Inspection on 15/02/07 for 64 Farlington Road

This inspection was carried out on 15th February 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

64 Farlington Road 19/08/08

64 Farlington Road 27/02/08

64 Farlington Road 05/09/07

64 Farlington Road 16/10/06

64 Farlington Road 18/11/05

64 Farlington Road 02/06/05

64 Farlington Road 05/10/04

64 Farlington Road 21/05/04

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

CARE HOME ADULTS 18-65 64 Farlington Road North End Portsmouth Hampshire PO2 7HU Lead Inspector Neil Kingman Key Unannounced Inspection 15 February 2007 15:00 64 Farlington Road DS0000011686.V325812.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 64 Farlington Road DS0000011686.V325812.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. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 64 Farlington Road Address North End Portsmouth Hampshire PO2 7HU 023 9243 1941 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) Independent Care (Portsmouth) Limited Mrs Linda Janice Rosa Walsh Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category LD are only to be admitted between the age of 20 and 45 years 16 October 2006 Date of last inspection Brief Description of the Service: 64 Farlington Road is a residential home providing care, support and accommodation for up to three younger adults with learning disabilities. The home is one of a terrace of ordinary family style houses, situated in a residential area of Portsmouth. There is a public house and some local shops close to the home, and a shopping centre, which includes a cinema, approximately a mile away. The three single bedrooms for residents, each with a lockable door, are sited on the first floor. Bedrooms do not have wash hand basins. However, a communal shower room with WC and wash hand basin is close by. The home is centrally heated and windows are double glazed. Communal areas comprise a thru-lounge and separate kitchen/dining area. There is a small garden to the rear of the property to which the residents have access. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by 64 Farlington Road and brings together accumulated evidence of activity in the home since the last key inspection on 16 October 2006. At that inspection a large number of requirements were identified, including some areas of concern that needed prompt attention, e.g., a disabled smoke detector, damage to ceilings caused by water leaks and condensation, poor standard of cleanliness, and fire safety checks and records. A letter was sent to the home setting out the areas of concern and requiring the issues to be addressed within specified timescales. Additionally, an improvement plan was required to be forwarded to the Commission by 17 November 2006. At the inspection on 16 October 2006 it was noted that staffing levels had reduced since the previous inspection on 18 November 2005. At that inspection a significant staff reduction had been noted since the previous inspection in June of that year. It was judged that the reduction in staffing levels had resulted in poor outcomes for the people who live in the home. As a consequence a Statutory Requirement Notice to increase staffing levels was sent to the Company setting the 24 November 2006 as the required date for compliance. No response to the requirement for an improvement plan has been received at the Commission. On 18 December 2006 two inspectors carried out a random inspection of the home to monitor compliance with the Statutory Requirement Notice and also the areas of concern that had needed prompt attention. It was confirmed at the random inspection that the home had failed to comply with the Statutory Requirement Notice. Additionally, there were 27 outstanding requirements noted. A meeting was held with the manager and her solicitor on 5 February 2007 at which no explanation was given as to the failure to comply with the Statutory Requirement Notice. Included in this inspection was an unannounced site visit to 64 Farlington Road by an inspector on 15 February 2007. The manager was available and in charge of the home. During the visit the inspector spoke with staff on duty, all three residents, including discussions with two in the privacy of their rooms, and also a relative who was visiting the home at the time. The inspector toured the building with the manager and looked at a selection of records. What the service does well: 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 6 As at the last key inspection it was very apparent from the inspector’s observations that the staff are motivated to provide a good service for the residents. The care support worker, while inexperienced, was keen to learn and quick to highlight the effort that had gone into increasing the opportunities for residents to take part in activities outside the home. Residents are supported to lead active and varied lives during weekdays, and discussions with the residents showed they are very happy with the service provided by the home. What has improved since the last inspection? What they could do better: While significant improvements were noted, there remained some outstanding requirements from the last key inspection, the most important being an increase in staffing levels. Despite a Statutory Requirement Notice having been served over three months ago staffing levels remained essentially the same as at 16 October 2006. At the time of producing this report the manager has confirmed that pending the results of satisfactory checks staff will commence working in the home in 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 7 numbers sufficient to meet the requirements of the Notice. Once achieved, it is important that staffing numbers are maintained to provide flexible and consistent support for the residents during the evenings and at weekends. It is additionally important in a care service for people with complex needs that staff are given opportunities to develop the competencies to meet those needs through experience and service specific training. For the home to be seen as fully meeting the key standards assessed the following areas also need addressing: • • • • • With help from specialist healthcare professionals, to carry out and record the reasons for placing limitations on a resident’s right to undertake basic tasks. To properly record detailed risk assessments where risks to vulnerable residents are identified. To ensure designated staff are appropriately trained to administer medicines. To introduce the new Common Induction Standards for all newly appointed care staff with the emphasis on staff working in learning disability services. To arrange for a restrictor to be fitted to one resident’s window, which opens at waste height. As a good practice recommendation all financial transactions for residents should be witnessed and signed by two staff members. 