Inspection on 06/02/07 for 77-79 Bath Road

This inspection was carried out on 6th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

77-79 Bath Road 22/12/05

77-79 Bath Road 09/08/05

77-79 Bath Road 20/01/05

77-79 Bath Road 06/09/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Bath Road (77/79) 77/79 Bath Road Old Town Swindon Wiltshire SN1 4HB Lead Inspector Malcolm Kippax Key Unannounced Inspection 6th February 2007 9:30 Bath Road (77/79) DS0000003204.V309733.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 Bath Road (77/79) DS0000003204.V309733.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. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bath Road (77/79) Address 77/79 Bath Road Old Town Swindon Wiltshire SN1 4HB 01793 538074 F/P01793 538074 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) www.rethink.org Rethink Mrs Carole Leslie Laurelli Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd December 2005 Brief Description of the Service: 77/79 Bath Road opened in 1994 and provides accommodation and personal care for up to ten people affected by severe mental illness. The home is run by ‘Rethink’ a national charity that provides a range of care and support services around the country. Bromford and Carinthia Housing Association owns the property. 77/79 Bath Road is located in the Old Town area of Swindon and there are a range of shops and amenities within walking distance. The property was originally two attached houses, which have been converted internally to provide accommodation on three floors. Each service user has their own bedroom and there are various communal rooms on the ground floor. There are gardens to the rear of the property and a small parking area at the front. The fee level is £279.65 per person per week. Bath Road (77/79) DS0000003204.V309733.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 on 6 February 2007 from 9.30 am to 4.40 pm. A second visit was arranged and this took place on 12 February 2007 from 9.30 am to 2.05 pm. Service users were spoken with and there were individual meetings with three staff members, the team leader and with Mrs Laurelli, the home’s manager. There was a tour of the home and a number of the home’s records were looked at. Other information and feedback about the home has been received and taken into account as part of this inspection: • • • The manager completed a pre-inspection questionnaire about the home. Four service users completed surveys about their experience of the home. Seven comment cards were completed by relatives and visitors. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: There is a procedure for admissions, which includes introductory visits to the home and a full assessment of a new service user’s needs. This helps ensure that a prospective service user knows what to expect and that the home is suitable for meeting their needs. The home works closely with other agencies and outside professionals, which helps a service user to settle in as well as possible. New service users receive good information about the home and a copy of the most recent inspection report is readily available in the front hall. Each service user has a care plan, which provides good guidance about how their needs are to be met, in areas such as communication, personal care, mental health and mobility. This helps ensure that the staff team provides consistent support in the way that each person prefers. The care plans are regularly discussed at meetings between the service user and their key worker. This means that the care plans are kept under regular review and can be updated to reflect changes in the service users’ lives. The care plans generally do not include specific goals with timescales, although where appropriate, service users can participate in a self-care programme and take responsibility in areas such as preparing their own meals and looking after their medication. Service users feel that ‘house rules’ have been kept to a minimum and that they are treated as individuals. Service users can choose how to spend their time, although there is encouragement in some areas, such as for a service user not to stay in their own room all day. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 6 Service users can raise issues and concerns at regular house meetings, when they are also are consulted about matters such as the weekly menu and future activities. The service users’ right to make decisions is respected by staff, who assist people with making informed choices. Service users can manage their own personal money and support is available with its safekeeping if needed. Staff members are aware of the service users’ preferred routines; risk assessments are undertaken which support service users with being independent and help to reduce identified hazards. Service users have opportunities for personal development and benefit from the support they receive with their relationships. Their relatives can visit in private and are made to feel welcome in the home. The meal arrangements are flexible to meet the service users’ individual needs. Staff members provide information, which helps service users to make choices about healthy eating. The service users’ personal and healthcare needs are assessed and kept under review with the involvement of outside professionals. This helps ensure that service users receive the appropriate level of support. Medication is managed discreetly and the home’s procedures and practices encourage service users to take responsibility for their medicines. Service users are generally well protected by the way medication is managed. Service users have the opportunity to raise concerns and receive support from staff, which assists them with expressing their views. Staff members receive guidance and training that helps to protect service users from harm. The accommodation is meeting the service users’ needs. There are good communal areas, in addition to the service users’ individual rooms. The environment is generally homely, clean and well maintained. Service users benefit from staff members who understand their needs and undertake relevant training. There are recruitment procedures, which promote equal opportunities and help to protect service users from being supported by unsuitable staff. Service users benefit from a well run home and there are good systems for monitoring and improving standards in the home. Service users are asked for their views as part of the home’s quality assurance arrangements. The staff team are aware of ways in which service users may be discriminated against and the organisation provides training in equality and diversity. The health and safety of service users and staff are generally well promoted and protected. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The care plan forms included a section where the service user’s views can be recorded. On some forms this was blank, although the service users’ views were sometimes referred to in the main ‘type of support’ section. It would be beneficial to have a consistent means of recording the service users’ views and to record when a service user has not commented or expressed their view for any reason, rather than leave the section blank. This will ensure that there can be no misunderstanding about how a service user has contributed to the care plan and what their view of the plan is. There were sections on personal care and physical care needs in the service users’ care plans. These sections described the support that service users required in most areas. During the inspection, a question arose about nail cutting and whether a service user could be independent in this area of their personal care. This was not consistently recorded in the care plans. It may be useful to include more headings under the physical and personal care sections of the care plans, as a prompt to record the support that service users need in different areas. The service users’ views are recorded in the minutes of house meetings, which are displayed in the home’s front hall. Comments made by service users during these meetings may be of a sensitive and personal nature and it would not be appropriate for members of the public to have access to such minutes. The availability of the minutes should therefore be reviewed to ensure that the service users’ confidentiality is not compromised. The home needs to ensure that the staff members’ involvement with medication is always appropriately recorded in order to protect themselves and service users. One service user was looking after a week’s supply of their own medication. The recording of this was discussed during the visit on 6 February, when it was found that the home’s own procedure was not being fully complied with. This was corrected by the time of the visit on 12 February. It is recommended that the provision of smoking areas in the home is reviewed and action taken to ensure that the impact of smoking is reduced as far as Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 8 possible and the environment is improved as a result. The décor in some bathroom and toilet areas is deteriorating and showing signs of wear and tear. Redecoration of these areas should be planned for the near future, to ensure that good standards are maintained. There have been several staff changes during the last year and the number of qualified staff has reduced. A new staff team is taking shape and an increase in the number of qualified staff is now a priority. Service users are asked for their views, although these could be more fully reflected within the home’s system of quality assurance. 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. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 9 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 Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. New service users have their needs assessed and can get to know the home before moving in. This helps ensure that a prospective service user knows what to expect and that the home is suitable for meeting their needs. EVIDENCE: There was a procedure for referrals, which included joint working with a local NHS Trust. One service user had moved into 77/79 Bath Road during the last year and their pre-admission records were kept in the home. An application form had been completed and the home had received a range of information, in connection with assessments, risk screening and care plan reviews. The team leader said that she had visited the person with a staff member prior to the move. An admission checklist had been completed. Mrs Laurelli said that the admission arrangements for this person were unusual, in that they did not visit 77/79 Bath Road before moving in. The admission procedures normally involved the prospective service user making a number of visits to the home over a period of time. Discussions had taken place concerning the person’s views and the necessity for a move. Mrs Laurelli had liaised with other professionals and confirmed in a letter some conditions and some safeguards for the new service user that needed to be in place. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 11 This service user was met with during the visits and Mrs Laurelli said that they had settled in well. This view was supported by recent documentation in the home. At the time of the visits another person was staying in the home as part of the arrangements being made for a permanent move. The service users who completed surveys confirmed that they had been asked if they wanted to move to the home. Two service users had stated that they had received sufficient information when moving into the home and two people stated that they hadn’t. Mrs Laurelli said that she thought this difference might be due to when people had moved into the home and the information that had been available at the time. People now received better information, which included a Service user’s guide. In their comment cards, four relatives and visitors confirmed that they had access to the home’s inspection reports. A copy of the most recent inspection report was displayed in the home’s front hall, together with other information of interest to visitors. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. 