Inspection on 25/10/06 for 94 Chatsworth Road

This inspection was carried out on 25th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

94 Chatsworth Road 30/09/05

94 Chatsworth Road 18/04/05

94 Chatsworth Road 18/11/04

94 Chatsworth Road 21/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Chatsworth Road 94 Westfields Hereford Herefordshire HR4 9HZ Lead Inspector Jean Littler Unannounced Inspection 25th October 2006 13:00 Chatsworth Road 94 DS0000024688.V311597.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 Chatsworth Road 94 DS0000024688.V311597.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. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chatsworth Road 94 Address Westfields Hereford Herefordshire HR4 9HZ 01432 340560 01432 340560 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) Aspire Living Ceridwen Jones Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users who have a physical disability in addition to their learning disability can be accommodated in the Home. As some aspects of the layout of the Home fall below those recommended in the National Minimum Standards for wheelchair users any new service user who has a physical disability must not be admitted without an Occupational Therapy assessment being completed, and written agreement with the Commission regarding the suitability of the placement. 30th September 2005 Date of last inspection Brief Description of the Service: 94 Chatsworth Road is a service run by Aspire Living and Choices Ltd. which is a Voluntary Organisation. The head office is based at the Fred Bulmer Centre, Wall Street, Hereford, HR4 9HP. The Care Home provides personal care, social support and accommodation for four adults with learning disabilities, some of whom also have physical disabilities. The accommodation is provided in a purpose built bungalow within a modern housing development in Hereford. There are pubs, local shops, a supermarket and post office all within a short distance. Transport for longer distances is provided in the Homes unmarked minibus. The house contains four single bedrooms, communal rooms and an assisted bathroom and shower room. Information about the Home is available from the Head Office or the Care Home on request. The Home has a block contract with Hereford Local Authority, which means the fees are set and only residents funded by Hereford can be placed in the Home. The weekly fees are £1202. Additional charges are charged for personal items such as clothes and toiletries, and personal services such as haircuts and chiropody, holidays, some activities, vehicle hire and running costs and specialist equipment if the resident has more than £1000 savings. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine Key unannounced inspection was carried out on a weekday between 1pm and 6.15pm to assess the service against the Key National Minimum Standards. The manager completed a pre-inspection questionnaire to provide additional information, which was received by the Commission on 20th September 2006. The residents are unable to give specific feedback about the service due to their disabilities. The relatives involved were given feedback questionnaires, three of which have been returned. These indicated positive views through the tick box answers. A GP returned positive feedback and commented, ‘I have no concerns regarding the performance of the staff at the Home’. The providers have submitted monitoring reports to the CSCI following their monthly visits to the Home. These and previously know information about the service have been considered as part of the inspection process. The manager was on duty and assisted with the inspection process. As part of the inspection the house was toured, the medication was checked, the staff were observed interacting with all four residents. The residents could not give verbal feedback on their views due to their specific communication needs. Two care staff were interviewed in private. A sample of records were seen and two residents’ files and care arrangements were examined. What the service does well: What has improved since the last inspection? The manager has gained professional care and management qualifications. A line manager has been appointed to support the care home managers. All staff are now being offered more in depth medication training. Better arrangements have been introduced to monitor the quality of the service and plan for improvements. The décor and fittings in the Home and the level of specialised equipment provided have all been improved. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 6 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. Chatsworth Road 94 DS0000024688.V311597.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 Chatsworth Road 94 DS0000024688.V311597.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective residents have their needs assessed by external people. This process could be improved to demonstrate the manager’s input into judgement that the placement is the right one. Prospective residents have the opportunity to visit and trial the Home prior to moving in. Funding contracts are in place and there are Terms and Conditions of Residency. These had not been agreed in regards to the new resident. EVIDENCE: One resident has moved out of the Home since the last inspection. The vacancy was used from February 06 to provide respite care to a man who then moved in permanently in June. This meant he had a slow transition into the service, which was positive for him. An assessment of the man’s needs had been provided by the social worker, his next of kin had also provided information. The manager had not collated her own assessment or summarised the information she had collected to show that the service could meet his needs before he started using the service. A care plan had been developed but this was not dated to show when it had been completed. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 9 The funding contract for all four places is between Herefordshire Council and the Home. Terms and Conditions of Residency are in place and have been agreed for the other residents. The new resident’s representative had not been asked to sign this agreement. The manager reported that this was because of difficult personal circumstances for the family. She agreed this could now be discussed. The Home has been negatively affected in the past from a dispute over terms and conditions. This experience should have made gaining a signed agreement for the new resident more of a priority than it appears to have been. The inspector had been informed that a policy had been developed within the organisation about what residents will be charged for above their weekly fee. This should be fully reflected in the terms and conditions document before an agreement is reached for this new resident to demonstrate the Home is operating transparently. This is particularly important as the new resident’s relative intends to hand over responsibility for his finances to the organisation. Chatsworth Road 94 DS0000024688.V311597.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents’ needs and personal goals are recorded in their care plans but some areas for improvement were identified. The residents are being supported to make some decisions. They may be able to become more involved if communication methods are further developed. The residents are being enabled to take reasonable risks in order to enjoy their lives. EVIDENCE: Care plans are in place for all four residents. The two sampled contained relevant information to guide staff about each resident’s needs including sections about personal care, regular activities and personal preferences. The plans contain aims that are being worked towards to assist the residents to develop. These reflect the abilities of the residents and are considered quite long term. Health sections are in the care plan but health action plans have not been implemented. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 11 Risk assessments have been carried out with the support of the organisation’s health and safety officer. The sample seen showed that reasonable judgements were being made to balance safety and quality of life. Staff on each shift complete daily care records. The notes are brief but several charts are also used to record information about personal care and health issues. This information creates a picture of the residents’ wellbeing. The level of recording does not include details of whether a resident enjoyed or benefited from the activities they are offered. This would be useful to help judge what activities they like and want to continue with. Much of the information in the care plans seen is not dated so it is not clear if it is still current. The organisation’s care plan format includes a section for the manager to show the information has been reviewed each month. This is not being used. Discussions highlighted that some changes in care arrangements have not been reflected in the care plans. Monthly summaries of the care notes and other recording systems should be considered. If in place this process should pick up on areas for action e.g. unplanned weight loss. One of the care plan folders is very large and contains information that dated back to 2001. Old information should be archived so only current and useful information is there to guide staff. Staff have attended person centred planning training and some planning has taken place with residents and their representatives in the recent past. Although there is a personalised approach to the care, the formal planning work has not been updated recently and linked into the current goal plans. Formal review meetings are being held soon for all residents and this opportunity could be used to include person centred planning. Staff were observed to offer the residents choices and they responded positively to signs given by the residents as a means of communication. For example one resident became restless after tea and the staff knew this meant he wanted to leave the room. The organisation’s communications facilitator has supported the team to complete communication profiles for the residents. Some communication systems are in place to assist the residents to express their needs and choices e.g. pictorial menu cards, food choices are offered so residents can point at what they want, and some sign language is used. Enabling communication is very important and further developments should be considered in light of the technology now available e.g. digital photographs to show residents where they are going on outings or to involve them more in their review meetings. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents are being given opportunities for personal development and provided with appropriate outing in the community and in-house activities. Good support is being provided to help residents stay in touch with their relatives. A balanced and healthy diet is being provided and mealtimes are relaxed and homely. EVIDENCE: The residents seemed very relaxed and happy in their Home. Those that are mobile moved around the house freely with staff supervision. Each resident has an activities plan in their care plan and these are also on the office wall. The manager said the team has been focusing more on ensuring these activities are accessed as planned. The activities seemed suitable for the residents and they include music sessions, visits to a snoozalem and spar pool. Staff reported that enough staff drive the Home’s mini-bus to enable regularly community outings. In-house activities include guitar sessions, wine making, and hand massages. Staff were seen to offer the residents things to do while Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 13 indoors such as music or television, musical instruments, and sensory equipment. Holidays have been arranged for all residents and some are going away more than once this year. One resident is no longer attending a local session as it was judged that he was not benefiting from this enough for it to be value for money. The organisation funds this activity and it was felt that the money could be better spent on something more appropriate for him. It would support this type of decision if the records included details of whether a resident enjoyed or benefited from an activity. The staff spoken with showed they had a good understanding of the residents’ needs and rights. They reported that the care practice and daily routines are flexible depending on activity plans and the resident’s health and frame of mind. The residents are encouraged to develop their self-help skills and all have some personal goals they are working towards e.g. spreading butter on their toast. One resident’s goal is to push himself in his own wheelchair. He has not done this in the past put he has a new wheelchair and is making good initial progress. This resident had positioned himself in his wheelchair in his preferred spot directly in front of the television. A worker was observed to move him backwards without communicating what she was doing whilst informing her colleague that she had better follow his care plan. The resident looked irritated by this and moved himself back again. The manager needs to ensure the goals are implemented appropriately and residents are treated with respect at all times. The residents’ relationships with their friends and relatives are encouraged and visitors are welcomed. One resident’s care notes showed he is being supported to telephone a relative regularly. The food is purchased locally and staff prepare fresh meals daily. Records showed a balanced and varied diet is being provided. There are no set times for meals, and drinks and snacks are available throughout the day. Any limitations are on health grounds. The evening meal was eaten in a relaxed atmosphere with the staff eating with the residents and assisting them to be as independent as possible. The residents’ general preferences are known and considered when meals are prepared. A spicy meal was prepared and an alternative provided for one resident who cannot manage this type of food. Care records indicated this resident has been given spicy meals. The manager felt all staff were aware of his dietary restrictions and that the records may have been inaccurate. One resident eats some of his meals in his bedroom lying down. The deputy reported following the inspection that this has been cleared with health professionals and that the resident is given the choice to join the group for all meals. He had eaten his lunch with the group but the staff were not heard to Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 14 offer a choice for the evening meal and were heard to decide not to disturb him as he seemed comfortable. Chatsworth Road 94 DS0000024688.V311597.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are having their health needs met and their personal care is being provided in a personalised and flexible manner. Medication is administered safely, but recording can be improved in some areas. EVIDENCE: The care records are being written in an appropriately respectful way and staff were observed to interact with the residents in a pleasant manner. The daily routines are flexible taking account of residents’ needs, age and health. Where possible they are given choices about getting up and going to bed. The staffing arrangements do not allow same gender personal care to be given at all times as the majority of staff are female and all the residents are male. Self-help skills are being promoted, for example one resident is being encouraged to help clean his own teeth. The two residents whose care was case tracked have both had recent health problems. Support from health professionals has been accessed in a timely manner and the residents’ representatives have been appropriately involved. One resident could not give consent for an operation so two consultants were Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 16 involved in a best interest decision made on his behalf. Medical advice has been taken and care arrangements adjusted accordingly. Occupational therapy input has been accessed to try and meet one resident’s changing physical needs. The organisation’s health and safety co-ordinator has also been involved but no suitable equipment has been found to date. The staff spoken with were happy with these arrangements and felt they were not being exposed to unacceptable risks. The residents are being weighed periodically. The last entry for one resident indicated that he had lost a significant amount of weight in the previous period. He had not been weighed in the three months following this and there was no evidence that the weight loss had been picked up as an area to monitor. The weight recording form does not prompt staff to consider if any action is needed. The manager is planning to arrange for the new resident to change GPs. This is because it was difficult to park and access