Inspection on 05/06/07 for 76-78 Hampstead Road

This inspection was carried out on 5th June 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

76-78 Hampstead Road 26/11/08

76-78 Hampstead Road 04/06/08

76-78 Hampstead Road 06/07/06

76-78 Hampstead Road 15/11/05

76-78 Hampstead Road 13/07/05

76-78 Hampstead Road 13/01/05

76-78 Hampstead Road 18/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 76-78 Hampstead Road Brislington Bristol BS4 3HN Lead Inspector Sandra Jones Key Unannounced Inspection 5th & 8th June 2007 09:30 76-78 Hampstead Road DS0000026628.V335868.R02.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 76-78 Hampstead Road DS0000026628.V335868.R02.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. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 76-78 Hampstead Road Address Brislington Bristol BS4 3HN 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) 0117 9728513 0117 9699000 www.brandontrust.org The Brandon Trust Judi Lorentz Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 12 persons aged 18 - 65 receiving personal care. 6th July 2006 Date of last inspection Brief Description of the Service: 76/78 Hampstead Road is operated by the Brandon Trust. It is a registered care home for twelve younger adults with learning and/or physical disabilities. The property was purpose built to accommodate people with physical impairments. As the property is purpose built to accommodate people with physical impairments, there is level access and wide corridors. It blends well with its local residential environment and close to shops, park and bus routes. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted unannounced over two days in June 2007 with a second inspector and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedure. During the site visit, the records were examined, a tour of the premises was conducted and feedback sought from staff. The individuals at the home have profound learning disabilities and for this reason the interaction between staff and people at the home were observed to support judgements. “Have your say” surveys were received at the Commission relatives from people who use the service. Feedback Health and Social Care Professionals was sought and GP’s physiotherapist and a consultant psychiatrist responded through surveys. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the pre-inspection questionnaire and notified incidences in the home, (Regulation 37’s). This information was used to plan the inspection visit. Four people were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. What the service does well: Overall favourable comments were made by the relatives of people that live at the home and by health care professionals that visit the care home. Relatives expressed their gratitude to the staff for the standards of care provided to their family member. One person stated “ My brother’s has a good relationship with his keyworker and we have every confidence with the care provided.” The GP stated that staff show respect and are willing to learn new skills. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 6 Members of staff/ keyworkers consulted clearly have specific knowledge of the individuals and their approach was respectful and individual to the person. What has improved since the last inspection? What they could do better: The manager must address inconsistencies with the provision of care and the recording of information. While the staff’s awareness of dignity and respect is visible, it is not always consistent. The staff team must be aware that dignity and respect must be exercised at all times. Systems must be more efficient so that the people at the home receive individualised care. The Statement of Purpose must be reviewed to specify the age range and the range of needs that can be met by the staff at the home. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 7 Activities must be more consistently provided and meals must be varied and nutritious. Requirements made by the pharmacy inspector through a random letter must be actioned. The manager must ensure that the staff records, which are kept at the home, are up to date evidence a robust recruitment process. Repairs to the property must continue so that the people at the home have a homely environment. 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. 76-78 Hampstead Road DS0000026628.V335868.R02.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 76-78 Hampstead Road DS0000026628.V335868.R02.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Statement of Purpose must be reviewed to ensure that accommodation is offered to those individuals whose needs can be met by the staff at the home. EVIDENCE: There is one vacancy and the Trust is seeking to fill the vacancy with a suitable person. The Trust Admission policy is pending and the policy currently in place states that placements will be considered once a full assessment of need has been received from the funding authority. This indicates that only referrals from the Local Authority are accepted at the home. The manager stated that two individuals will soon be over 65 years and for these individuals to continue living at the home the Statement of Purpose must be amended. Recent changes in legislation require that the home stipulate within the Statement of Purpose, the category of needs and the arrangements for meeting individuals needs. Four “Have your say” surveys from relatives indicate that hey always get enough information to help them make decisions about the care home and three stated that it was usual. 76-78 Hampstead Road DS0000026628.V335868.R02.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The care planning systems is detailed and specific. However, the system must be more efficient so individuals at the home can receive individualised and consistent service. Individuals must be must be involved in making decisions about all aspects of their care. Risk assessments are in place for activities that involve an element of risks EVIDENCE: Planning for Life files contain the individuals background history, personal information, placements agreements and personal plans. Health plans and associated documentation from outside professionals is also held within the files. Relative surveys indicate that staff always meet the needs of the individual. Personal plans are detailed and are broken down into each area of need. The identified need is specific, with the support needed and desired outcome. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 11 Appended onto the action plan is the routine to be followed. Keyworkers undertake monthly reviews to assess the area of need and where necessary comments about changes in the care plans are added. A senior member of staff explained that previously there was little time for preparation before review meetings were convened and care plans amended. To allow for preparation reviews will be an all day process giving staff the opportunity to set the agenda before the meeting and to amend the care plan in a meaningful way. Members of staff said that choosing clothes, toiletries, maintaining rooms tidy and arranging holidays were part of their role as keyworkeers. Additionally, 1:1 time and maintaining daily records and undertaking monthly summaries were expectations of their role. One member of staff confirmed that there is an expectation that staff read Planning for Life Packs and stated that since the relocation of the files, reading files is easier. There is an expectation that staff record tasks completed for the person, observations, activities and outcome of visits. There is standard daily record format that incorporates a combination of tick box and space for comments from staff. The daily record is specific to the person and linked to the their personal plans. However, the daily records remain physically focussed and there is little evidence of the way the person spends their day or the activities undertaken. The manager stated that daily reports are to be reviewed and, members of staff will be expected to make comments for each specified routine. Information currently held within other records and reports will be drawn together and held within the daily reports to give a detailed picture of the individuals well being. Care plans are detailed about the way each person communicates, information about the way people without verbal communication make decisions is specific. Within the care plans the gestures, vocal sounds and behaviour exhibited, its meaning and the actions that staff must take is included. While daily reports are not clear about decisions made by the individuals, monthly summaries evidenced that people living at the home make decisions about their daily lives. The person’s ability to manage their finance is identified and specified in their personal plans. From the information held within the files it is evident that the people living at the home have little understanding of money and risk assessments are in place to confirm the findings. Two members of staff will be attending the Mental Capacity Act training and feedback for all staff will be arranged through meetings. Individual risk assessments are generally based on bathing, mobility and eating. Where the risk is identified, risk assessments are completed, which lists the options available to inform the action to be taken to reduce the level of risk and decisions taken. Medical health care risk assessments are also in place for staff to follow. Generic risk assessments are in place for restricting access to the first floor, for not giving keys to individuals. In terms of the front door key, the individuals at the home have little understanding of the purpose of having keys to the home. Regarding risk assessments for access to 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 12 the first floor, risk assessments indicate that by restricting access to the first floor individuals at the home have safe independent access to all parts of the home. Within each Personal Planning for Life Pack there is a brief description of the person likelihood of leaving the home without staff support. For the majority of the people at the home, they would leave the home without staff support if the front door were to be left open, for this reason the doors are always secured. 76-78 Hampstead Road DS0000026628.V335868.R02.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Individuals must have more opportunity to become part of the community, their activities need to be structured to ensure that those with complex needs are met and are encouraged to fulfil their potential. Members of staff must ensure that individual’s dignity is respected at all times and meals must be more varied. EVIDENCE: An activities program was seen for both house one and house two and these documents show that an attempt to input some structure had taken place. Documentation held within case files indicate that individuals are entitled to a set number of hours for day care. This demonstrates that the service is aware that activities form a part of the resident’s personal development. The day care activities consist of sessions at the snoozlem, local community walks, visits to the pub and music sessions. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 14 Members of staff were consulted about in-house activities. One member of staff said that the person they have keyworker responsibility is not keen on going out and in-house activities are provided instead. Three staff stated that activities are not happening, “days out” no longer take place and there is insufficient staffing to do in-house activities with individuals. Another stated that the manager no longer rosters staff for “days out”. There is an expectation that keyworkers plan the event then set the date and request it to be added to the staff rota. Staff comments were discussed with the manager who explained that previously individuals were not having a full “day out” because staff were not planning the outing in advance and this way keyworkers will have to plan and discuss the day out with senior staff. Two selected care files were case tracked in order to gain a snapshot of the quality of the individual’s lifestyle. The recording within the care files were inconsistent, for instance the care plan for one person stated that the person needs time talking and sharing a game. However, the recording for this was not available and indicates that the activity did not take place. Improved recording in the care plans would provide staff members with the relevant information needed to provide consistent care. In- house activities such as sitting out in the garden, and having meals are taking place. However, the garden is currently an uneven area that may cause problems for the individuals. The Gardening Club, which consists of a number of individuals living at the home and staff, participate in painting the garden sheds, planning edible plants and herbs, tending to the hanging baskets. The gardening club has also assisted in the redesigning part of the plans for the garden work, which