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 visits to the home. Service users benefit from the information that has been recorded about how their needs are to be met. This helps ensure that the staff team provides consistent support, in the way that they prefer. The service users’ right to make decisions is respected by staff, who assist service users with making informed choices. Assessments are undertaken which support service users with being independent and help to reduce identified hazards. EVIDENCE: Three service users’ individual records were looked at. There were care plan forms that covered different aspects of the service users’ needs, such as communication, personal care, mental health and mobility. One section of the care plans included information about the intervention of staff and the type of support that was needed. The care plans were being regularly discussed and reviewed during meetings between the service user and their key worker. The Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 13 main points of these keyworker sessions were recorded, together with any changes to the care plan that had been agreed at the time. The care plan forms had been updated in January 2007. There was also a section on the care plan forms to record the service user’s views. On some forms this was blank, although the service users’ views were sometimes referred to in the main ‘type of support’ section. The method of including and reflecting the service users’ views within their care plans was later discussed with Mrs Laurelli. The service users’ main aspirations and needs were highlighted in the records. Mrs Laurelli said that she did not think that it was appropriate to identify goals with timescales, other than when a service user was working towards achieving a specific task as part of independence training. At the time of the visits, one service user was involved in a self-care programme and was taking responsibility in areas such as preparing their meals and looking after their own medication. In their surveys, three service users confirmed that they always made decisions about what to do each day. One service user stated that they usually did. In response to the question ‘Do the carers listen and act on what you say?’ two service users confirmed that this was always the case, one person stated that they usually did and another that they never did. Service users did not add any comments in connection with this. During the visits, the service users spoken with did not feel that there were any unreasonable house rules. They confirmed that they had keys to their rooms and could choose where to spend their time. One service user said that they were encouraged not to stay in their rooms all day. Service users used a pay phone in the front hall. The minutes of a house meeting were displayed in the front hall. This may have implications for confidentiality, as they included comments that had been made by named service users. Service users said that the meetings were useful and they could raise issues and concerns that affected them. At the most recent meeting, service users had been informed of changes in the staff team and been asked for their suggestions, for example about the weekly menu and future activities. The majority of service users were managing their own personal money. Their personal files included guidance about how they could access this independently and any specific arrangements that had been agreed. Some service users received support with the safekeeping of money and records were kept of deposits and withdrawals. The system was discussed with a staff member, who said that the records were checked twice a day to ensure accuracy. Examples of the records were looked at. Normally the service user and the staff member both signed that record when a transaction was made, Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 14 although one service user had chosen not to sign. A check was made of one service user’s money. The amount recorded as the current balance tallied with the actual money that was being kept on the service user’s behalf. None of the service users had advocates. The complaints leaflet given to service users explained that the local ‘Mind’ group would provide help if needed. The service users’ files included crisis self-management forms. The staff spoken with were aware of the service users’ preferred routines and of particular actions that had been agreed and recorded in the care plans. The plans included personal information about the service users’ backgrounds and their abilities and wishes in different areas. Risk assessment forms had been completed in a respect of various hazards, including smoking. Control measures had been identified on the assessment forms, which helped ensure that service users could act independently. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Service users can exercise independence in the home and have opportunities for personal development. Service users benefit from the support they receive, which helps to maintain relationships and develop individual skills. The service users’ rights and responsibilities are recognised within the daily routines. The meal arrangements are flexible to meet the service users’ individual needs. Staff members provide information, which helps service users to make choices about healthy eating. EVIDENCE: During the visits, service users spent time in different parts of the home and were engaged in individual activities. Some service users preferred to have company, others were occupied in their own rooms. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 16 When going around the home, staff respected the service users’ private space and their routines. Bedrooms were only entered with the occupants’ permission. Service users had keys to their bedrooms. Keys to the front door were not routinely given out for security reasons, although staff said that service users would be given a key to use if they were going out and expecting to return home late. House rules appeared to have been kept a minimum. Service users said that they could go to bed and get up when they liked. Service users were expected to help with keeping their rooms clean. On occasions, this had been confirmed in a written agreement with the service user, with a condition that staff will assist with this. Service users were able to go out by themselves. The location of the home meant that service users were part of the local community and well placed for getting to local amenities and a range of shops. Some service users met with had been out shopping earlier in the day. A cinema trip was discussed as something service users might like to do in the evening. There was unrestricted access to the garden at the rear of the property. At a house meeting in January 2007, service users were asked for suggestions about forthcoming activities. Some service users attended local colleges and day services, including a voice hearer’s group and an I.T. college course. In their comment cards, the relatives and visitors all confirmed that they are welcome in the home at any time and can visit in private. Information about family backgrounds and significant relationships was recorded in the service users’ personal files. Service users said that they could meet with visitors in one of the communal areas or in the privacy of their own bedroom. Staff members spoke about service users respectfully and were