Inspection on 16/11/07 for 87 Bouncers Lane

This inspection was carried out on 16th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

87 Bouncers Lane 28/10/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 87 Bouncers Lane 87 Bouncer`s Lane Prestbury Cheltenham Gloucestershire GL52 5JB Lead Inspector Mr Richard Leech Key Unannounced Inspection 11:00 – 18:15 & 10:45 – 15 & 16 November 2007 12:00 th th 87 Bouncers Lane DS0000070500.V352077.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 87 Bouncers Lane DS0000070500.V352077.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. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 87 Bouncers Lane Address 87 Bouncer`s Lane Prestbury Cheltenham Gloucestershire GL52 5JB 01242 572446 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.caretech-uk.com CareTech Community Services Ltd ****Post Vacant**** Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 4. Date of last inspection New Service Brief Description of the Service: 87 Bouncers Lane is a semi-detached property situated in a residential area of Cheltenham. The home provides accommodation for up to four adults who have autistic spectrum conditions. Service users are accommodated in single rooms. There is a bathroom and shower room. The home also has a lounge and a kitchen/dining area. A small office is provided in the garage. Prospective service users and others involved in their care are provided with copies of the Statement of Purpose and Service Users Guide. Fee levels were reported to be between £1400 and £1700 per week. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The service was taken over by CareTech in July 2007 and was therefore classed as ‘new’ for the purposes of this inspection. A visit was made to the home, from late morning on a Thursday through to early evening. During this time the acting manager, area manager and a number of staff were met with, as well as all of the people living in the home. A brief visit was made to the office on the following day to complete the inspection and to provide feedback. Various records were looked at during the inspection. These included examples of care plans, risk assessments, medication charts, training certificates and health & safety documentation. Before the inspection an AQAA (Annual Quality Assurance Assessment) was completed by the service, providing a self-assessment and information about how the home operated. Survey forms were also sent out to people with an interest in the home, resulting in feedback from different sources. What the service does well: The needs of people who are referred for admission are fully assessed in order to check that the service would be appropriate. Care is taken to ensure as far as possible that the people who will be living together are compatible. People are enabled to communicate their choices. These are acted upon both on a day-to-day and longer-term basis, helping service users to feel in control of their lives. Staff are sensitive to expressions of concerns and dissatisfaction from the people living in the home. People living in the home are enabled to access activities appropriate to their needs and interests, and to stay in contact with family and friends. People receive the help that they need and want with personal care. A varied and balanced diet is provided for the people living in the home, with account taken of their preferences, choices and dietary needs. Staff are knowledgeable and skilled and have access to professional development opportunities. Arrangements are in place to promote the health and safety of the people living and working in the home. Steps are taken to safeguard the people living in the home from harm and abuse. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 7 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 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A framework is in place which helps to ensure that the needs of people who are referred to the service are appropriately assessed and that there is sensitively towards compatibility issues. EVIDENCE: The Statement of Purpose and Service Users Guide were not checked in detail but it was noted that these documents had been updated to reflect the change of service provider. There had been no new admissions to the service. The area manager said that there were two referrals and that assessment was at an early stage. One person was already very well known to the service. In the case of the second referral, an initial meeting had been held with the person and their parents, with a further meeting planned. The area manager described the next steps should the referral be progressed. However, the admissions process was being put on hold related to compatibility issues in the home which were being addressed. This demonstrated sensitivity and an approach which put the 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 9 service users’ needs at the centre of the process, rather than rushing to fill vacancies. The acting manager confirmed that visits to the service would be offered where appropriate. It was reported that the service operates a three-month trial period. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some aspects of care planning need to improve in order that the information is up to date. Similarly, some risk assessments need review in order to help ensure that significant risks are assessed and appropriately managed as far as possible. People are enabled to communicate their choices. These are acted upon both on a day-to-day and longer-term basis, helping service users to feel in control of their lives. EVIDENCE: Care plans for two of the people living in the home were looked at. On one file information was seen about activities and related goals. These were dated February and March 2006, with no evidence of review/update since. A personal planning book (a tool for person Centred planning) had been started but was incomplete. Records of monthly keyworker minutes were seen, although the 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 11 last record on file was for January 2005. The acting manager reported that the person did not currently have a keyworker. It was stated that the behaviour support plan for the person was being updated. The existing plan was seen. This included reference