is due to start in a few months. This demonstrates that the service is inclusive and aware of the needs of the people living at the home. There are currently plans to change the garden into a stimulating environment. For instance, the plans for the garden include, a water feature, hot tub, planting area, gazebo hood for those who are light sensitive, and an outdoors sensory area. Thoughts of a memorial for a resident who had died are also being discussed. Where ever possible attempts are being made to maintain relationships both internal and external to the home. One person from the home maintains contact with the community through their attendance to weekly church service. Daily walks to the local shops or café also encourage friendships outside of the home. Other relationships are made during the day care sessions that also have other groups within the community. Four “Have your say” surveys from relative state that the staff always help the people living at the home to keep in touch with their relatives and friends. One person stated that it was usual for the staff to support people at the home to maintain links with relatives. One relative commented that “ I am unable to visit my daughter and I am particularly grateful that the staff bring my daughter to my house for lunch and for a few hours.” 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 15 Individual’s routines are specified within their Planning for Life Packs. However, daily reports are not consistently maintained to evidence that preferred routines are followed. The awareness of dignity and respect is visible but not always consistent. For instance, during the inspection, one person living at the home was wearing damp clothing and despite staff attention being drawn, no action was taken. The staff team must be aware that dignity and respect must be exercised at all times. Members of staff were consulted about the way they engage with individuals and not with each other. One person stated that by spending time to speak to individual they always received a response. This service has a four weekly menu that the staff team has been allocated the task of designing the menus. However, the range of foodstuff lacks variety and much of the items on the menu have been rotated on different days and weeks. One member of staff said that there never seems to be enough food to go around and another said that there was insufficient choice and there is no rotation with who is helped to eat their meals first. One member of staff did recognise that staff could take more responsibility about rotating who is assisted with their meals. Staff’s comments were discussed with the manager who explained that members of staff were instructed to develop menus that were consistent with their perception of individual’s likes and dislikes. It was further stated that staff were instructed to prepare the menus and then produce shopping lists to ensure there is sufficient food for the individuals at the home. The manager recognises that more input to develop menu is needed from senior staff. The range of food held at the home was assessed and tinned, fresh and frozen food was found. Staff interaction with individuals at the home was observed during the lunchtime meal. In some cases, the support from staff to individuals was adequate and in other instances was lacking in pace and consideration. For example a drinking cup was held to the mouth of a resident with very little pause for intake of breath. The staff team must be aware that care plans are working documents and have been written to provide guidelines on preferred care. Additionally during the lunchtime meal it was observed that a meal was one person’s meal was reheated and was offered without rechecking the temperature of the food. This is a potential for risk of burning. The staff team must ensure that food is of the correct and safe temperature. There are opportunities for the residents to be involved with the weekly shopping as seen on the activities programme. However there is little evidence to show how far choice is being given. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 16 A number of requirements had also not been met in regards to temperature control for the fridge and freezers. The recording was found to be inconsistent. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Individuals at the home can expect sensitive and prompt support for their personal care needs. There are inconsistencies in the way health care advice is followed at the home. Action must be taken to make the medication systems safe for people living at the home. EVIDENCE: Personal plans are specific about they way personal care is to be provided to the person. The individual’s routine is appended and guide the staff to consistently meet the identified need. Within the routines for personal care the person’s likes and dislikes are described. Routines are based on the way the person communicates and staff’s perception of the individual. It is stated within the daily routines whether the person prefers to have a male or female carer. Where individuals have personal hygiene needs, care plans inform the staff about the way personal care is to be met. The person appearance is clearly detailed and takes account of their right for dignity. For example, clothing 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 18 must be age appropriate and must reflect the weather. While care plans are detailed there is little evidence that the plan of actions are successful. Care plans indicate the people have access to the Community Learning Disabilities Team (CLDT) and referrals are made the staff for input from physiotherapists, dieticians, and speech and language therapists. Two “Have your Say” surveys from health care professionals were received and state that the home sometime meet the health care needs of the individuals. The people living at the home have mobility needs and the home was purpose built to allow for wheelchair uses to move around with ease. There are hoists and specially adapted baths and, Manual Handling risk assessments are clear about the techniques to be used when supporting people inside and outside the home. Occupational health referrals are also made through the CLDT for people that need assistance with mobility. It is evident that one person has pressure sores and the care plans guide the staff to prevent further breakdown of pressure sores. However, there is little recorded evidence in the daily records that staff are following medical instructions. There is a wide