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. 64 Farlington Road DS0000011686.V325812.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 64 Farlington Road DS0000011686.V325812.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): 2 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. To ensure residents care and support needs are met, a proper assessment is undertaken before they move into the home. EVIDENCE: Pre-admission assessment 64 Farlington Road provides long-term care and support for up to three younger adults with learning disabilities. At the time of the inspection the home was accommodating three residents, all of whom have been referred through Social Services Care Management, the most recent having moved into the home in August 2000. It is therefore the case that the home has not had to implement its pre-admission assessment process for almost seven years. However, it was noted that each resident has a needs assessment on his or her file. The manager showed a good understanding of the importance of a preadmission assessment in the process of choosing the right home, describing how there would be several introductory visits by the prospective resident to establish compatibility with existing residents, and to judge whether the home would be suitable. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While opportunities for residents to make decisions and choices in their lives are determined by assessment and recorded in individual personal plans, not all plans are ‘person centred’ enough to reflect best practice in this area. Additionally, opportunities have been limited because of staff shortages. Residents are enabled to take control over their lives. However, not all limitations are identified in the assessment process and recorded in their personal plans. They are encouraged to be as independent as possible and to take sensible risks, which enhance their enjoyment of life. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 11 EVIDENCE: At the last key inspection this outcome group was judged to be adequate and requirements made in respect of assessments and care planning. At this inspection there was evidence of some improvements having been made. Personal plans – Each resident has an individual personal plan and the inspector viewed all three. The intention was to look at the outcomes for residents in general by assessing the information and support, which helps them to express their views and lead the lives that they choose. At the last key inspection it was judged that the residents were not involved in the process of developing or reviewing their personal plans, in fact there was no evidence of reviews having taken place. At this site visit the manager said that personal plans were in the process of being reviewed and developed in a format that better meets the residents’ needs. It was noted that one had almost been completed. The inspector noted this particular plan was more ‘person centred’ than the other two with each section having been signed by the resident. In discussions with this resident it was clear that they had been included in the development of the plan, which included such information as: • • • • Weekly programme of preferred activities, including dates for trips out from the home. Care plan, which identifies problems/needs, goals/outcomes and interventions to be used. Safeguards and risk management, which identifies the activity/situation, benefits, support needed, potential hazards and monthly review. Healthcare checks and specialist visits. The manager confirmed that the other two plans would be reviewed and similarly developed. Decision making Speaking to the residents and observing their interactions with the staff showed that while they have cognitive impairment they do know how to express their opinions and make choices in their lives. They carry out many tasks independently around the home but need support with activities away from the home. The revised format of personal plans provides information about choices and the level of support needed. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 12 At the last key inspection it was noted that limitations were placed on one resident’s right to perform basic tasks. It was judged that the home was not managing the resident’s behaviour in a dignified and appropriate manner. The manager gave a full explanation of the situation and the reasons for the action taken. However, there were no strategies or guidelines to manage the behaviour drawn up with the involvement of the community health specialists. The manager said the community psychiatric team had been involved over the years but had not been so easily accessible when called upon recently. It is important that any limitations on an individual’s right to make decisions about an activity are fully recorded as part of the assessment process and where possible are discussed with the relevant healthcare specialist. The manager said that two of the residents did not have the cognitive ability to manage their own finances and need staff to assist them. The inspector looked at the system in place to safeguard their monies and noted that records balanced and receipts were kept. It is recommended as good practice that all transactions are witnessed and signed by two staff members. The manager is appointee for one of the residents who has their own bank account. One