to triggers and sources of anxiety and strategies for supporting the person. There was a clear and detailed description of the impacts of the person’s autistic spectrum condition. Care plans were seen covering areas such as personal care, diet, mobility, family contact, money and health. Whilst these generally provided reasonable and clear guidance with information about the person’s preferences and routines, they were clearly in need of review and update. They were dated February 2006 with no evidence of subsequent review. Out of date information included reference to sometimes only letting the former manager provide support and also to a health condition which had changed since the plans were written. A second person’s care plans and behaviour support plan had recently been reviewed. These provided clear and person-centred guidance, including detailed information about routines, communication, the impacts of autism and the management of challenging behaviour. During the visits different staff were observed using approaches described in the care plans, although a note had been written in the communication book expressing concern about this not always being the case (dated 14/11/07). The acting manager described how she aimed to address this inconsistency. Whilst the majority of documents were signed and dated, some were not. This should always be done. Care plans referred to offering people choices and accommodating people’s decisions and preferences as much as possible. Daily records, observation and discussion with staff provided evidence of the people making choices and of these being respected, such as about clothing, diet and activities. During the visits one person was seen to make a choice using a photograph book. A staff member later used an object to communicate that an activity was being proposed. These indicated that total communication principles tailored to people’s individual needs were being well used in the home. As noted, there was information about communication in care plans and staff were seen to use the approaches described. Some of the people using the service had expressed that the home was no longer where they would choose to live. As a consequence one person had moved on to their own home and another person was being supported to do 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 12 the same. This is excellent practice, in terms of recognising and responding to people’s clear communication about what they want to happen in their lives. The AQAA noted some of the complexities that can present around choice and decision-making for people with autistic spectrum conditions. Observation and discussion with staff provided evidence of awareness of these subtleties. The AQAA also noted intentions for issues around choice to be better documented. Rick assessments for two people were looked at. Care plans seen also crossreferenced to risk issues and their management. One person’s risk assessments dated from August 2006 with no evidence of subsequent review. It was agreed that these need to be reviewed both in terms of current content but also as to whether there are any other areas which now required risk assessing. Some examples of risk assessments for a second person were seen to be up to date, including consideration of risk issues around a healthcare procedure earlier in the year. Observation, discussion with staff and daily records provided evidence that the people living in the home are supported to take risks as part of leading full lives which reflect their needs and interests, with particular reference to activities in the community. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are enabled to access activities appropriate to their needs and interests, and to stay in contact with family and friends, enhancing their quality of life. There is respect for people’s rights and individuality. A varied and balanced diet is provided for the people living in the home, promoting their health and wellbeing. EVIDENCE: Daily records for two people were looked at over a two-week period in November 2007. Activities recorded included going for drives, visiting places of interest, using sensory facilities, swimming, horse riding, walking, going to local shops and pubs, visiting family, watching DVDs and listening to music. People were seen to have a busy and varied schedule. There was also reference to people electing not to take part in a particular activity at times. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 14 One person’s activity timetable (dated February 2006) was seen to be out of date and should be updated at the same time as care plans. People living in the home went out on activities on the day of the inspection, including accessing sensory facilities and going for a walk. Discussion with the area manager and acting manager provided evidence of the team making efforts to develop good relationships with neighbours. It was clear that the team faced great challenges at times, and it is to their credit that people have continued to be actively supported to access the community and to lead busy lives. Care plans included information about promoting contact with families. As noted, daily records provided evidence of the people living in the home being supported to maintain this contact. Staff also described very close relationships and good liaison with family members. Further evidence for this came from notes made in the communication book and from observation on the day. Care plans and behaviour support plans made clear reference to people’s rights. The Statement of Purpose and Service Users Guide also included information about this. Daily notes and discussion with staff provided evidence of flexible routines based around people’s needs and wishes. During the visit to the home people were seen moving around freely and exercising their right to be alone or in company as they chose, although there was discussion about one incident of restrictive physical intervention which was observed (see Standard 23). People were observed helping in the home, for example taking their plate into the kitchen once they had finished eating. Some mealtimes were observed, with people eating at their own pace and appearing to enjoy their food. Food records in daily diaries provided evidence of people being offered a varied and balanced diet, with individual choices accommodated. Staff reported that the people living in the home chose their own breakfast and lunch, and that individual preferences and needs were also responded to with the evening meal. No menu was in place as such, though the acting manager said that a menu may develop in the future. Care plans were in place about eating and drinking, making reference to special diets and people’s likes and preferences. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are appropriately met, promoting their dignity and wellbeing. Service users are supported to access routine and specialist healthcare, but documentation in this area needs review and update to ensure that everything possible is being done to optimise people’s health. Some shortcomings in medication storage need to be addressed in order that people’s medication is handled properly. EVIDENCE: Care plans described how people’s personal care needs were to be met. These included information about people’s routines and preferences, such as for the gender of the person providing support. Staff described how they provided personal care in ways which respected people’s choices and upheld their individuality, privacy and dignity. Two people’s healthcare notes were looked at. One person’s records included details of the circumstances around a hospital stay and the related healthcare 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 16 condition, with evidence of referral to, and follow-up from, the Community Learning Disability Team. However, there was no health action plan in place. An OK health check had been completed in February 2006. Whilst much of the information as said to be still in date, some was clearly in need of review, such as in respect of the healthcare condition which had resulted in a hospital admission. The document also had no action plan/summary. In addition, it was difficult to gain a picture of how some aspects of routine healthcare were being comprehensively monitored. A health action plan for the above person was seen in the office. This was work in progress. Similarly, the second person had good information about some aspects of healthcare such as specialist interventions, but also had an OK health check dating from February 2006 which would benefit from review and update. Write-ups were seen for appointments with doctors and recommendations from dental practitioners. There was evidence of good liaison with Community Learning Disability Team. The AQAA described plans for a total communication approach to hopefully enable people to better communicate their health needs. Arrangements for the handling of medication were checked. A filing cabinet was in use. A medication cabinet was available. However, this was not screwed to the wall and was missing its internal shelving. Staff said that this had been reported on several occasions but with no result to date. Ideally internal and external preparations should be separated. This will be easier once the cabinet is fitted and has shelving. A controlled drug (CD) was seen to be in use but was not being stored in a CD cabinet. The pharmacist inspector has advised that with changes in regulations it is likely that by 31/3/08 there will need to provide a proper CD cabinet built and fixed in accordance with The Misuse of Drugs (Safe Custody) Regulations 1973. The cabinet must be of appropriate construction. It must be fixed on a solid wall with rag or rawl bolts. The medication in question was supplied as part of an MDS (monitored dosage system) pack, making appropriate storage more difficult. The pharmacy could be approached for advice about this, and could be asked not to supply it in the MDS format. The garage door was said to often be unlocked. The office door was also, at times, unlocked. It was agreed that there was potential for unauthorised access to the medication storage facilities. The cabinet was being used for some medication storage and, as noted, this was not fixed to the wall. It was also pointed out that this potential access to the office jeopardised the security 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 17 of other information in the room and was likely to breach data protection requirements. It was suggested that, as a minimum, the garage door be kept locked when not is use. Protocols were seen for ‘as-required’ medication. Medication administration records were sampled and appeared to be in order. A British National Formulary (medication reference book) was seen in the home, dated September 2005. A homeopathic remedy and some barrier creams were found in a kitchen cupboard. These were transferred to the medication cabinet. 87 Bouncers Lane DS0000070500.V352077.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 & 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are sensitive to expressions of concerns and dissatisfaction from the people living in the home and others with an interest in the service, helping them to feel listened to. Steps are taken to safeguard the people living in the home, although there is scope for improving aspects of recording. EVIDENCE: The service has a complaints policy and procedure. A pictorial version is available. Information about complaints to the service was supplied in the AQAA. The service had also kept CSCI informed about them at the times they were received. The complaints were discussed with the acting manager and area manager, who described the steps that had been taken to address the issues. Staff spoken with described how different people living in the home expressed if they were unhappy about something and how they responded. A strong awareness of autism-related issues and a very person-centred approach was demonstrated. As noted, verbal and non-verbal indications of dissatisfaction with the home have resulted in people moving on to alternative accommodation and in this being planned for others. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 19 The organisation has policies covering adult protection and whistle blowing. Staff spoken with were clear about their responsibilities around adult protection. They were confident about raising concerns if necessary and that appropriate action would follow. Information supplied to CSCI during 2007 has provided direct evidence of concerns being followed up and appropriate action taken to safeguard the people using the service. The organisation’s staff induction programme includes coverage of adult protection issues. Ongoing training as evidenced in staffing files was also seen to include input about safeguarding adults. Staff confirmed that they had received training in adult protection matters. Arrangements for handling people’s finances were checked. Receipts and records appeared to be in order although it was noted that: • • A store loyalty card had been used for a transaction involving a service user’s money on 09/10/07. It was confirmed that no service user had their own loyalty card. The organisation has a policy of checking cash balances at the end of every shift but records indicated that this was not being done consistently. The organisation’s policies and procedures refer to physical intervention only being used a last resort. It was also stated that, “staff must receive appropriate training where physical intervention strategies need to be deployed. This training needs to be refreshed periodically”. Whilst training certificates and discussion with staff provided evidence of people receiving this training there was no evidence found of refresher training (either general or bespoke for the service). Studio three was the organisation’s provider of this at the time. They are accredited by the British Institute of Learning Disabilities. Some incident records were checked. In some cases there was not a clear record of the nature of the physical intervention, with terms such as ‘escorted’ and ‘removed’ used or, in one case, ‘wrestled’. The organisation has a form for the recording of any restrictive physical intervention and this should therefore be brought into operation in the service. An incident of restrictive physical intervention was observed on the day of the visit to the home, with one person prevented from accessing the garage. It was later stated that this was not normal practice and that the person was usually able to move freely around the home including to the office/garage area. The action was put down to it having been an unusual day for the service in terms of the inspection but also other visitors and events contributing to a very hectic and stressful day. This was accepted. Some of the incidents recorded may have fallen into the category of being notifiable under Regulation 37. This was discussed with the acting manager and a summary of the kinds of issues to notify CSCI about was forwarded. 87 Bouncers Lane DS0000070500.V352077.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 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the physical environment (as soon as feasible) in order to promote the comfort and safety of the people living in the home. EVIDENCE: The service operates from a semi-detached house in a residential area. A summary of maintenance issues had been prepared by the previous manager in August 2007. There had been a meeting with a representative from the estates department. Whilst there was evidence of some issues being addressed, there were a number of areas where the environment needed attention. • In the dining area sections of the vinyl flooring were raised/bubbling. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 21 • • • • • • The kitchen (including the units extending into the dining area) was in a poor state of repair, with some doors/fronts and plinth missing, staining and chipped tiling. The fire alarm trigger point in the kitchen was missing its glass frontage. The sensory room and lounge were spartan and missing screening on the windows for reasons that were explained. Plans and timescales for this to be rectified were discussed. It was agreed that the bathroom had tired décor and would benefit from refurbishment, particularly as some fittings were loose and some areas of sealant were very worn. The shower room was locked by a key and there was no apparent way of overriding the lock if necessary. The mirror in this room was beginning to rust. Some bedroom doors were kept open, in accordance with the occupants’ wishes. However, as they were fire doors it was recommended that advice be sought from the fire authority about ways of safely holding them open. Bedrooms were seen to be personalised as far as possible and to reflect people’s needs. The home has a large garden, used by the people living in the home. It was reported that there were plans for outstanding issues to be addressed, including refurbishing the kitchen and bathroom, as well as developing the garage into a more useable space. It was acknowledged that the physical environment received a significant amount of wear and tear and that major investment should wait until some accommodation/placement issues were resolved. However, it was expected that this was imminent and that work on renewing the environment could therefore begin in the near future. The home was seen to be clean throughout. Some staff spoken with described the infection control measures in the place in the home and confirmed that protective equipment was available. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are knowledgeable and skilled and have access to professional development opportunities, enhancing the quality of care. However, some shortfalls in training provision and associated record-keeping need to be addressed in order to ensure that all staff have the training they require. The arrangements for recruitment and selection should help to safeguard the people living in the home. Improvements are needed to supervision arrangements in order that staff have the support that they need. EVIDENCE: As noted in the report, staff were observed supporting the people living in the home in ways which accorded with the care plans. Staff spoken with were able to confidently describe the needs and conditions of the people that they supported as well as how they managed challenging behaviour. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 23 There was some use of agency workers at the time. Staff reported that it was generally possible to have the same agency workers returning in order to promote continuity of care. According to the AQAA one staff member out of 11 had attained NVQ level 2 or above in health and social care. However, during the visits many staff reported that they were undertaking NVQ qualifications. This supported the information in the AQAA that six more staff were working towards NVQs. It was reported that none of the existing staff team had been recruited since the new service provider took over. Coordination of recruitment and selection along with gathering necessary information had been centralised to the Human Resources section of CareTech. Local functions included identifying vacancies and informing Human Resources, shortlisting, interviewing and appointing (subject to confirmation of checks being satisfactory). Staffing files contained a CSCI proforma which included information such as when references and the Criminal Records Bureau check were completed. This was accepted, although it will be clarified whether the organisation needs a separate agreement to that of the parent company in respect of storing staffing files centrally. It was noted that according to one staffing file the second reference had been returned on 15/02/07. However the person’s start date had been 06/02/07. However, this was before the change of service provider and will therefore not be taken into account. The acting manager confirmed that all references are now being obtained before a person is employed. It was reported that the induction includes an introduction to the service and to the wider organisation as well as taking the person through appropriate units of the LDQ (Learning Disability Qualification) within the nationally agreed timescale of 12 weeks. Existing staff were also being supported to undertake a LDAF (Learning Disability Awards Framework) induction in order to give all workers had a common baseline of knowledge. This is good practice. The LDQ framework will replace the LDAF programme. Staff are provided with a copy of the GSCC code of practice during induction. The area manager said that training coordination was now centralised, and that regular updates about the team’s training needs are sent through to this section. A quarterly training programme is generated by the organisation. Training records for five people were looked at. The only information available was certificates in staffing files and a summary list (also in staffing files) which in most cases appeared not to be up to date. As such it was difficult to evidence what training different staff had undertaken. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 24 One person’s file included certificates for an NVQ, fire safety and studio three. No other information was available, such as about first aid, food hygiene, moving & handling, medication, autism or adult protection. Another person’s file had much more information, but was missing evidence of fire safety training. They confirmed that they had not had this training. Files for newer staff members did not include a certificate about training on autism usually covered during the induction. It was reported that they had not had this specific input, although the induction to the home and the people living there was orientated towards working with people with autistic spectrum conditions. Staff also have access to literature and audio-visual material about autism. Longer-serving staff were in need of updates in aspects of mandatory training according to information in staffing files. The acting manager acknowledged this. As noted under Standard 23, there was also a need for refresher training in the management of challenging behaviour. It was reported that staff had not received training about the Mental Capacity Act 2005, though this was planned. This input should be provided. Staffing files included dates of people’s supervision meetings. In one case the most recent record was dated September 2006. Another file’s most recent supervision record was dated July 2005. The acting manager understood that some records may be on the laptop of the previous manager and would not now be accessible. However, discussion with staff indicated that the regularity of one to one supervision had been patchy, with some people saying that they had not had a meeting since July or August 2007. Staff reported feeling well supported on a day-to-day basis. The organisation had implemented a new on-call system. However, some staff were uncertain about how to access this. The way that the on-call system works should be reiterated to staff. Staff reported receiving good handovers when they came on shift. The communication book was seen to be well used. It was stated that staff meetings did happen although there were practical difficulties with holding these in the home. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A high standard of care has been maintained but a permanent manager is needed in order to make necessary improvements to the running of the home and to formalise accountability. There is scope to improve quality assurance in the home such that the views of service users and other stakeholders contribute in a more structured way to the development and improvement agenda. Arrangements are in place to promote the health and safety of the people living and working in the home. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 26 EVIDENCE: The home has experienced two managers leaving over the course of 2007. At the time of the inspection it was without a registered manager. The acting deputy was managing the home with the support of the area manager. The AQAA reported an intention to recruit a manager. Clearly this needs to be done as soon as possible and the person will need to register with CSCI. In the meantime staff reported that the service was continuing to run well and were very positive about the interim management of the home. Staff reported how the home had been through a very difficult period in terms of changes in the team and also the people living in the home experiencing periods of crisis and ill-health. However, there was a feeling that the team had pulled together very well and maintained a high standard of person-centred care. This was borne out by many of the findings noted in the rest of the report. The acting manager felt that she was getting a good level of support. Clearly some areas needed attention, such as around training and supervision. The acting manager was reported to be supernumerary for the