CARE HOME ADULTS 18-65
Eworth Close (7) 7 Eworth Close Grange Park Swindon Wiltshire SN5 6BT Lead Inspector
Malcolm Kippax Key Unannounced Inspection 24th July 2007 10:20 Eworth Close (7) DS0000003195.V345283.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 Eworth Close (7) DS0000003195.V345283.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. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Eworth Close (7) Address 7 Eworth Close Grange Park Swindon Wiltshire SN5 6BT 01793 878169 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) mariaarthur18@yahoo.co.uk Ian Charles Mrs Maria Arthur Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than six service users with a learning disability may be accommodated at any one time. 24th July 2006 Date of last inspection Brief Description of the Service: 7 Eworth Close is run by a partnership, which operates under the name of Ian Charles. The home is located in Grange Park, which is a residential area on the outskirts of Swindon. It is a two storey detached property with a large garden. Each service user has their own bedroom. Two bedrooms are on the ground floor and they are therefore suitable for people who cannot manage the stairs. One of the bedrooms on the first floor has an en-suite toilet. There are two bathrooms on the first floor and a ‘wet’ room with a shower on the ground floor. The communal rooms consist of a large lounge and a kitchen with a dining area. There is an office on the first floor, which is also used as a staff sleeping-in room. Service users receive support from the home’s manager and a team of support workers. The range of fees is £500 - £700 per week. There are additional charges made for hairdressing, toiletries, activities, papers and magazines, day centre activities and transport. Information about the home and Ian Charles is available in a ‘Statement of Purpose’. Copies of inspection reports can be obtained from Ian Charles and are also available through the Commission’s website at: www.csci.org.uk Eworth Close (7) DS0000003195.V345283.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 visit to the home, which took place on 24 July 2007 at 10.20 am and lasted for eight hours. Evidence was obtained during the visits through: • • • • Time spent with the six service users. Meetings with Mrs Maria Arthur (the home’s manager) and with a member of staff. Observation and a tour of the home. An examination of records, including three of the service users’ personal files. Other information has been taken into account as part of this inspection: • • • An Annual Quality Assurance Assessment (referred to as the AQAA) that was completed by the home’s manager. Notifications and reports that the Commission has received about the home since the last key inspection. A telephone conversation with the home’s manager on 31 July 2007. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well:
People’s needs are assessed before they move into the home. Following their move, the manager and staff team find out more about what service users like to do and about their preferred routines. Individual plans are produced, so that there is good information about the support that service users require. The individual plans are regularly reviewed to ensure that they reflect any changes in the service users’ circumstances. Risk assessments are undertaken, which help service users to be safe in the activities that they want to do. Service users live in a well established residential area and have regular contact with the wider community. They can make decisions about how to spend their time. They receive help with doing the things they want to, such as having a part time job or going to a concert. There is an imaginative approach to finding activities that people will enjoy and benefit from, such as experiencing new places and being part of the audience in a television studio. In the home, service users participate in the daily routines within their capabilities. They participate in the planning and preparation of meals and receive support with eating when this is required.
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 6 Service users receive support with appointments, so that they can maintain good health. Some service users also have specialist needs, which the manager and staff respond to by involving the appropriate professionals from outside the home. Service users receive assistance with managing their medication, so that they do not come to harm. House meetings are arranged, which give service users the opportunity to talk together about routines in the home. Service users are also asked about any concerns that they may have. There are procedures in place that help to protect service users from harm. The accommodation is generally homely and is meeting the service users’ needs. Service users receive good support with keeping the home looking clean and tidy. Staff receive training and guidance which enables them to provide good support and helps ensure that service users are not put at risk. Checks have been carried out on new staff, which help to ensure that they are suitable to work in the home. The staff team meet together regularly so that they can share any issues and agree a consistent approach. The service users’ health and safety is generally well protected by the systems in place. Service users benefit from a well run home. The home’s manager is experienced and knows the service users and their needs very well. What has improved since the last inspection?