resident takes control of their own monies with support from a family member. The inspector discussed the situation with the resident and noted a lockable facility in their bedroom. Risk taking – The inspector noted that personal plans contained risk assessments for daily living. Additionally, in respect of one resident who can present with some difficult behaviour there are clear and specific guidelines around the management of the behaviour and the use of physical interventions. At the last key inspection there was confusion about one vulnerable resident’s guardianship order and the level of protection needed to safeguard the individual from abuse. At this site visit the manager was able to clarify the present situation and provide documentary evidence. It is important however, that where there has been a particular risk identified, as in this case, the level of risk is recorded, together with the action required to minimise the risk. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14,15, 16 and 17 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and supported to take part in a range of activities appropriate to their age and individual likes and dislikes. However, staff shortages have limited their opportunities for community links, especially in the evenings and at weekends. They are supported to maintain regular contact with their families. Routines in the home promote independence for the residents who have unrestricted access around the home. They are offered meals they enjoy, which are varied and healthy. EVIDENCE: At the last inspection this outcome group was judged to be poor, due to staff shortages, resulting in a lack of flexibility for existing staff to meet the residents’ individual social needs. At this inspection, while there remained no 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 14 overall increase in staffing levels an effort had been made to increase opportunities for trips out and other social engagements. Education and occupation The manager said that the residents’ assessed needs are such that seeking jobs for them, either paid or voluntary is not appropriate. Education and training is limited to that which is offered through the day services they attend throughout the week. The inspector spoke with two residents in the privacy of their rooms. There was evidence from discussions that they lead varied and active lives, especially during the day throughout five days of the week. The day services provide therapeutic activities, which according to a visiting relative have particularly benefited one resident who travels to a workshop in Southampton several days each week. Another resident described going to college, two day-centres and a social club to experience a good range of craft based and social activities. It was confirmed that the bulk of support provided for the activities was from outreach workers who have worked with these residents for several years. Community links, social inclusion, relationships, and leisure activitiesA weekly programme of activities ensures that the lives of the residents are as varied and interesting as possible, although this does focus on daytime activities as described above. It was clear from discussions with the manager that staff shortages last year had all but eliminated opportunities for evening and weekend activities. However, it was understood that since the last inspection the home has made a significant effort to support residents to engage in activities in the evenings and at weekends. An increase in staffing levels would provide the flexibility for one-to-one excursions being achieved without existing staff having to work long hours. The inspector was shown the minutes of two residents meetings that have taken place since the last key inspection. They showed that residents have been consulted about a wide range of topics, from their choice of leisure activities to the layout of the home. An activities folder has been developed and feedback sought at the meetings on whether activities so far taken up have been enjoyed. The inspector noted activities included a variety of trips to local attractions and places of interest. The manager and the care support worker said that while some trips had already taken place the benefit would be felt when more staff had been recruited and the warmer weather arrived. Two residents maintain regular contact with their families and often visit with them away from the home at weekends. The inspector had an opportunity to speak with one family member who was visiting at the time of the inspection. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 15 The feedback was positive. Special mention was made of the benefits noted since the resident started at the Southampton workshop. The home supports one resident to maintain a personal relationship with a person of choice. This resident has a cat, and feeds and cares for it daily. The inspector noted in discussions with this resident that the fact that they were able to spend Christmas at the home with the cat was a very positive event in the persons life. Daily routines Bedrooms were seen to be well personalised and reflected residents’ different interests and preferences. Staff respect their privacy and were seen to knock before entering their rooms, and to address the residents by their preferred names. During the site visit the inspector observed the interactions between staff and residents. Both the manager and the care support worker showed understanding, patience and respect for their privacy. All residents assist with housekeeping tasks around the home. The inspector observed them washing and clearing up after the evening meal and one resident confirmed that Sunday mornings was generally a time for tidying the bedroom and helping with the Sunday lunch. Meals – During the site visit the inspector asked residents about meals. They said they were very happy with the food provided. One confirmed that the weekly menu is chosen on a Sunday and that they generally ate what they liked. Menus showed food to be varied and generally nutritious, with fresh fruit available and vegetables a feature in several of the meals. At the site visit the inspector observed the evening meal was a social occasion with all residents eating in the dining area as a group. Typically during the day they would take a packed lunch, or eat food provided at the day service. Meals are cooked by the care support staff who have undertaken basic food hygiene training. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The shortage of staff has meant that support for residents lacks flexibility and consistency, making it difficult to respond to their changing needs. However, staff do encourage residents to make choices, which reflect their individual personalities. Residents’ healthcare needs are assessed and staff support them to receive healthcare checks at appropriate intervals. The assessed needs of the residents are such that the home takes responsibility for administering their medication. While medication is securely held and appropriate records maintained, staff have received no formal training in the safe administration of medicines. EVIDENCE: Personal support – Personal plans identify the support and/or encouragement residents need from staff; the revised format being the preferred method as previously described. All are fully mobile and none has a disability that requires aids or adaptations 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 17 in the home. From discussions with residents and staff it was evident that residents choose their own clothes and styles, which reflect their personality. One in particular is very conscious about appearance. It was identified at the last inspection that one resident’s difficult behaviour raised the issue of how the home managed personal hygiene and infection control. At this inspection significant improvements were noted, e.g., cloth towels in communal hand washing areas were fresh and clean and staff have received training in infection control procedures. However, it is important, as previously stated that strategies, agreed with specialist healthcare professionals for the management of difficult behaviour are fully documented. Healthcare – Care records showed that residents’ health care needs are identified and regularly addressed. They receive checks from the GP, dentist, optician and specialist health care professionals according to their individual needs. The manager said that all residents have their own GP in Portsmouth and visits are supported either by the home or by family members. Medication The inspector looked at the home’s arrangements for residents’ medication with the manager. This had been the subject of requirements at the last inspection. The inspector noted that one but not both requirements had been met. It was understood from talking to the manager and the care support worker that the cognitive abilities of the residents were such that they would not be able to take control of their own medicines. Since the last inspection the manager has introduced a policy to reflect the change to a new medication administration system. The policy was available for inspection. At the time of this site visit medication for residents was securely held and records relating to its safekeeping and administration were found to be in good order. The manager said that she had not yet been able to source medication training for staff and was exploring the possibility of a college course. At the time of producing this report the manager has confirmed that a ‘care and control of medicines’ foundation course has been booked for 27 February 2007. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ complaints are treated seriously and given an appropriate response. The home’s policies, procedures and practices ensure that residents are safeguarded from abuse. EVIDENCE: Complaints The home has an appropriate complaints policy and procedure in place. Residents said they were happy with the way they were treated and would speak to the staff if they had any worries or concerns. The manager said that all three residents were very assertive, and would not hesitate to talk about anything they were unhappy about. The visiting relative said they had confidence in the manager and would not hesitate to go to her with any concerns. Adult protection The home has a ‘whistle-blowing’ policy for staff, and an appropriate adult protection policy and procedure. Staff training covers abuse. The care support worker was very clear about how to recognise abuse, what to do, and the importance of reporting issues of concern without delay. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s premises are suitable for its stated purpose. They are reasonably comfortable, safe and maintained. On the day of the site visit the home was clean, hygienic and free from unpleasant odours. EVIDENCE: At the last inspection this outcome group was judged to be poor due to identified environmental shortfalls, which had the potential for putting residents at risk. At this inspection the inspector focussed on the action taken by the home to address those issues. Premises The inspector toured the building with the manager who showed him round. It was noted that in general terms the house is suitable for its stated purpose; accessible, as the three residents are mobile; safe and now reasonably well 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 20 maintained. All three bedrooms are for single occupancy, and are located on the first floor. The sizes of the lounge and dining room are adequate for the numbers of residents and staff, with enough seating and space for relaxation and activities. There is a kitchen/diner, shower room with toilet, and separate toilet with wash hand basin. The manager said, and records of residents meetings confirmed that they had had opted to keep their lounge where it was in spite of the front room (used as the office) being more light and airy. While overall the home would benefit from an injection of funds to modernise it the premises are reasonably decorated and comfortable. Rooms looked to reflect the personalities of the residents and were clearly decorated according to their individual tastes. Hall, stairs and landing