board in used by the staff to record the times the person was “turned”. However, the record is not consistently maintained. Records kept by the staff are inconsistent about following the advice given by health care professionals. For example, the records for one person that has epilepsy and the turning people in bed to prevent pressure sores. Planning for Life packs contain personal health care, health care profiles, daily routines and medications records. From the information held within care plans it is clear that the individuals at the home require full support during any consultation with health care professionals. A record of health checks is maintained and indicates that individuals regularly visit the dentist and opticians. Members of staff complete medical reports whenever GP’s is contacted and record the advice given, medication prescribed, with any further action. Documentation from health care professionals clearly indicates that members of staff monitor individual’s health and take appropriate action. Eight “Have your Say” surveys from relatives state that the staff always keep them informed about important issues affecting their family member. Two stated that the homes sometimes kept them informed. A pharmacist inspection took place in respect of medication systems at the home and there is a separate report that must be viewed in conjunction with this report. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Relatives and members of staff ensure that concerns about the service provided to individuals at the home are listened to. The manager must ensure that relatives are aware of the procedure for making complaints. This will enable relatives to advocate on behalf of the individual at the home. Measures are in place to ensure that the people living at the home are safeguarded from abuse. EVIDENCE: A record of complaints received at the home is maintained and since the last inspection, two complaints were received at the home. One complaint was made by the staff on behalf of one individual living at the home, which concerns the service received by an airline. The other was from a neighbour about clinical waste. Regarding the complaint made by the neighbour, the manager is taking action and the neighbour will be consulted about the outcome. Seven “Have your Say” surveys were received from relatives and indicate that three people know how to make a complaint, three couldn’t remember and one person did not know. The manager has agreed to provide relatives with copies of the complaints procedure to ensure their awareness. Trust policies and procedure about the approach towards safeguarding adults from abuse are in place. The manager stated that Protection of Vulnerable 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 20 Adults form part of the induction programme for new staff. Members of staff giving feedback were clear about the factors of abuse and the procedure to be followed for reporting alleged abuse. The manager stated that there are no disciplinarys in progress. Through “Have your Surveys” one relative remarked on a response received from a previous manager about the way the staff safeguards individuals from abuse. The manager will be writing to this relative to reassure them about the measures in place that protect adults from abuse. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home must be better maintained so individuals can benefit from living in a comfortable and homely environment. EVIDENCE: Hampstead Road is purpose built to accommodate people with physical and sensory impairments that have learning disabilities. The accommodation is arranged into two separate dwellings, which is linked by shared space and office upstairs. There are six single rooms, lounge and kitchen/dinner in each house. Other shared space consists of a laundry, Snoozelum and activity room. It is located close to shops, places of worship, amenities and bus routes. The home is clean and free from offensive smells. A tour of the premises was conducted during the site visit and action to maintain a comfortable and homely environment to the people that live at the home. The manager explained that the kitchen in house 1 will be replaced and 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 22 rooms 9,8 and 7 will be redecorated. It was also noted that room 2 would also benefit from redecoration. While the lounges are adequately decorated and it was understood carpets are shampooed regularly, dirt is engrained into the carpet. One individual at the home was observed trying to access the rear garden but because the paths are rough and the garden uneven, access is restricted to this individual. Showers, bathrooms and toilets are functional and equipment was updated in the smoozelum for the people at the home to use. In each house there is a bathroom, shower room and toilet with six room arranged into a circle. Bedrooms are single and lockable and members of staff ensure rooms are decorated to their perception of the individual. Bedrooms have furniture and fittings that reflect their lifestyle and needs. There is a lounge in each house and there is sufficient seating for the residents in the house to sit together. The laundry is away from both kitchens and shared by both housed. The walls are painted and there is vinyl flooring for easy cleaning. There are two small washing machines with specific programmes for sluicing and tumble dryers. One member of staff stated that one washing machine was recently purchased. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager must ensure that the records regarding recruitment process are up to date and establish that the recruitment process is robust and protects individuals at the home. Members of staff have the skills to meet the needs of people with learning disabilities. EVIDENCE: Staff personnel records are kept at the Trust office and the managers’ are expected to visit the head office to check documentation for new employees. An Employee record checklist is then completed and kept in the home to evidence that a robust recruitment process was followed. Personal details and qualifications are listed within the record and, a tick box system is used to indicate that the manager saw references and proof of identification. The serial number of the Criminal Records Bureau (CRB) disclosure and POVA First check obtained are also specified. However, serial number of CRB disclosures and evidence references were seen was missing for some staff. It transpired through the Pre-Inspection Questionnaire that twelve staff