The facilities have improved in a number of ways. A new bedroom has been created, which has given one service user their own en-suite toilet and wash hand basin. There is a new bathroom and a wet room with a shower. The latter is particularly useful for people who cannot manage the stairs or prefer not to use one of the baths. Decoration has taken place in a number of areas. Some items of furniture and floor coverings have been replaced, so that the service users continue to have good facilities in their rooms. Opportunities for staff training and development are improving. Staff members have undertaken a range of courses during the last year. This has included training in infection control, safeguarding vulnerable adults and health and safety. Service users will be better protected as a result. An annual report has been produced. Quality assurance systems have improved generally, to give better information about how the home is performing. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eworth Close (7) DS0000003195.V345283.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 Eworth Close (7) DS0000003195.V345283.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 the visit to the home. Prospective service users have their needs assessed before moving in. EVIDENCE: One service user had moved to 7 Eworth Close since the last inspection. This person was met with during the visit, although verbal communication with them was very limited. They appeared to be settled and to be enjoying the day’s activities. Mrs Arthur and a staff member said that the move had gone well and they felt that the service user’s needs were being met. Mrs Arthur said that she had visited the service user in their previous, permanent residence before the move. However, the arrangements had not been straightforward because the service user had needed to live in temporary accommodation before moving into 7 Eworth Close. The service user had an individual file in the home, which contained assessment records and other pre-admission documentation. A community care assessment had been undertaken. Records had been completed about the service user’s likes and dislikes and their personal and domestic skills. Other information had been obtained directly from the service user’s previous residence, including a personal profile and reports from health professionals.
Eworth Close (7) DS0000003195.V345283.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 good. This judgement has been made using available evidence including the visit to the home. The service users’ needs are reflected in their individual plans. They are supported to make decisions and to take risks within their capabilities. EVIDENCE: Each service user had an individual care plan that had been reviewed and updated since the beginning of the year. Mrs Arthur confirmed that it was the intention to review the plans at least every six months. The care plans were in a similar, written format. Some new forms had been introduced during the last year to help provide a clearer record of people’s care needs and the outcome of reviews. There were also forms that staff had signed to confirm that they had read the care plans. The plans covered a range of needs, in areas such as household tasks; developing social activities; meal arrangements; personal care; health and managing behaviour. In addition to identifying areas of need, there were other sections in the plans that showed the agreed objectives and the actions
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 11 that were to be taken. For example, under ‘meal management’, the agreed objective for one service user was to ensure good food and fluid intake. The action to be taken by staff included being aware of swallowing difficulties and other warning signs. A staff member met with said that they thought the plans gave a good account of people’s needs and the support that they required. The particular preferences and needs of individual service users were also reflected in other records, including a ‘Resident Profile’. The individual plans mentioned areas of risk in relation to the service users’ activities and support. A number of risk assessments had been carried out and recorded separately in respect of each service user, although there was no consistent system used for cross-referencing. Assessments had been completed for activities such as going out, eating and drinking and using the shower. The assessments reflected an individual approach and recognition that people had different abilities and needs. There was a risk assessment for the service users’ finances, which included the misuse and abuse of money. One service user looked after their own money. Mrs Arthur and a staff member described the arrangements in place for supporting other service users with managing their personal money. Staff members did not have direct access to the service users’ money, but requested money for specific purposes. Receipts and change were then returned. Mrs Arthur confirmed that she maintained the records and that receipts were being obtained for expenditure. Decisions about the service users’ personal goals and needs were being made at review meetings to which relevant people from outside the home were invited. The service users met together about once a month to discuss issues and to make decisions about the day to day arrangements. There was an agenda for each meeting and minutes kept. At the last meeting in June 2007, service users had talked about the menus and about new places that they would like to visit. They had also been asked to think about any topics that they would like to be included on the agenda for the next meeting. Service users had unrestricted use of the accommodation during the visit. There were some limitations on the use of particular facilities, as recorded in the service users’ individual plans and risk assessments. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good overall and excellent in respect of some of the service users’ activities. This judgement has been made using available evidence including the visit to the home. Service users have different routines and occupation, which reflect their individual interests and abilities. Service users benefit from the support that they receive with participating in new activities that they enjoy. Service users receive support with maintaining contact with the local community. Staff provide assistance, so that service users can be involved in the preparation of meals and have food that meets their needs. EVIDENCE: People were engaged in different activities at the time that the home was visited. Three service users were out attending planned day activities and two service users were having home-based days. Somebody else was getting
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 13 ready to go to a gym for a keep fit session. This person said that they were going with a staff member, but sometimes they went out by themselves, for example to a local shop. They also made some bus journeys independently. The individual plans showed that service users needed different levels of support, for example with going out and doing things in the home. Mrs Arthur spoke about the activities that were available and said that she was in the process of producing written timetables for each service user. One example was seen, which showed what the person had done at different times of day during the previous week. Activities during this week had included attending a resource centre and another day centre on three days. The person had also been bowling and gone swimming. At the weekend they had gone to a concert and visited a steam railway. Mrs Arthur said that some service users had recently enrolled on new courses at Swindon College. A range of leaflets were kept in the home, which gave information about local attractions and events that service users might be interested in visiting. Mrs Arthur explained that these were shown to people and their names were then recorded on the leaflets to show who was keen on a particular activity or event. This looked like a very good way of involving those service users who were less able to give their views verbally about what they wanted to do and which places to visit. One relatively new activity involved service users being audience participants at the live screenings of some popular television programmes. This had become an on-going interest, as tickets were applied for ‘on-line’ and service users waited to see if they had been successful in obtaining tickets. Service users had visited Cardiff and London in connection with this. In addition to the enjoyment of the show itself, service users were also gaining experience of different train journeys and the process used for obtaining the tickets. Each service user had unstructured time during the week. This could be spent on household tasks, such as cleaning bedrooms. During the visit, one service user was doing laundry and they hung out their washing on an outside clothesline. Mrs Arthur reported on the contact that service users had with their relatives. Two service users had lunch together in the dining room. They had been asked what they would like for lunch and decided on macaroni cheese. This had been blended for one person. They both received encouragement to eat and one person had individual assistance. This took the form of a ‘helping hand’, which enabled the service user to maintain some independence with using the utensils. Their individual care plan was looked at and it described the support that they needed with their meals and with eating. After lunch,