sensitive to how people might feel. They were aware of service users who would welcome talking to a visitor and others who might find it more difficult to engage, or may not wish to. Staff members, in their role of keyworkers, were supporting service users with their relationships. Family members were asked to complete satisfaction surveys as part of the home’s system of quality assurance. The main meals were cooked for service users, except when a service user prepared their own on certain evenings, as part of ‘self-care’. One person was on a ‘self-care’ programme and chose to prepare most of their own meals. The menu for the week was compiled following consultation with service users and then displayed in the kitchen. The menu showed when alternatives to the planned meals had been provided, including a number of vegetarian dishes that were prepared for one service user in particular. Given the number of hand written changes and additions, it would be beneficial to find a clearer way of recording the amendments on the menu record. Service users who wanted Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 17 an alternative to the planned evening meal were expected to request this by 3pm. Lunch was prepared during the visits and service users were able to choose whether to participate and when to have their meal. The type of meal (soup and rolls) meant that there could be some flexibility in the arrangements. The main cooked meal was served in the evenings and Mrs Laurelli said that this was a more communal meal, which service users had together. The dining area was a light and spacious room next to the main kitchen. Service users made their own drinks and snacks during the day, using facilities that were separate from the main kitchen. There was a ‘Rethink’ policy on nutrition. It was recorded in the minutes that this had been discussed at a house meeting in January 2007 and two service users had expressed an interest in learning more about nutrition. Fresh vegetables were being used. At the staff handover in the afternoon there was information passed on about how well certain service users had eaten. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. 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 visits to the home. The service users’ personal and healthcare needs are assessed and kept under review with the involvement of outside professionals. This helps ensure that service users receive the appropriate level of support. The home’s medication procedures and practices encourage service users to take responsibility for their own medicines and exercise independence. Service users are generally well protected by the way medication is managed. EVIDENCE: It was reported in the pre-inspection questionnaire that none of the service users required help with their physical care, although each person had needs relating to their mental health. The service users’ care plans included sections on personal care and physical care. There was guidance for staff about service users who would need prompting with personal care, for example with having baths and shaving regularly. Staff members confirmed that their role was primarily to advise service users and encourage independence with personal care. Mrs Laurelli said that some service users required support with toenail cutting and received Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 19 assistance from people outside the home. Staff confirmed that this was not a task that they undertook with service users. It was not always clear from the care plans how service users received support in this area of their personal care. Information was recorded about how service users are affected by mental illness and the impact this may have on the service users’ day to day routines. There were well established arrangements in place for service users to receive support from outside health professionals, including community psychiatric nurses. In their surveys, each relative and visitor reported that they are satisfied with the overall care that service users receive. Service users were registered with local GPs. Details of medical appointments were recorded in the service users’ individual records. One record seen included information about diabetes and staff spoke about how they supported the service user with this condition. A staff handover took place during the afternoon, when this was discussed. The service user was taking responsibility for monitoring their diabetes on a daily basis. They shared the results of the tests with staff, who then considered any advice or follow up action that needed to be taken, in conjunction with the service user. Observations about the service users were commented on during the staff handover and the need to follow up any changes in well-being was discussed. Health matters were also discussed at regular staff meetings. Medication was kept securely and dispensed in a designated room that was away the main communal areas. This meant that medication could be administered in a discreet and personal way. Staff members confirmed that they received training in the medication procedures. The records of administration were looked at. A monitored dosage system was used and the dispensing pharmacist was due to visit to carry out a routine inspection visit. The records showed that staff members were consistent in recording the medication that they administered. In some cases the printed instructions on the recording sheet needed to be updated to reflect a change to ‘as required’ administration. This was something that needed to be raised with the dispensing pharmacist. It was recommended at the last inspection that clearer guidelines are produced for staff about when some P.R.N. (‘as required’) medication should be administered. This has received attention and the new guidelines showed a good approach to ensuring that ‘as required’ medication is used carefully and in a way that takes into account the views of both service users and staff. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 20 As part of a ‘self-care’ programme, one service user was looking after a limited supply of their own medication. The recording of this was discussed during the visit on 6 February, when it was found that the home’s own procedure was not being fully complied with. This was corrected by the time of the visit on 12 February. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. 