majority of the time in order to being to address some of the immediate issues needing attention, pending the recruitment of a permanent manager. The AQAA reported that the deputy manager and senior worker were undertaking NVQ level 3 in health and social care. Regulation 26 reports were checked in the home. The most recent on file was for July 2007. However, reports for September and October 2007 were located in the organisation’s Cheltenham office. Copies need to be kept in the home. A requirement is also made that copies of these reports be forwarded to CSCI. The reports themselves were seen to be thorough, noting actions needed in areas such as the environment, risk assessment and record keeping, although it was unclear whether these had been acted on in view of the management changes. It was reported that there was a weekly medication audit. Records of this were not checked. The acting manager understood that CareTech was working on implementing new quality assurance systems, with a view to linking these to the annual quality assurance assessment to be supplied to CSCI. No other formal quality assurance systems were in place at the time, although the acting manager said that there were very good links with service users’ families, resulting in regular informal feedback. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 27 Staff spoken with felt satisfied with the health and safety arrangements in the home. Records provided evidence of routine checks being done at appropriate intervals, such as on fire safety equipment. It was noted that some hot water temperatures were too high. The acting manager said that the thermostat had been turned down the day before to try to address this. This will need to be monitored to ensure that the people living in the home are not put at risk. 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 x 2 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 2 2 x 2 x 2 x x 3 x 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA6 YA9 YA20 Regulation 15 13 (4) 13 (2) Requirement Ensure that care plans are kept under review and up to date. Ensure also that risk assessments are kept under review and up to date. Ensure that the controlled drug referred to in Standard 20 is stored appropriately in a CD cabinet. Ensure that medication and associated records (as well as other confidential information stored in the office) are stored securely (with reference to potential access through the garage). Ensure that for every incident of restrictive physical intervention there is a complete record of the circumstances and the nature of the restraint. Ensure that the floor in the kitchen/dining area is level (with reference to the uneven vinyl). Undertake necessary work such that the kitchen is safe, hygienic and fit for purpose. Replace the glass front on the fire alarm trigger point in the kitchen. DS0000070500.V352077.R01.S.doc Timescale for action 31/01/08 31/01/08 31/03/08 4 YA20 13 (2) 30/11/07 5 YA23 13 (8) 30/11/07 6 YA24 23 (2) 31/03/08 7 YA24 23 (2) 31/12/07 87 Bouncers Lane Version 5.2 Page 30 8 YA35 18 (1) 17 (2). Sch 4 (6) g All staff must have training appropriate to the work they perform (including appropriate training about supporting people with autistic spectrum conditions). Keep a record of all training that staff have undertaken. Staff must be appropriately supervised. Ensure that records are kept in the home of all supervision meetings. Appoint a manager. Keep a copy of all reports made under Regulation 26 in the care home. Supply a copy of these reports to CSCI. 31/03/08 9 YA36 18 (2) 17 (2). Sch 4 (6) f 29/02/08 10 11 YA37 YA39 8 17 (2). Sch. 4 (5) 26 (5) 29/02/08 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA19 Good Practice Recommendations Ensure that all documents are signed and dated. Review the information in OK health checks, either using the same format or an alternative health action planning format. Ensure that the information is up to date and that a summary/action plan is arrived at which describes the support each person needs with routine and specialist healthcare. Obtain shelving for the medication cabinet and have it appropriately screwed to the wall. Transfer medication from the filing cabinet to the purpose-designed medication cabinet. Discuss with the supplying pharmacy issues around 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 31 3 YA20 controlled drug storage and supply, as noted in text. Ideally, internal and external preparations should be separated. Verify that staff are not using their own loyalty cards for transactions involving service users’ money (see example in text). Implement the organisation’s own policy of checking service users’ cash balances against records at the end of each shift (and recording this). Staff should receive refresher training in the management of challenging behaviour at appropriate intervals. Use the organisation’s form for the recording of any restrictive physical intervention. As soon as feasible take steps to renew the décor and fittings/furnishings in the lounge and sensory room. Explore ways of providing appropriate screening in the lounge to replace the curtains which had been taken down. The bathroom should be refurbished and any areas of wear and tear attended to. Replace the rusting mirror in the shower room. The locking mechanism of the shower room should be replaced with a system which can be overridden from the outside in an emergency. Consult with the fire authority about safer ways of keeping bedroom doors open in cases where the person indicates that they would like their door to remain open. All staff should have training about the Mental Capacity Act as soon as possible. The way that the on-call system works should be reiterated to staff. Develop additional quality assurance mechanisms based on seeking the views of service users and other stakeholders. Retest hot water temperatures before the routine monthly check to ensure that the action taken to reduce the temperature has been successful. 4 YA23 5 6 7 YA23 YA23 YA24 8 9 10 11 YA35 YA36 YA39 YA42 87 Bouncers Lane DS0000070500.V352077.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 87 Bouncers Lane DS0000070500.V352077.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. 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