suggested that further discussion also takes place with the speech and language therapist about other possible communication systems, which may be of benefit, as discussed. Each resident’s care record includes contact sheets for relevant healthcare professionals detailing appointments and outcomes. They indicate a good level of support from external healthcare services. The proposal to introduce health action plans will be a further positive step in developing the focus on healthcare issues, as is the securing of places for the residents on a healthy lifestyle course, for those wishing to attend. At present none of the residents is felt able to self-medicate. The home has an appropriate system in place to manage medication on behalf of residents, which provides a proper audit trail for medication. Medication administration record, (MAR), sheets were properly completed, within a two stage administration recording system to reduce the risk of error. The manager undertakes and records a weekly medication storage check, and there is a detailed medication procedure available in the medication file, 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 19 together with a signature sheet for staff to countersign to indicate their understanding of the procedure. The staff training spreadsheet indicates that all permanent staff have received medication training, though for some, this dates back to 2004. Given the subsequent changes in some drug nomenclature, and for reasons of regular knowledge update, it would be prudent to provide periodic refresher training on medication for all staff. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives indicated that they were happier that their views would be heard by the current manager and responded to appropriately. There is, however, a need to establish a written record of complaints. Systems are in place to protect residents from abuse, and the staff receive training in this area. Identified gaps in the on-site recruitment records do not enable full evaluation of the vetting process. (Requirement on this matter made later under Standard 34). EVIDENCE: The home has an appropriate complaints procedure in place. The procedure is mentioned in the Statement of Purpose, but this section would benefit from the inclusion of more detail at the next review of the document. Residents care files included a copy of a complaints leaflet in symbol and text format. No complaints log could be located for inspection. The manager is required to set up a complaints record/log as a brief summary of any issues or complaints raised by or on behalf of service users, together with a summary of the action taken and outcome. Entries need to conform to the Data protection Act. Paperwork associated with complaints such as correspondence, copies of statements, etc. should be held confidentially, and it is suggested that such 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 21 records be held separately, cross referenced to the complaints log entry, though they should be available to CSCI inspectors and in-house senior managers, on request to enable monitoring. The manager confirmed that there had been only one complaint since the previous inspection, which had been addressed satisfactorily, and this was also itemised in the pre-inspection questionnaire. One of the residents indicated that the staff sorted out any concerns he has and listened to him. Feedback from relatives indicated that they had been made aware of the complaints procedure. One relative stated that they were confident that the new manager would listen to and address positively, any concerns they might raise. One resident’s care manager also observed that there had recently been a noticeable improvement in the level of consultation with residents’ families. Most of the staff attended POVA training in December 2006, and two others had done so in June 2006, as part of the rolling training programme. One staff member is booked on this training in February. There had been no adult protection issues since the last inspection. Previous issues around the behaviour of one resident towards others had been addressed. The manager has liaised effectively with neighbours to address any concerns raised. The home has a satisfactory adult protection procedure in place. There are gaps in the evidence of CRB/POVA checks on staff, available in the unit, which do not enable evaluation or verification of the full vetting procedure. If the provider chooses to retain these records at head office, a suitable confirmatory record should be available in the unit recruitment records for inspection, clarifying that the required checks have been undertaken. (Requirement made under Standard 34 later in report). Where the home manages or looks after residents’ funds on their behalf, any monies are held securely in separate cash tins, and individual balance sheets are maintained detailing the amounts in and out, together with receipts for expenditure. The records are reportedly checked twice a day, and the balance sheets are sent to head office weekly. Three of the residents go each week to the bank with staff support, and withdraw £20, which they spend on items of their choice including toiletries, books, lunch out etc. Larger sums can be made available by prior arrangement with the bank. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ground floor environment has improved significantly, though the upstairs remains to be brought up to the same standard. The plans for two en suite facilities are very positive. There is a need to repair or replace some items of damaged furniture and replace the blinds, where they have been removed during redecoration. Fire safety is addressed effectively. Standards of hygiene are satisfactory and the laundry is appropriately equipped. EVIDENCE: The home has four individual bedrooms within which the standard of décor was variable, and some of the bedrooms would benefit from redecoration and the repair or replacement of some damaged furniture items. In one case, this is awaiting the redevelopment of an old shared bathroom into a new en suite facility for the room, to include a jaccuzi bath and possibly 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 23 other adaptations, (following OT advice), and another new en suite is to be created in a currently unused space next to a second bedroom, at which point this bedroom too will be redecorated. The remaining two bedrooms each have a bathroom next door for their occupant’s exclusive use. The possibility of providing sensory equipment within one resident’s bathroom, is also under consideration. Two of the residents showed me their bedrooms, which were personalised appropriately to reflect their interests. One resident has his own computer in his bedroom. Both were happy with their rooms. One resident had been involved in redecorating his bedroom with support from his family, and had chosen the colour scheme. The communal areas on the ground floor have all been redecorated since the last inspection, and are now fairly homely, though in some areas the blinds are still to be put back at the windows. These rooms were now pleasantly decorated, though some items of damaged furniture do need to be repaired or replaced as a priority. It was stated that the redecoration of the upstairs of the home was now due to be undertaken. Fire doors throughout the building have been fitted with appropriate holdback devices, integrated with the fire alarm, which allow the door to close should the fire alarm sound. This maximises mobility for residents during the day and enables staff to more readily monitor activities within the home, whilst addressing fire safety requirements. The rear garden is a pleasant and practical space, which was said to be popular in the warmer weather. There was a barbecue on the patio. The standard of hygiene throughout the building was observed to be satisfactory and the home has an appropriately equipped laundry, which residents are supported to use. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 & 35: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further progress has been made on core training, to ensure that the residents receive support from an appropriately trained staff team, and some progress has also been made on NVQ and recruitment, though additional recruitment remains a priority. There is a need to address the ongoing use of such a high level of agency staff and in such large numbers, as this conflicts with the needs of residents. Evidence suggests that there have been significant improvements in staff morale, consistency and teamwork, especially since the appointment of the current manager. Whilst the undertaking of the required vetting on new staff has been confirmed verbally by head office, the available evidence of this process, within the unit is not satisfactory and must be improved. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 25 EVIDENCE: Although at present only 40 of the team have at least NVQ level 2 or an equivalent qualification, a further two staff are working towards NVQ level 2, and another towards NVQ level 4. Four other staff have completed their LDAF induction and are finishing foundation training, and will then undertake NVQ. Since the last inspection two new full-time and two part-time care staff have been appointed, though one part-time day care staff, and a part-time waking night staff have also left in the same period. The manager felt that overall recruitment and the level of response to adverts was improving and a further recruitment round was due to start. At the time of inspection, there were three full-time and one part-time care staff vacancies, all being covered on an “as-and-when required” basis. The level of agency usage was reported to be reducing, though the rotas from November 6th to December 3rd, indicated this was still at around 60 shifts over the four-week period, which in such a small unit is a high level of agency staffing, especially given the residents’ Autism, and the resulting particular benefits of consistency and continuity of staffing. In order to minimise the effects of this level of agency usage, the manager tries to use known agency staff, who are familiar with the unit and the needs of residents, but despite this, ten different agency staff were utilised over the given period for which rotas were supplied, (November 6th-December 3rd), in addition to the current permanent staff of nine. In order to address this issue in the interim, until further appointments can be made, the provider must take steps to reduce the number of different agency staff being used. It is suggested that some of the current agency staff be offered short-term contracts, so that a significant proportion of the hours are covered by far fewer individuals, in order to reduce the number of different staff experienced by the residents, unless other alternatives are available. A sample of recruitment and vetting records were examined. The manager had had some success in obtaining copies of previously missing records from head office and from the staff directly, and was still pursuing photographs from one or two staff for filing as proof of ID. However, there were gaps in the available evidence of CRB/POVA checks on staff, which did not enable effective evaluation or verification of the full vetting process. The existence of valid CRB checks was confirmed verbally on the phone from head office, who also indicated that the CRB check number should appear on the training file front-sheet, but this was also absent in one case. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 26 If the provider chooses to retain these records at head office, a suitable confirmatory record must be available in the unit recruitment records for inspection, which clarifies that the required checks have been undertaken. This should include confirmation of a POVA check, and that a satisfactory, enhanced CRB check has been returned, together with the date of its receipt, and the CRB check number. Individual training records have been established for each staff member, containing a training summary and copies of relevant certificates, and the manager is working with staff to bring these fully up-to-date retrospectively. During the inspection, a copy of an overall spreadsheet for core training was emailed to the unit at the inspector’s request, which indicates that good progress is being made in terms of core training, with all permanent staff receiving training in key areas, though in some cases, this was as long ago as 2004 and will need to be updated in the near future. All staff had recently taken part in a team re-induction day, as part of the strategy to improve the consistency of approach and understanding of roles within the team. The issues addressed during the re-induction day had been recorded in detail, which is good practice. Observation of staff-resident interactions during the inspection would indicate that this has been beneficial, and this is supported by feedback from external professionals, as well as some of the staff themselves, who felt the home was now a more positive and relaxed environment, where the training, morale, teamwork and clarity about their role had improved. This is backed up by feedback from relatives who also made similar observations about the staff morale and the atmosphere in the home. The new manager was described as approachable and supportive, and it was said that staff were now encouraged to raise any concerns they had, and to contribute their views in the team meetings. The staff demonstrated an understanding of their primary role, to enable and prompt residents, and were seen to support and encourage the involvement of the residents in day to day tasks. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 27 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: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Evidence suggests that residents, relatives and other interested parties are much happier with the care provided under the current manager and that in the short time she has been manager, she has been able to make significant improvements in a number of areas within the home. Although the provider has commissioned a quality assurance survey late in 2006, the outcomes do not appear to have been conveyed to participants in a summary report as required. The manager has, however, worked to improve communication with families, and there is evidence that residents and families feel that their views are now better heard. The provider needs to improve future quality assurance surveys to include the provision of written feedback and the content of monthly Regulation 26 visit reports should also be improved. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 28 The health and safety of residents is promoted by the home in general. There is a need to improve accident recording as described, and to review the home’s fire risk assessment. EVIDENCE: The manager has extensive experience of work with adults with learning disabilities. She has been the manager at Adkin Way for two months, having previously been deputy manager. She has almost completed here NVQ level 4 and Registered Manager’s Award, and expects to do so by February. Feedback from residents, relatives, staff and external professionals indicates a positive relationship with the new manager, who is credited with having worked with staff, to improve the atmosphere, morale and the quality and consistency of care, since being appointed. Examination of a sample of the records also indicated that good progress had been made towards addressing previous shortfalls in this area. The manager ensures that appropriate support and communication forums are available to staff, with regular staff meetings and supervision in place. Staff meetings are minuted, and staff are invited to contribute to the agenda. Staff described the meetings as positive. As already noted, a team re-induction day was held recently to ensure everyone understood their role and the expectations upon them. In September/October 2006, an external quality assurance survey was commissioned, and undertaken on the service, though no copy of the resulting report was available on site to examine, and no summary report had been provided to participants. The area manager also undertakes three-monthly service checks, which focus on health and safety, risk assessments, training, finance and accidents. These reports were seen on site but were not public documents. In addition to undertaking quality assurance surveys, which should seek the views of residents, their representatives and other stakeholders, there is a requirement to produce a summary report of the findings which should be made available to participants. The manager indicated that she was due to undertake a project on quality assurance as part of her NVQ and RMA studies, and it was suggested this might present an ideal opportunity to undertake a further full QA cycle to include consultation with all of the relevant parties and the production of a summary report to participants. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 29 This would be beneficial as it is evident, from feedback to CSCI that the views of residents, relatives and others about the home have changed in recent months and this would provide an up-to-date picture of how the service is currently perceived. The provider undertakes monthly Regulation 26 monitoring visits and copies of the resulting reports were available on file in the unit, as required. However, the reports lacked a significant level of feedback from residents or staff, or other comments about the standard of care provided, which is a requirement of these visits. These omissions need to be addressed. The new risk assessment format should enable a more effective and consistent assessment of risks to individuals and provides clearer guidance to staff arising from the risk assessment. The home’s overall fire risk assessment was last reviewed in 2005 and should be reviewed again. The manager indicated that for the current residents, individual evacuation plans were not necessary, as successive fire drills had demonstrated that everyone responds appropriately to the general evacuation procedure. This should be detailed within the updated fire risk assessment. The home’s fire log indicated monthly fire drills had been held, which is good practice. Accidents are recorded on a detailed carbonated format. The manager has recently started to hold copies collectively for monitoring, and plans to establish a file for these, as required, following discussion during the inspection. However no record of an accident to a resident is currently included within the relevant resident’s case record as required. It is suggested that one copy of the completed accident form is placed in the relevant case record once the form is signed off. Accident record forms are signed-off by the line manager, who undertakes a monthly audit, and the manager provides a monthly summary of accidents to the local commissioning quality assurance officer. Examination of a sample of health and safety-related service certification indicated that required servicing had taken place with the necessary frequency. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 30 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 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 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 2 3 3 X 3 X 2 X X 2 X 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Timescale for action 04/04/07 2. 3. YA22 YA24 4. YA33 The manager must ensure the completion of the transfer of care plans into a suitable and consistent format. 17(2) & The manager must establish Schedule 4.11 an appropriate record of complaints within the home. 23(2)(b)(c)(d) The manager/provider must ensure that the remaining refurbishment is completed, and that damaged furniture is either repaired or replaced. 18(1) The manager/provider must take steps to reduce the number of different agency staff used in the home in the interim, until permanent staff can be recruited, in order to maximise continuity of care. 04/02/07 04/04/07 04/02/07 5. YA34 17(2)&(3)(b), & Sched. 4.6 19(4)(b), 1 This issue was also the substance of a previous inspection requirement around continuity of care, which has been only partially addressed in the interim. The provider must ensure that 04/02/07 comprehensive evidence is available within the unit to enable evaluation of the DS0000013060.V326137.R01.S.doc Version 5.2 Page 32 61 Adkin Way vetting process for new staff. A previous requirement regarding this issue was made at the previous inspection, and has only been partially addressed. Regulation 26 visits and the 04/02/07 resulting reports must address all required areas. The manager must review and 04/03/07 update the unit’s fire risk assessment. The manager must ensure 04/02/07 that records of accidents to residents are included within their case record as well as being held centrally for monitoring purposes. 6. 7. 8. YA39 YA39 YA39 26(4) 23(4) 17(1)(a) and Sched. 3.3(j) 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 2 Refer to Standard YA18 YA39 Good Practice Recommendations The manager should review and update the individual communication profiles for residents, in consultation with the speech and language therapist. The provider should ensure that future quality assurance surveys seek feedback from all relevant parties and make available the results of the survey to participants via a summary report. 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 61 Adkin Way DS0000013060.V326137.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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