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 14 one of the service users looked at an album containing photographs that had been taken during some recent outings. This gave the service user a lot of pleasure and interest and the album had been very personally produced. The service users who had been out came back to the home later in the afternoon. One person said that they had been working in a café, which they did on two days a week. People had their evening meal together in the dining area of the kitchen. Some service users helped to get the table ready and chatted to staff who were serving the meal. Two service users said that they enjoyed cooking and were able to do some baking, usually at the weekends. A staff member said that service users made their own breakfasts, with varying degrees of support. Service users said that they liked the meals. The menus were discussed at house meetings. Service users had recently agreed a list of meals that would be included on the weekly menus. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. The service users’ personal and health needs are being met. Some preferences and needs could be better reflected in their individual plans and assessments, to ensure that staff always have good information. Service users are protected by the way that their medication is dealt with. EVIDENCE: The individual support plans showed that people had different personal and healthcare needs. The plans included guidance about the occasions when service users required support with their physical care, such as when using the shower. This provided guidelines for staff, which would help them to keep service users safe. It was also detailed enough to give some personal information about people’s individual preferences. For example, in one plan it was recorded that staff should try and make sure that water did not go into the service user’s face when they were being assisted with hair washing. There was a mix of male and female service users and also within the staff team. A staff member who was met with was not aware of any restrictions on
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 16 how personal care was provided. The arrangements were discussed with Mrs Arthur, who said that there were some expectations about who would do what but there was nothing written down as a policy. Records were kept of the appointments that service users had with their GPs and other healthcare professionals. Forms were completed after each appointment, which provided a good report of the outcome and any action that needed to be taken as a result. Separate guidelines and records had been produced in respect of particular health conditions and specialist needs. This included epilepsy and two service users had management plans, which were being reviewed with a community nurse at the time of the visit. Staff were recording any epileptic activity on individual charts. A staff member said that each service user’s weight was checked every month. Some of the service users’ care needs and daily living activities had been the subject of risk assessments. For example, a risk assessment for eating and drinking had been undertaken. Hazards, such as choking had been identified and a number of control measures were listed. The outcomes of the risk assessments were not consistently recorded on the form. Assessments had been undertaken in respect of medication. In the case of one person, this included the risk of medication being refused. Another assessment concerned unsafe storage. During the visit, Mrs Arthur carried out a stock check of the medication, which she said was a regular check that she made on that day of the week. Service users received support from staff with the safekeeping and management of their medication. The medication was kept securely and records were being maintained of its administration. Examples of the current records were looked at and these were up to date. There was a medication file, which included medication profiles and records of medication received into the home. One service user was prescribed a particular medication that was to be administered on a PRN (as required) basis. Guidelines about the use of this medication were included in the service user’s care plan. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users are listened to and there are procedures in place that help to protect service users from harm. EVIDENCE: Mrs Arthur said that no complaints had been received since the home was last inspected. The Commission has not received any complaints about the home during this time. A complaints procedure had been produced and was available in the home. Some service users would need assistance with making a complaint. Service users who were spoken to during the visit mentioned people who they could talk to if they were not happy with something. It was seen from the minutes of a house meeting in May 2007 that service users had been asked if they had any complaints and were reminded of the home’s procedure. They had also been asked about any compliments and one service user thanked people for a nice day out in Weston Super Mare. At a staff meeting in June 2007, staff were reminded about a complaints file that is kept in the home. The service users’ personal files contained a ‘Resident Profile’ that included information about activities or events that they might find stressful. Their risk
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 18 assessments included how to minimise the risk of being abused and of selfharm. There had been no safeguarding adults referrals during the last year. The home had written policies and procedures which covered safeguarding adults, the prevention of abuse and whistle blowing. There was a flowchart displayed in the office, which showed the action that needed to be taken if there was a concern involving possible abuse. A staff member who was met with said that she had read the ‘No Secrets’ booklet, which gave guidance about the local procedures for safeguarding adults. They also said that they had received training in the protection of vulnerable adults during the last year. Eworth Close (7) DS0000003195.V345283.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, 26 and 30 Quality in this outcome area is mostly good. This judgement has been made using available evidence including the visit to the home. The accommodation is homely and meets the service users’ needs. Service users are benefiting from improvements in the facilities, although the wash hand basins in their own rooms were not all in working order. The home is kept clean and tidy. EVIDENCE: 7 Eworth Close is in a quiet location in a residential area on the outskirts of Swindon. Service users regularly used some local amenities and made trips into Swindon. There was a bus route nearby. There was a parking area at the front of the home and a garden at the rear, which people were using during the visit. Each service user had their own room, which they could decorate and personalise as they wished. Some floor coverings and furniture had been replaced during the last year, as had been discussed at the last inspection.
