Inspection on 25/02/08 for 8 Queensview Crescent

This inspection was carried out on 25th February 2008.

CSCI found this care home to be providing an Adequate service.

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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

8 Queensview Crescent 18/03/09

8 Queensview Crescent 26/10/06

8 Queensview Crescent 09/03/05

8 Queensview Crescent 21/09/04

8 Queensview Crescent 03/03/04

8 Queensview Crescent 27/01/02

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 8 Queensview Crescent Warley Road Scunthorpe North Lincolnshire DN16 1QN Lead Inspector Stephen Robertshaw Key Unannounced Inspection 25th February 2008 09:00 8 Queensview Crescent DS0000002871.V360228.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 8 Queensview Crescent DS0000002871.V360228.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. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Queensview Crescent Address Warley Road Scunthorpe North Lincolnshire DN16 1QN 01724 280862 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) Maria.Powell@dimensions-uk.org www.dimensions-uk.org Dimensions (UK) Ltd Maria Powell Care Home 6 Category(ies) of Learning disability (6), Physical disability (3) registration, with number of places 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: 8 Queensview Crescent is a care home providing personal care and accommodation for six adults aged 18-65 years with learning disabilities, three of these places are for people who also have a physical disability. 8 Queensview Crescent is owned by Dimensions (UK) Ltd and is situated close to two other homes owned by Dimensions The home is located in a residential area close to the centre of Scunthorpe. It is close to local shops, amenities and public transport. The home has it’s own transport. The home is a purpose built bungalow. All of the people that use the service have access to a single bedroom with a wash hand basin. Bedrooms are decorated and furnished to meet individual service users requirements and preferences. Communal areas of the home are decorated and furnished in a domestic style. Aids and adaptations are provided as required to meet service users needs. The current weekly fees for the service are £877.20. There are additional charges for hairdressing, private chiropody treatment and for newspapers and magazines, holidays and activities. Information on the specific charges for these can be obtained from the manager of the home. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit to the service was unannounced and took place on 25 February 2008. The Commission were at the home for approximately 7 hours. Before the visit took place we sent out questionnaires to the people that live at the home, the care staff and outside professionals. Only five survey’s were received that could be included in the evidence for this report. The visit included meeting and talking to staff, management, visitors and people who live at the home. It also included a tour of the premises, observation of staff and individuals care files and all of the other documents that related to the service. Four individuals were at home on the day of the site visit. Most of the people that lived at the home had very limited verbal or manual communication skills; therefore the Commission spent time observing activities instead of conducting formal interviews. The Commission also interviewed the manager and three of the care staff. The owner of the home completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. There are a number of requirements from previous reports that remain unmet. The owner and manager of the home must prioritise these for action as failure to meet the regulations could result in enforcement action being taken by the Commission in the future. What the service does well: The people that live at the home are provided with a comfortable and homely environment. They also said that they are well looked after, one person said ‘I like it here’. Individuals have good support with their personal health and can see their GP or the district nurse whenever they need to. The social and health care that they receive at the home helps to keep the people as independent as possible. Visitors are made welcome at the home and there are no restrictions to their visits at any reasonable time. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 6 8 Queensview is clean and staff work hard to make sure the building is free from any bad smells. People said they are happy with their bedrooms and a walk around the home showed that they and can bring in their own possessions, making it feel more like their own homes. The staff and the people that live at the home appear to have very good relationships with each other and the atmosphere between them is relaxed. This helps the service users to feel very settled and this means that they can rely on the staff for any support that they may need. What has improved since the last inspection? What they could do better: The manager must ensure all staff are provided with adult protection training. This is needed to ensure staff fully understand adult safe guarding matters and to make sure that they understand the local arrangements for reporting allegations or suspicions of adult abuse. This is something that has been asked of the home for a long time. The staff need to receive regular formal recorded supervision. This will help to identify if they have all of the knowledge and skills to be able to care for all of the people that they are responsible for in a safe and appropriate manner. The home needs to put in place a better quality monitoring system. This is needed to make sure that everyone is consulted about the running of the home and to ensure continuous improvements are made. The assessments and care plans in the home need to be developed further to identify how individuals prefer to be looked after and how mush individual support they need. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 7 When staff accompany people to activities and holidays the people that use the service should not be expected to pay for the staffs meals or accommodation. 