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 visits to the home. Service users have the opportunity to raise concerns and receive support from staff, which assists them to express their views. Staff members receive guidance and training that helps to protect service users from harm. EVIDENCE: In their surveys, each service user confirmed that they know who to speak to if not happy with something and that they know how to make a complaint. Within the home, service users had the opportunity to raise concerns and were encouraged to air their views, for example in house meetings and during the monthly keyworker sessions. The Commission has received no complaints about the home in the last twelve months. Mrs Laurelli reported that no complaints have been made to the home during this time. A book was kept in the office for the recording of any complaints that are received. There was a complaints procedure that outlined the steps to take if there are any complaints. Service users were given a copy of the procedure to keep in their rooms. There was an organisational policy and procedure about responding to allegations of abuse. Staff members were given guidance on the local arrangements for the protection of vulnerable adults and had received copies Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 22 of the ‘No Secrets in Swindon and Wiltshire’ booklet. A ‘Whistle Blowing’ procedure was also available to staff. All new staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. The accommodation is meeting the service users’ needs. The environment is generally homely, clean and well maintained, although could be further enhanced in some areas. EVIDENCE: 77/79 Bath Road had been converted from two houses to provide residential accommodation. The location of the home meant that service users could walk to a range of local amenities and shops that they liked to use. The accommodation looked spacious and the areas seen were generally well maintained and decorated. An exception to this was the décor in some bathroom and toilet areas, particularly the condition of the paintwork. Mrs Laurelli said that she was aware of these areas and acknowledged that they were in need of attention. One of the kitchens was shortly to be refurbished. The bedrooms varied in outlook and size. One empty bedroom was a particularly large room at the front of the building. A staff member said that this room had been offered to an existing service user, who had preferred to Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 24 stay in the smaller room that they already occupied. One service user was met with in their own room. They were satisfied with their room and said that it had what they needed. The home was well off for communal areas, having three lounges and a separate dining room. Two of the lounges were designated as smoking areas; a no-smoking policy applied to the rest of the communal space. One of the smoking lounges was in a central location between the office and dining room. This resulted in other areas being affected by smoke, particularly as the doors were held open with automatic devices. There were mature gardens at the rear of the property. One of the staff members met with suggested that the upkeep of the garden could be improved and that service users would benefit from having more shaded areas, which would help in hot weather. The accommodation seen was generally clean, with no unpleasant odours. However the condition of the décor in some bathroom and toilet areas, as reported above, made it difficult to produce a clean and hygienic appearance. The home had a cleaner who knew the house and the service users’ needs well, as she had previously worked as a member of the support staff. Standards of furnishings in the lounges varied. Chairs in one lounge had some staining but the chairs looked much smarter in another lounge. Staff said that as part of the keyworker role they supported service users with the cleaning of their own rooms. In some cases, agreements had been made with individual service users about the staff members’ involvement to ensure that suitable standards of cleanliness were maintained. Laundry was carried out in a room that was separate from the other domestic areas. There were individually named cupboards to help keep things separate. Guidance on good practice with infection control was on display. At a staff meeting in January there had been a presentation on hand hygiene. In their surveys, three service users stated that the home was always fresh and clean. One person thought that this was usually the case. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is mainly adequate and improving. A new staff team is taking shape and an increase in the number of qualified staff is now a priority. This judgement has been made using available evidence including the visits to the home. Service users benefit from staff members who undertake relevant training, although changes in the staff team have reduced the number of qualified staff. The recruitment procedures promote equal opportunities and help to protect service users from unsuitable staff. EVIDENCE: Information was provided in the pre-inspection questionnaire about the training undertaken by staff during the last year. This had included training events in a range of subjects, including anti-discriminatory practice, race equality, medication and working with people who experience psychosis. Staff members attended refresher courses in first aid and food hygiene during November and December 2006. Individual files with training profiles were kept in the home for each staff member. Two files were looked at, which provided a chronological record of the training events that the staff members concerned had undertaken. Some training was provided ‘in-house’, for example by viewing and discussing a ‘No Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 26 Secrets’ video at a staff meeting, although Mrs Laurelli said that this would not necessarily be recorded as a training event. One member of the staff team had completed the Certificate in Community Mental Health. This was the qualification that the organisation intended staff to achieve, as being equivalent to a National Vocational Qualification at level 3. Mrs Laurelli said that changes in the staff team over time had reduced the percentage of qualified staff, which at one time had been about 70 . The figure was now well under 50 . Mrs Laurelli said that arrangements were being made for other staff to start the course, with the involvement of an assessor who was based at another home in the area run by ‘Rethink’. Mrs Laurelli has described the last year as being a difficult one for staffing because of a number