carpets looked tired and worn, and, according to the manager and the maintenance record, are due for replacement during 2007. Outside is a small, enclosed garden and patio area. The following outstanding requirements were noted to have been met: • • • • • • • • All discolouration to ceilings caused by water leaks have been addressed. Causes of leaks have been identified and repaired, and ceilings repainted. The poor state of the shower room has been addressed. All areas are clean, and work is in progress to create a large extractor fan to eliminate condensation, which had caused the formation of mildew. Bedside tables and lights are now in place in bedrooms. The faulty smoke detector has been replaced. Dining furniture has been renewed. The homes central heating system was working efficiently and records evidence a recent boiler inspection. The back garden has been cleared of rubbish, all brambles and weeds removed and the soiled turned over. The manager confirmed that the area would be laid to lawn when the weather improved. All parts of the kitchen were clean, including the cooker and lampshades. The skirting had been secured. Windows are double-glazed and the front door has been replaced with a new sealed door unit. A restrictor must be fitted to the window in one resident’s room as it opens at waist height. Cleanliness The inspector noted all areas to be very clean, reasonably tidy and free from unpleasant odours. The manager said that since the last key inspection when 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 21 concerns were raised about the state of the environment a domestic has been employed to undertake periodic deep cleaning where required. Generally support workers undertake the domestic tasks; an arrangement that seems to work in what is essentially a domestic style setting. Laundry is carried out in a small utility room just off the kitchen. Since the last inspection the home has received a visit from an environmental health inspector and all issues have been addressed including confirmation that the current arrangements for washing soiled articles is appropriate. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a staff team that has limited experience. Staff numbers are sufficient to support residents’ needs, some, but not all of the time. Staff have achieved some of the necessary skills and experience to meet the needs of the people who live there. However, at the time of the inspection there were no staff qualified at NVQ level 2 or above. The home operates a robust staff recruitment procedure, which ensures residents are protected. Staff receive the support and supervision they need to carry out their jobs EVIDENCE: At the last inspection this outcome group was judged to be poor, due to identified shortfalls in staffing levels, experience and training. At this inspection there was evidence of steps having been taken to improve the situation. However, the home has yet to meet the minimum standards in some areas. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 23 Staffing levels At this site visit the inspector noted the manager and a care support worker on duty in the home, the care support worker having arrived at 15:00 hours. The staff rotas showed little change in the position as at the last random inspection in December 2006, in that the home still only has two care support workers, with only one being on duty with the residents at times during the week and at weekends. It was evident that the home remained in breach of the Statutory Requirement Notice served on 7 November 2006 to provide two staff on duty at all times during the day, unless the assessment for each service user, as recorded and agreed in each individual plan, demonstrates that one staff member is sufficient to meet the needs of all services users at specified times and for specific activities. The timescale for compliance was given as 24 November 2006. In light of the fact that failure to comply within the given timescale left the registered manager liable to prosecution without further notice the inspector cautioned the manager before asking for an explanation as to why the requirement had not been met. The manager said that she had been trying to get staff and had been interviewing people and doing the required criminal record and protection checks. She confirmed that someone was about to start subject to reference checks. The inspector gave advice about the process for carrying out reference checks. The manager recognized that there were insufficient staff especially at weekends but asserted that since her health had improved she had been able to provide more cover in the home to enable existing staff to facilitate some of the planned activities. At the time of producing this report the manager has confirmed that the recruitment of additional staff is imminent and the gender mix of staff and residents has been taken into consideration. Staff recruitment – The homes recruitment process includes: • • • • • • Application form. Contract of employment. Criminal record (CRB) and Protection of Vulnerable Adults (POVA) checks. Two written references. Medical fitness questionnaire. Copy of the home’s induction programme. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 24 The recruitment records of both existing care support workers were in order. Staff training, development and competencies Currently no staff in the home have achieved a NVQ at level 2 or above. The care support worker spoken with was very clear about undertaking the training during 2007. The inspector looked at the staff training plan and was shown a selection of training certificates. The plan sets out the mandatory training achieved and the scheduled dates for 2007. The mandatory training undertaken by the two care support workers includes: • • • • • • Manual handling. Health and safety. Basic food hygiene. First aid. Infection control. Fire safety. Additional training includes adult protection awareness and the management of aggression. However, it was noted that staff do not undertake any service specific training relating to the care and support of people with learning