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. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that all of the people that live at the home have their needs assessed by the service before they are admitted, however these assessments are very basic and may mean that individuals needs will not be recognised or met through the service. EVIDENCE: The Commission case tracked three of the people that live at the service. This included looking at all of the written information in the home, sending out surveys including contact with outside agencies and observation of interactions between staff, individuals and each other at the time of the site visit. We looked at the initial assessments of need completed by the home before the individuals went to live there. These assessments were based on a form that had been prepared before the assessment. The information supporting the assessment was very basic and did not provide enough information in relation as to how individual needs affect people in their daily lives and the support that they would require to meet these needs. An example of this is the assessments identified that people needed support with bathing, however this 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 10 did not include any detail in relation to the support would be required for individuals. An example of this is did the person just need encouragement to wash him or herself, or did they need physical support with actually washing. The individual care plans also included a copy of the care management assessment and care plan for the people living at the home. All of the individuals that were case tracked by the Commission had received an assessment of their need before they had been admitted to the home. Observation of the interactions and interviews with the people that live at the home and the staff supported the evidence that the staff have the knowledge and skills to be able to care for the individual needs of the people that use the service. One person spoken to said that it was ‘good’ and that the home was ‘nice’, another said ‘its friendly’. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service are given opportunities for making choices to meet their needs through their daily lives at the home. EVIDENCE: We case tracked three people that were living at the home service. This means that we looked at their care files and all other documentation in relation to their care held by the home. It also included sending out surveys to people that use the service, as well as staff, relatives and health and social care professionals. Direct observation on the day of the site visit also contributed to these National Minimum Standard Standards. Individual support plans were in place for the two of the people that were selected for case tracking and these set out the health and personal care needs identified for each of them. However the detail included in the plans was very 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 12 generic and did not detail how individuals would prefer their needs to be met through the support of the home. The care plans had been regularly evaluated by the relevant key workers on a monthly basis. The third person that was case tracked had been ion the home for approximately one year following an initial short-term placement. They did not have a support plan in their care file. Although the staff interviewed and observed at the site visit clearly understood the needs of the people living at the home, new or agency staff would not have this knowledge and therefore their individual needs may not be appropriately met. Risk assessment tools for were in position for peoples mobility, tissue viability, bed rail provision, medication, nutrition needs; again the risk assessments were generic and did not provide any detail of how the risks affected the individuals involved. The risk assessments had not been evaluated on any regular basis and therefore may not have been appropriate. The care plans and risk assessments were not in a format that was suitable to most of the people that use the service. As identified in the last inspection report 26/10/2006 the service needs develop ‘the support plans and risk assessments in more suitable formats for the service users as one means of improving the accessibility of these important documents for service users.’ There was evidence to support that the appropriate funding authorities regularly reviewed the care of the people that they were responsible for. Direct observations supported the fact that people are encouraged to make decisions for themselves in the daily lives at the home. This included what to eat, when to have drinks and whether or not to become involved in any activities. Confidential records are kept in a filing cupboard in the dining area of the home. This unit was open. The lock was broken. We spoke to the manager about this who assured us that a replacement would be provided. We recommended that until the replacement is in position the filing cabinet should be removed form the public area to where it could be held secure and meet the requirements of the Data Protection Act 1998. A professional survey returned to the Commission stated ‘service users are currently consistently supported and enabled to express themselves and make choices. Individuals at times require guidance to safe guard themselves and others’. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service are encouraged to develop and maintain their personal lifestyles while resident at the home, however some of the finances for activities need to be reviewed by the service. EVIDENCE: The people that live at the home are encouraged to maintain and develop their personal lifestyles. The home does not have an activity co-ordinator, however the support staff try to engage the individuals in daily activities. One the day of the site visit one person went out for the day with one of their relatives and another played board games with one of the staff. The staff ensured that everyone in the home was occupied with something but this did not always include stimulating activities. This included a staff member playing a board 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 14 game with one person and two other individuals being left with soft toys to occupy them. Staff interviewed stated that the activities in the home were planned on an individual basis. This included; hands massages and nail care, outings, pub visits and shopping trips. Observation of a sample of people’s personal allowances showed that they had gone out to a pub and paid for their own lunches, however the receipts also identified that the people that use the service also paid for the meal of the support worker that had accompanied them to the pub. There was no indication in the service user guide or statement of purpose that these charges would be made to the person using the service. It is appropriate that individuals should pay for their own meals to help them understand about their personal finances, however they should not be expected to pay for the staff meal as well. The home has a minibus to transport individual to different places in the community. The service user guide states that people who use the transport will be asked for a contribution towards the fuel costs for the vehicle when the distance travelled is over ten miles. This is acceptable providing that the charges are fair and equitable. The service should also re-consider its policy included in individual finance support plans that state ‘in addition any additional costs such as repairs which are incurred during the year to the vehicle or any changes of the aides and adaptations will be invoiced to each individual on a separate notice’. This does not appear to be fair and equitable. Additional costs should clearly be included in the homes statement of purpose and the people using the service should have access to advocates to support them with any additional financial transactions to make sure that they are in their best interests. These additional costs should also be clearly identified to the relevant funding authorities so that it can be included in their contracts with the service. Staff interviews and observation of documentation support that people that use the service are provided with the opportunity of an annual holiday. However the person that uses the service is responsible for paying for their own accommodation and must also pay for the accommodation for the staff that are supporting them. This is not acceptable. National Minimum Standard 14.4 states that ‘service users in long-term placements have part of the basic contract price the option of a minimum seven-day annual holiday outside of the home which they help to choose and plan.’ The service user guide should clearly identify any contributions that the company will make towards the cost of an annual holiday. The registered person must, on a regular basis consult with the people that use the service in relation to the programme of activities on offer in the home and 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 15 to make sure that individual support plans reflect the individual’s preferences and capabilities. This should include regular meetings to be held with people that use the service and their families. The information form these meetings could contribute towards the homes quality assurance systems. People that live at the home previously attended day services provided by the local authority. This service is no longer available; therefore the individuals are more reliant of the homes staff to develop their activities for them. This needs to be kept under review to make sure that people that use the service have their social, emotional, recreational and personal development needs met in an appropriate way. Individuals are encouraged and supported to maintain relationships with their families and friends. Complimentary cards were observed identifying the good work carried out by the home. Care files showed when people had contact with their families and friends. Interviews with staff and visitors to the home supported that visitors are made to feel welcome at any reasonable time. Key workers continue to support individuals to maintain family contact by sending cards at significant occasions such as birthdays and Christmas. Meals at the home are very good. One person said ‘I like the food’. Good stocks of varied food were in the home and the kitchen was kept exceptionally clean and tidy. People that use the service are provided with three meals a day. Food likes and dislikes were recorded in individuals care plans. Staff were observed offering appropriate assistance to individuals to eat their meals in a sensitive manner and assisted them with their drinks if they needed help. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the personal and healthcare needs of the people that live at the home are met through the services provided through the home and its partners. Personal support is offered in such a way as to promote and protect the service users privacy and dignity. EVIDENCE: Direct observation of staff interactions with the people that use the service supported the evidence that the privacy, dignity and independence of the individual’s is supported in the home. All the bedrooms provided in the home are for single occupation this means that treatments and examinations can be carried out in private. The Commission case tracked three of the people that live at the service. All of their files included information that identified who their General Practitioner was. Record of routine eye tests, dental and chiropody checks had been maintained and service user weights were being monitored, although not on a 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 17 regular basis. Several of the people that live at the home require seated scales to weigh them. Previously this had taken place at a local resource centre, however the manager of the home stated that this service was no longer available