of comings and goings. Agency and bank staff have been regularly used, as the home has been down by one permanent staff member. In their comment cards, one person stated that ‘Staff are friendly and caring’ and another felt that the home had ‘lost three of their best staff during the year - two altogether and one to part-time cleaner’. New staff have joined with different backgrounds and experiences. The staff team included staff at different stages of their professional development. One of the staff members met with was undertaking a six-month probationary period. Their induction had included going to the ‘Rethink’ offices in Birmingham for certain training events and an introduction to the organisation and its approach to mental health. The staff member said that they had received training in racial equality and anti-discrimination and was shortly to attend a course in health and safety. Staff recruitment was supported Rethink’s human resources department and followed the organisation’s policies and procedures. Recruitment and employment documentation was kept in the home and the records for two of the newer staff were looked at. Staff were interviewed using a standardised set of questions and a scoring system. They had Criminal Records Bureau (CRB) checks and were checked against the Protection of Vulnerable Adults (POVA) list. Two written references were obtained prior to employment, together with proof of identity. The manager met with staff during their probationary period to review progress. There was evidence that the manager had addressed performance issues with individual staff as they had arisen and continued to monitor progress after their probationary period. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. 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 visits to the home. Service users benefit from a well run home. Systems are in place for monitoring and improving standards in the home. Service users are asked for their views and the staff team are aware of ways in which service users may be discriminated against. The health and safety of service users and staff are generally well promoted and protected, although smoking in the home is having an impact on the environment and some individuals. EVIDENCE: The manager, Mrs Laurelli, had many years’ experience of working with people with mental health needs. Mrs Laurelli’s qualifications included a Professional Certificate in Management and an NVQ at Level 5 in Operational Management. The deputy manager had an NVQ Level 4 in Management and a City & Guilds Certificate in Advanced Management for Care. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 28 ‘Rethink’ overviewed the running of the home with monthly visits and through the organisation’s quality assurance system, which involved the carrying out of an audit to look at the home’s performance in relation to some key principles and outcomes. The home was due to receive an audit in the next few days. Mrs Laurelli said that this would include looking at how service users are surveyed about their views. Within the home, satisfaction surveys had been given to service users to complete in December 2006. The feedback had then been collated and letters sent to service users about the outcome. Other means by which service users gave feedback was discussed with Mrs Laurelli. This happened on a regular basis through the house meetings and keyworker sessions, as well as on more informal occasions. Relatives and outside professionals were also surveyed. The home had an action plan for achieving ‘Cultural competence’, which was one of the standards that the home was expected to achieve as part of the organisation’s quality assurance audit. This had been discussed at a staff meeting in January 2007, when it was agreed that race equality would be a standing agenda item at future team meetings. An ‘Operational Plan’ for 2007/2008 had been produced which reflected on events during the last year and what had been achieved. This included an analysis of accidents and it was noted that incidents involving service users against staff had reduced. Risk assessments were well documented and kept under review. A ‘Top ten’ of risks had been identified, as well as other one-off risks, such as bonfire night, heat waves and passive smoking. Two staff members met with said that they disliked the effect that regular smoking had in particular areas of the home, although they recognised the service users’ right to smoke. All staff had food hygiene training and food temperatures were recorded on a daily basis. A check of the home’s fire log book showed that a fire drill had last taken place on 5 February 2007. The fire alarms were tested on 6 February 2007. A health and safety audit had taken place, which was reported in January 2007 to have been satisfactory. Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 29 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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA7 Good Practice Recommendations That the service users’ views are consistently recorded in the care plans That the availability of the house meeting minutes is reviewed to ensure that the service users’ confidentiality is maintained. That a second staff signature is obtained whenever possible if a service user chooses not to sign their personal money account sheet. That consideration is given to having some headings under the personal care / physical care sections of the care plans to act as a prompt in ensuring that all areas are included, for example nail cutting That environmental changes are made which will reduce the effect of smoking in the home and ensure that all ‘noDS0000003204.V309733.R01.S.doc Version 5.2 Page 31 3. YA7 4. YA18 5. YA24 Bath Road (77/79) smoking’ areas are kept smoke free. 6. 7. YA24 YA32 That timescales are identified for the redecoration of the bathroom and toilet areas. That action is taken as soon as possible to enable staff to progress and have the opportunity to undertake a relevant qualification. That all types of training are recorded to ensure that there is good evidence of the training undertaking by staff. That all the ways in which service users give feedback about the home and the service they receive are seen as part of quality assurance and then reflected in the home’s annual development and improvement plans. 8. 9. YA35 YA39 Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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 Bath Road (77/79) DS0000003204.V309733.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!