have left the home since the last inspection. The manager explained that the people that have been recruited since appointment as manager have 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 24 remained, the staff that have left completed exit questionnaire and unrecognisable differences with the manager were not listed. The manager further stated that with the exception of 2 FTE all vacancies have been filled. The manager stated that staff’s training needs are addressed through supervision and the main focus is to ensure that staff complete statutory training. There will be an expectation that members of staff attend report writing and IT courses, which has become part of the job for support workers. The manager said that Learning Disability Award Framework (LADF) follows from the induction programme. Staff is then automatically registered onto vocational qualifications, which depends on the availability of assessors. “Have your say” surveys were received from relatives and health care professionals. Two relatives stated that the staff always have the right skills and experience to look after people properly and five stated usually they have the right skills. One person named four staff including the two senior support workers as compassionate and outstanding. The GP said that staff demonstrate a clear understanding of the care needs of the people at the home. The physiotherapist stated that staff sometimes have the right skills and commented, “some staff are very skilled but occasionally new staff take a while to get “up to speed”. The consultant psychiatrist stated that the staff are sometimes skilled and training was recommended. The manager and senior support staff contradicted the comments made by the psychiatrist. It was stated that the training recommended was provided to all staff. The manager further stated that the physiotherapist and other visiting professionals have made positive comments that the home has changed for the better. Members of staff were consulted about the training available at the home. Three newly appointed staff were consulted and confirmed that they have completed the induction programme attended statutory training and have started LADF. 76-78 Hampstead Road DS0000026628.V335868.R02.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People at the home can expect to live in a safe environment and there is a business plan to develop and monitor the service provided. EVIDENCE: The manager was successful in the CSCI “Fit Persons” process and is registered as manager of the home. The manager described the way the homes plan links to the Trust business plan. It was stated that there are first three objectives for the home is communication which focus on assisted, technology and makaton to develop better communications with individuals at the home. Individuals at the home are to be involved in the recruitment 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 26 process through supported activities, informal evenings and through community inclusion. The manager stated that the style of management at the home is open and supportive and the role includes following policies and procedures, maintaining adequate staffing levels, undertaking supervision and staff meeting. It was further stated that to offer consistency of care and stability to the people at the home, supervision takes place to address problems, resolve issues, offer training and discuss the responsibility of the roles. The delivery of eleven packages of care to the people at the home provides individualised care enabling the person to live their desired lifestyle. The manager confirmed that monthly visits take place by the external manager. One member of staff stated that there is a strong management style and, the manager is approachable and fair. Supervision occurs regularly and is based on work performance, personal development and suggestions. Staff meetings also take place and one member of staff stated that these forums are more respectful and there are opportunities to make suggestions. Two relatives and the GP made additional comments about the way the home delivers a service to the people at the home through the surveys. The GP stated that the staff show respect and are willing to learn new skills and relatives stated that the staff show care and concern to the people at the home. The Manager explained the system in place for reviewing and developing the service to the people at the home. The Trust business plan contains three objectives and care homes must then set their internal objectives to achieve the business plan. The manager said that through questionnaires, person in control visits and visiting professions the success of the plan is assessed. The records that relate to Health and Safety were examined. Fire Risk assessments were initially devised on 7/9/06 and reviewed annually by the manager. The safety of the people at the home is maintained by annual checks, which include the heating system and portable equipment. There is Control of Substances Hazardous to Health (COSHH) in place and the manager is seeking data sheets for all the products used at the home. Generic risk assessments are formulated for moving heavy equipment. 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 1 13 3 14 x 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 3 x 2 x x 3 x 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 28 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA24 YA1 Regulation 23(2)(b) 6 Requirement Attend to repairs to the property The Statement of Purpose must be reviewed to specify the category of needs including the age range and the way their needs are to be met by the staff at the home. The staffing levels at night must be assessed to ensure members of staff can evacuate the home safely at night in the event of a fire (Not followed-up at this inspection) Individuals at the home must participate in in-house and community based activities. The rights of the individuals at the home must be respected. Individuals at the home must have a varied and nutritious diet The manager must ensure the records that evidence a robust recruitment process are up to date. Timescale for action 30/11/07 30/10/07 3. YA41 18 (1) (a) 30/08/07 4. 5. 6. 7. YA12 YA16 YA17 YA34 16 (2) (m) 12 (4) (a) 16 (2) (i) 7,9,19 Sch.2 30/08/07 30/08/07 30/08/07 30/09/07 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 76-78 Hampstead Road DS0000026628.V335868.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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