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 20 There was a large lounge with sofas and a television. This room was relatively bare at the time of the visit and consideration was being given to how it should be decorated and made more homely looking. Work had taken place in the home during the last year to provide a new bathroom and a downstairs wet room, with a shower. This had improved the facilities that were available to service users. A new bedroom with an en-suite toilet and wash hand basin had also been created on the first floor. This had increased the number of places in the home from five to six. It had been found at the last inspection that not all the basins in the service users’ rooms had a supply of hot and cold water. A requirement had been made in connection with this. The water supply to the rooms was looked at again during the visit. Not all the basins had a supply of hot and cold water. This was discussed with Mrs Arthur, who said that there were concerns about two service user having access to water in their rooms for safety reasons. Risk assessments had been undertaken, which referred to the risk of flooding and electrical problems that could arise. Mrs Arthur said that significant incidents had arisen in the past. Mrs Arthur said that the use of a press down tap, which would automatically stop the flow of water, had not been considered as an alternative. In the case of two other rooms, Mrs Arthur thought that the lack of supply would be due to a maintenance problem and said that this would be looked at. Following the visit, Mrs Arthur has confirmed that there had been a problem with the system, which had since been put right. In other respects, the home looked well maintained, tidy and clean. The dining and domestic arrangements were discussed with Mrs Arthur. Space for dining was limited and laundry and domestic work was being carried out in close proximity to the dining area. This had been commented on at the last inspection, with a requirement made that staff receive training in infection control. This requirement had been met and the staff members had attended a day’s course in Swindon about infection control. There was also some scope to extend the dining and utility areas, or to relocate one of these. Mrs Arthur felt that this could have a number of benefits in terms of space and the separation of tasks. She said that there was the possibility of using the garage as a laundry area. There was an internal door to the garage. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including the visit to the home. Opportunities for staff development are improving and should continue in order to ensure that service users benefit from appropriately trained and qualified staff. Service users are protected by the home’s recruitment practices. EVIDENCE: The staff team included four full time and three part time staff members. No temporary staff had been used in the last three months. Two new full time staff had been appointed during the last year to replace people who had left. One staff member had achieved a National Vocational Qualification (NVQ) at level 2 or above. Other staff members were undertaking a NVQ at the time of the visit. A staff member who was met with described the induction that they had received when starting in the home. This had lasted for three months and was
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 22 followed by an appraisal at the end of six months. For the first few weeks of their employment they had worked alongside somebody. They were now doing their NVQ at level 2. In the AQAA, Mrs Arthur has reported that one of the things that the home could improve on would be to better link their induction and training to the Induction and Foundation element of the ‘Skills for Care’ standards. It had been recommended at the last inspection that staff new to learning disability services completed Learning Disability Award Framework (LDAF) training. Mrs Arthur said that this development had not yet happened. There was a staff training plan in the home. In the AQAA, it was reported that training was one area in which the home had improved on during the last 12 months. In addition to the development of a training audit and plan for staff, it was reported that staff had received training in Basic Food Hygiene, Fire Safety, Infection Control, No Secrets, Safe Storage and Handling of Medication, and Challenging Behaviour. Staff training records were looked at in the home, which confirmed the training that staff had received in these areas. Staff had also received first aid training in March 2007 and attended a course titled ‘Positive Intervention’ in January 2007. Mrs Arthur said that she had also facilitated some in-house training sessions with staff, which covered topics such as epilepsy, dementia, non-verbal communication and Prader-Willi Syndrome. These were not recorded as training events in the staff records. A requirement had been made at the last inspection for staff to receive training in meeting the needs of adults with learning disabilities. This was discussed with Mrs Arthur. It was agreed that progress was being made with training, although this needed to be sustained and developed over time in order to show that the requirement was being fully met. The main training events during the last year had concerned areas of mandatory and health and safety related training. The contents of the staff training plan was discussed with Mrs Arthur. It was agreed that this would be developed to include learning disability related topics, based on the service users’ individual needs and diagnoses at the time. Recruitments records in the home contained evidence of appropriate checks having been carried out on new staff. These included Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA) checks. A staff member said that they received supervision and attended staff meetings about every two months. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including the visit to the home. Service users benefit from a well run home. Quality assurance systems have improved to give better information about people’s views and how the home is performing. The health and safety of service users are generally protected by the systems operated in the home. EVIDENCE: Mrs Arthur had been in post as manager for over nine years and had over twenty years’ experience of working in learning disability services. Mrs Arthur has undertaken the Registered Managers Award during the last year. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 24 There was a requirement at the last inspection that a report on the outcome of the home’s quality review system must be produced. An annual report has since been written in response to this. A member of staff had responsibility for quality assurance in the home and the services of an outside consultant had also been obtained during the last year. The consultant had produced the annual report and included further information about how quality assurance was being addressed in the home. Some elements had not yet been implemented. Feedback from service users was being obtained through questionnaires and group discussions. The annual report was contained in a quality assurance file. The file also included evidence of the surveys that had been sent out earlier in the year. Mrs Arthur said that the next report would be produced at the end of the year and would be based on feedback that was being obtained during 2007. There was a health and safety file in the home, which included COSHH (Control of Substances Hazardous to Health) information and a range of environmental risk assessments. The assessments included fire, hot water, water in general, window openings and radiators. As with some of the individual risk assessments, clear outcomes were not consistently recorded on the forms and the forms did not have a section where this could be recorded. There was a discussion with Mrs Arthur about the home’s fire risk assessment and the need to show whether the existing control measures were adequate. Further information is available about the carrying out of a fire risk assessment. A staff member said that there were plans to fit ‘hold-open’- devices on two selfclosing doors, so that these could be safely kept open. The portable electrical appliances had been tested for safety in March 2007. A risk assessment had been undertaken concerning a service user’s use of electrical equipment. A fire file was being kept. This showed that the fire precaution systems were being regularly checked and tested. A drill had last been held on 18 July 2007. Heath and safety issues were being discussed at the staff meetings and the house meetings. The fire procedure was discussed with service users at a meeting in June 2007. Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 25 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 3 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes, in part 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. 6. Standard YA26 Regulation 23(2)(j) Requirement The registered person must ensure all sinks in service users’ bedrooms have hot and cold running water. This requirement from the last inspection has been met in part. If an alternative arrangement is being proposed because of safety concerns, then the details of this must be confirmed in writing with the Commission. 7. YA32 18(1)(c) (i) The registered person must ensure staff receive training in meeting the needs of adults with learning disabilities. This requirement from the last inspection has been met in part. In order to show compliance with this requirement, the staff training plan needs to be developed to include learning disability related topics, which are based on the service users’ individual needs and diagnoses at the present time. Progress with implementing the training plan will be assessed at a future date.
Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 27 Timescale for action 31/08/07 31/08/07 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 YA6 Good Practice Recommendations That the service users’ individual care plans are produced in a range of formats which will meet the service users’ different needs. This is so that all service users will have a better understanding of what is recorded in the plans. That a system of cross-referencing is used in the service users’ individual plans to show when risk assessments have been undertaken. This is so that the all the relevant information in respect of a particular need is more readily identified. That a policy is produced on gender and the provision of personal care. This is so that there are guidelines for staff about the personal care that they can provide to service users and about any safeguards that need to be in place. That developments are undertaken which will increase the size of the dining area and create a clearer separation between the dining and laundry areas. That details of all training undertaken, including in-house events, are recorded in the staff members’ training records. This is in order to provide a fuller record of the different types of training that staff have received. That the outcomes of risk assessments are clearly recorded on the assessment forms. This is so that there can be no misunderstanding about whether any controls measures identified are adequate or not. That guidance on carrying out fire safety risk assessments in residential care premises (available from the website: www.firesafetyguides.communities.gov.uk) is obtained and used as a resource in the home. 2 YA9 3 YA18 4 YA30 5 YA35 6 YA42 7 YA42 Eworth Close (7) DS0000003195.V345283.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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
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