and that alternative weighing methods or facilities must be identified and be utilised. The manager should make sure that this is introduced within a short period of time so that individuals weight can be regularly monitored and be assessed against their other personal health care needs. The home does not provide nursing care and therefore any nursing interventions are carried out thorough the local district nursing team. Clear records were in position for whenever individuals received treatment from a nurse or other healthcare professional, however the outcome of the treatment or visit was not always recorded on the persons file notes. A professional survey returned to the Commission stated that in relation to healthcare needs ‘as far as I am aware, such needs are discussed at review and other appropriate times’. The manager of the home stated that they were in discussions with the local health care practice to provide the home with a new system for the administration of prescribed medication. Currently all medication held by the home is kept in separate boxes with individuals names on. The medication record sheets were all up to date and had been accurately recorded. The medication records also included a photograph of the people that were in receipt of prescribed medication. This makes it easier to identify whom the medication is for particularly when they have the same first name. The medication was stored in a locked metal cupboard. Since the last inspection the home is now regularly checking the temperature of the drugs cupboard. It is important that medication is stored at the right temperature and where needed action should be taken to ensure medication is stored in line with guidance issued by the manufacturer. Nobody at the home had been prescribed a controlled drug. However the home maintains a controlled medication book so that any changes to this can be appropriately recorded. Staff training records and interviews with management and staff identified that the only people that administer medication to people that use the service are staff that have received appropriate accredited training. At the last inspection of the service there were some difficulties identified with the staffs management of Percutaneous Endoscopic Gastrostomy (PEG) feeding. This is no longer required at the home. However staff training records showed that staff had received training for this procedure. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints system and staff and service users can be assured complaints and concerns will be listened to and acted upon. However the safe guarding adults systems need to be supported through a recognised staff-training programme. EVIDENCE: The complaints records for the home identified that no formal complaints had been received by the service since the last inspection. No complaints had been directed to the Commission either. Interviews with staff showed that they had no complaints about the home and identified that they would feel confident to raise issues of any concern with the management of the service if they arose. None of the residents were able to confirm to the inspector their understanding of the complaints process. No referrals had been made to the local safe guarding adults team since the last inspection report. A procedure for responding to allegations of abuse was available, which reflected the multi-agency procedures in respect of referral and investigation. Staff training records showed that not all staff have received appropriate safe guarding adults training. This is an outstanding requirement from previous inspections and must be addressed to promote the health, safe and well being of all of the people that use the service. We 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 19 suggested to the manager of the service that she makes contact with the local authority to arrange formal training for the staff group. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that environment provided for the people that use the service is homely, comfortable and suitable to meet their needs. EVIDENCE: We made a tour of the premises as part of our assessment of the environment. The home was clean, tidy and was free of any offensive odours. Since the last inspection a new floor covering has been included in the dining area. This area is no longer carpeted to allow easier cleaning and to provide a more hygienic and healthier environment. We suggested to the manager that a environmental risk assessment should be put in to place to cover this area We looked at two of the individual bedrooms in the home. They were both clean and tidy and were furnished and decorated in a homely style and in a 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 21 manner that included the personal tastes and preferences of the people using the rooms. This included a range of personal items including furniture, ornaments, photos, pictures and posters. Two people asked about their bedrooms said ‘I like it’ Specialist equipment needed to ensure service users needs could be met was observed to be available in the home and this included a mechanical hoist, additional moving and handling equipment and specialist bathing equipment. Service and maintenance records for all of this equipment were all seen to be in place and were up to date. The bathrooms were well spaced around the unit. In the pink bathroom hot water pipes were exposed and were at a high temperature. These pipes need to have a protective cover to prevent any harm to people that use the service. Also in the same bathroom detergent bottles were left on a open shelf. This could cause problems if somebody ingested what was in the bottles, or used it and it wasn’t suitable to their needs. The laundry area was well organised and tidy. The washing machine was programmable to disinfection and sluicing standards. The ironing board was very rusty and could be a health and safety risk to the people using it. The home was due to have its electrical hardwiring test completed the week after the site visit. The manager was requested to send a copy of the new certificate to the Commission when it is completed. The gardens have improved a little since the last inspection. A decked area is in the process of being laid to provide a flat surface that all of the people in the home can access. However the remainder of the garden remains largely inaccessible to all of the people that live at the home due to problems with layout and design. As stated in the last report (26/10/06) ‘This matter has been identified in inspection reports spanning the last fours years. During this time little or no work has been carried out to improve the attractiveness and accessibility of the garden and the manager confirmed that there are no plans to do so. This means service users do not have free access to all parts of their home. Action must be taken to address this.’ The perimeter fence at the last inspection was identified as being damaged and broken. Since that time a new fence has been built. Staff and management spoken to by the Commission stated that is was an improvement, however they would have preferred a higher perimeter fence to safe guard the property and the people who live there. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the staff have the knowledge and skills to be able to safely care for the people that they are responsible for. However they are not all up to date with their mandatory training that would support this. EVIDENCE: We interviewed three staff that work at the home and they all clearly understood their personal roles and responsibilities and those of their colleagues. All of the care staff were sent surveys before the site visit took place. None of these surveys had been received back by the Commission before the writing of this report. At the time of the site visit five people were living at the home. Two support workers are normally on duty at anyone time. Through the night there is one waking staff and one sleep in worker on duty. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 23 Staff interviews, professional and relatives surveys identified that although there is adequate staff at the home, the people that use the service would benefit from more staff availability for 1-1 work and activities. At previous inspections staff personal files were observed in the home and were open to inspection. Since the last inspection of the service the staff records are now held at the central office of the company and are non longer available for unannounced inspections. Although at the last inspection the inspector confirmed that ‘the home takes appropriate steps to protect service users through sound recruitment and selection practice’ We were unable to confirm that his is still the current practice. Staff interviewed by the Commission supported the homes employment procedures one said ‘I couldn’t start work until I had received my CRB back’. The home had a structured induction programme in position, which met the Common Induction Standards of Skills for Care for new members of staff. A new member of staff had recently completed the Learning Disability Qualification (LDQ) and was waiting for the work to be verified. Four if the nine support staff had completed a National Vocational Qualification (NVQ) in care at level 2 or equivalent. This equates to 44.4 of the staff having achieved the award. A further two staff are working towards their NVQ qualifications. The registered person must continue with the NVQ training programme to make sure that a minimum of 50 of the care staff achieve an NVQ or equivalent in care. There was no evidence to support that staff receive regular supervision to make sure that they understand their roles and responsibilities and to identify any of their training needs. Since the last inspection there had been some slippage in the frequency of supervision for some staff. The manager must make sure that staff are provided with a minimum of six formal recorded supervision sessions per year (pro-rata). Staff interviewed by the Commission stated that although formal supervision was not regular informal supervision was available all of the time. A programme of mandatory training was identified, however staff training records showed that much of the training needed to be updated to make sure that the staff had the knowledge and skills to care for the people that they are responsible for. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the management of the home runs the business in a caring manner, however some of the policies and procedures are not in the best interests of the people that use the service. EVIDENCE: The manager of the home has had a great deal of experience of working and managing in a residential care setting. She also has a clear understanding of the needs of the people that use the service. There is an outstanding requirement in relation to the manager completing the Registered Managers Award. The manager stated that there had been 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 25 difficulties within the companies training department to support her with the award. Therefore her registered Managers Award has been transferred to an external training provider. The manager of the home has not received any formal supervision for approximately eighteen months. This must be introduced to make sure that the manager has the knowledge and skills to run the home and care for the people that live thee, it is also needed to help to identify any training needs that she may have. A professional survey returned to the Commission said that the management were competent and approachable they said ‘ I do not know all the staff team, but I have confidence in the manager and other members within the team’. The home does not have a specific quality assurance and quality monitoring system. It is very important that this is developed to give other people opportunities to say how they think that the home delivers the services to the people that live there. This should include sending out surveys to people who use the services, their families, outside professionals and staff