disabilities. Currently the home’s induction training does not meet the standard. TOPSS England became ‘Skills for Care’ in April 2005 and produced a new set of Common Induction Standards (CIS) designed to be met within a twelve-week period. Since September 2006 the CIS have been the minimum induction standards for staff in care homes. Information about the induction of new staff can be found on www.skillsforcare.org.uk. The manager recognised the importance of appropriate staff training but raised the cost of training packages for such a small service as an issue. She said as an interim measure she would be introducing an initial introduction to learning disabilities in the form of instructional videos while she tries to source training with Southdown College. Staff supervision – Since the last key inspection the manager has introduced a programme of formal staff supervision. Records were available for inspection. The care support worker spoken with confirmed that formal supervision was in place and felt well supported by the manager. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by a manager who, while not yet fully qualified, has many years experience working in a service for people with learning disabilities. To ensure the home is run in the best interests of the residents quality assurance measures are in place for measuring its performance based on seeking the views of residents. The home’s policies, procedures and staff training generally ensure as far as is reasonably practicable, the health and safety of the residents and staff. EVIDENCE: 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 26 Management The manager has been in post at 64 Farlington Road since about 2001 and achieved the Registered Managers Award (RMA) in the summer of 2006. She confirmed that due to ill health she had to defer her training for an NVQ at level 4 in care. However, she has since resumed the training with Southampton City College. The care support worker spoken with regarded the home as being well run. She confirmed that the manager was approachable and supportive. Quality assurance Since the last inspection the home has made progress towards developing an effective quality assurance system. The home is relatively small and domestic in scale. It is considered that due to the residents’ cognitive impairments the written resident surveys currently in place are not the most appropriate means of gauging their satisfaction with the service. In discussions with the manager it was clear that regular one-to-one discussions and residents meetings now in place were a far better way of seeking their views. The inspector noted that an audit and development plan for 2007 had been produced, together with a staff training plan. The manager and care support worker made the point that with so few residents it was possible to have a comprehensive knowledge of the ongoing views of the people who receive the service. Records and Health and safety All care support staff undertake mandatory training, which includes health and safety awareness, food hygiene, first aid, manual handling and fire training. The inspector was shown the range of policies and procedures for the home, which have been variously updated in line with the shortfalls identified at the last key inspection. The inspector looked at records, which evidenced the fact that requirements identified at the last inspection had been met. The following records were found to be in good order: • • • • • Fire equipment checks and logs. Portable Appliance Tests (PAT) and electrical wiring inspection. Gas boiler and cooker service. Maintenance and renewal programme. Public liability insurance. DS0000011686.V325812.R01.S.doc Version 5.2 Page 27 64 Farlington Road The inspector noted that health and safety risk assessment for the building had not been carried out. The manager confirmed that her daughter was due to undertake a health and safety risk assessment course on 19 February 2007, at which point arrangements would be made to complete the assessments in the home. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 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 2 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 x 3 3 3 2 x 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 12 Requirement Where limitations are placed on a resident’s right to make decisions or undertake basic tasks an assessment must be carried out and recorded, with guidelines and strategies drawn up following advice from specialist healthcare professionals. (Requirement outstanding from last inspection on 16/10/06) Where risks to vulnerable residents are identified an assessment must be recorded in sufficient detail so as to determine the level of risk, together with the action required to minimise the risk. (Requirement outstanding from last inspection on 16/10/06) Staff deemed competent to administer medicines must be designated and appropriately trained. (Requirement outstanding from last inspection on 16/10/06) Timescale for action 31/03/07 2 YA9 13 09/03/07 3 YA20 13 31/03/07 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 30 4 YA33 18 5 YA35 18 6 YA42 13 To provide two staff on duty at all times during the day, unless the assessment for each service user, as recorded and agreed in each individual plan, demonstrates that one staff member is sufficient to meet the needs of all services users at specified times and for specific activities. (Requirement outstanding from last two inspections on 16/10/06 and 18/11/05) To introduce the new Common Induction Standards for all newly appointed care staff with the emphasis on staff working in learning disability services. (Requirement outstanding from last inspection on 16/10/06) To arrange for a restrictor to be fitted to one resident’s window, which opens at waist height. 09/03/07 31/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations All financial transactions for residents should be witnessed and signed by two staff members. 64 Farlington Road DS0000011686.V325812.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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