that work at the home. This is an outstanding requirement and as stated in the last report ‘This is needed to make sure that everyone is consulted about the running of the home and to ensure continuous improvements are made. This remains an outstanding requirement from previous inspections and action must now be taken to address this’. Failure by the management of the home to meet previous requirements could result in enforcement action being taken by the Commission. The home has all of the required policies and procedures in position. However some of these should be re-looked at as stated earlier in this report especially in relation to individual’s finances. The home maintains all of the records required for the protection of the people that use the service, however as stated earlier in this report the information recorded in some of the documentation including assessments and care plans were basic and included generic and not individual specific information. 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 26 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 2 2 2 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 2 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 2 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 2 3 3 2 X 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 YA14 Regulation 4 Requirement Timescale for action 30/04/08 2. YA2 14 3. YA6 15 The registered person must make sure that all fees payable by people who use the service are included in the homes statement of purpose and service user guide. This must include the services contribution towards a seven-day annual holiday and any costs that may be incurred to people that use the service. This will allow individuals to make a more informed choice in relation to moving to the home. The registered person must 30/05/08 make sure that all assessments completed for people that live at the home are detailed and are specific to their need and are not included on a generic ‘plan’. These assessments must be completed before the person is admitted to the home with the exception of an emergency admission. The registered person must 30/05/08 make sure that individual DS0000002871.V360228.R01.S.doc Version 5.2 Page 28 8 Queensview Crescent 4. OP6 5. YA9 6. YA11 YA14 7. YA16 8. YA23 care/support plans include enough information to make sure that staff can understand the way in which the care should be delivered. This would support the health and safety of the people that use the service. 12(3) The responsible person must develop support plans in a more accessible format for service users. (Previous Timescales of 31.3.05 and 31.11.05 and 31/03/06 and 31/03/07 were not met.) 13(4a),(4b),(4c) The registered person must make sure that completed risk assessments are supported with risk management plans and these must be evaluated on a regular basis to make sure that they are still appropriate to the individual needs of the people that use the service. 4, 13.6 The registered person should make sure that the people who use the service are not expected to pay for staff meals and accommodation when they support individual’s out for lunch or on holiday. 20 The registered person should review the homes policies and procedures for transport. People that use the services transport should not be expected to pay for the maintenance of the vehicles involved and this must not impede their freedom of movement. 13 The registered person must DS0000002871.V360228.R01.S.doc 30/06/08 30/05/08 30/04/08 30/04/08 30/06/08 Page 29 8 Queensview Crescent Version 5.2 9. YA28 23(2)(o) 10. YA27 13 (4),(a),(b),(c) 11. YA34 19 (Schedule 4) 12. YA37 18 13. YA39 24 ensure staff are provided with adult abuse training. (Previous timescales of 31.3.06 and 31/12/06 were not met) The registered person must ensure that the gardens are safe and accessible to all service users. (Previous timescales of 16.10.03 31.11.05, 31.03.06 and 31/01/07 were not met) The registered person should make sure that bottles of shampoo and other cleaning agents are not left open in the bathroom to protect the health and safety of the people that use the service. The registered person must make sure that staff records are open to inspection. This will make sure that employment policies and procedures are followed. The registered manager must obtain an NVQ level 4 or equivalent. (Previous timescales of 31.12.05, 31.7.06 and 31/03/07 were not met) The registered person must develop a quality assurance and monitoring system that meets the requirements of this standard and produce an annual development plan based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. (Previous timescales of 19/2/04, 31/12/05, 30.4.06 and 31/01/07 were not met) 30/06/08 01/03/08 30/05/08 30/07/08 30/06/08 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA10 Good Practice Recommendations The registered manager must make sure that all confidential material in the home is stored securely in accordance with the Data Protection act 1998. This includes the filing cabinet in the dining area. The registered person should make sure that appropriate arrangements are made so that all of the people that use the service can have their weights monitored on a regular basis this will help to monitor their general health. The registered person should make sure that all hot water pipes surfaces and protected to uphold the health and safety of the people that use the bathrooms and toilets. The registered person should make sure that a minimum of 50 of care staff achieve an NVQ 2 in care or equivalent. The registered person should replace the ironing board in the laundry to maintain the health and safety of the people using it. The registered manager should forward a copy of the homes electrical hard wiring test when it has been completed. 2. YA19 3. 4. 5. 6. YA27 YA32 YA42 YA42 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 8 Queensview Crescent DS0000002871.V360228.R01.S.doc Version 5.2 Page 32 - 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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