his current surgery. This GP knows the resident well and carried out a health check on request when the resident moved into the Home. This resulted in a serious health condition being identified. The manager plans to transfer the resident to the surgery where the other residents are registered, however these GPs do not offer annual health checks. The manager must ensure that the resident’s best interests are promoted when decisions of this type are made. Medication was being securely stored. Records showed that doses had been given as prescribed. The management of stocks of medicine could be improved as spare tablets are being held in a separate cabinet but are not included in the balances marked on the administration charts. They are therefore outside of the auditing process. Some medicines had not been dated when the packets ere opened. Dating can help create an audit trail. All residents are having their medication kept under close review by the doctors involved. Protocols are in place to guide staff in the use of emergency medication and the health specialist involved has now approved these. All staff administer medication. New staff have been given this responsibility prior to them attending formal training. The manager reported that staff shadow colleagues and are not given this responsibility until they are deemed competent. It would be good practice to keep records of this process. It is positive that the level of staff training is due to be increased and all staff are booked onto accredited Safe Handling of Medicines training. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are systems in place to support residents or their representatives to raise concerns. A framework is in place to help protect residents from abuse, however as part of this recruitment procedures need to be made more robust and the level of training provided could be increased. EVIDENCE: No formal complaints have been received by the Home or the Commission since the last inspection. The Home has a complaints procedure. Efforts have been made to help residents understand their right to make complaints e.g. happy and sad faces are used as a communication aide. All residents have someone outside the home to advocate on their behalf and keyworkers also have this role. A protection policy is in place, which reflects the local multi-agency Vulnerable Adult guidelines. No adult protection issues have been raised since the last inspection. Adult Protection (AP) is covered during the induction and the Learning Disability Award Framework. Specific training is available, free, through the local AP coordinator, but this has not been accessed recently so newer staff have not attended this. The staff spoken with said they would report any concerns to the manager. As detailed in the staffing section below, recruitment practices need to be made more robust to increase the protection offered to residents. The organisation has a poor record on implementing legal requirements relating to recruitment since the standards became more robust in 2002. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents are being provided with a clean and well-maintained environment that has been attractively decorated and comfortably furnished. Their bedrooms have been personalised and specialist equipment has been provided to promote independence. EVIDENCE: The Home is situated near to Hereford town centre and the local amenities. The bungalow has level access with wide corridors and doorways throughout to take account of the needs of wheelchair users. There are four single bedrooms with sinks. The bedrooms are smaller then the standards recommended for wheelchair users but the total average living space exceeds the size set in the National Minimum Standards. Communal facilities consist of a lounge, an open plan dining area and kitchen, a laundry, an adapted bathroom and separate level access shower-room. The lounge leads onto a patio area and the garden that has been fitted with some adapted equipment. Opened in 1996 the premises met relevant building regulations at that time. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 19 The house is homely, modern and attractive. The residents’ bedrooms are individually decorated and furnished. They are fitted out with personalised items to enable the residents to use them independently e.g. have time alone to listen to music and use sensory equipment. Since being in post the manager has consistently worked to improve the environment by arranging regular redecoration and for adaptations to be fitted to meet the residents’ physical needs. Most recently a new shower room floor has been laid and a ceilingtracking hoist fitted into one resident’s bedroom. The manager has appropriately consulted occupational therapists when equipment and adaptations have been considered. Staff reported that repairs are dealt with promptly and no hazards were noted. The Home is being kept clean by the care staff while the cleaners post is recruited to. There were no unpleasant odours. The laundry is well equipped and systems to reduce the risk of cross infection are in place. Protective clothing is readily available to staff. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being well supported by an effective, qualified and competent staff team who are being suitable trained and supervised. The staff recruitment processes are not adequately protecting the residents. EVIDENCE: The sample of rotas seen showed that three staff normally work the morning shift and two cover the afternoon/evenings. At night one worker sleeps in who is on call if needed. The rotas showed that staffing is arranged around the residents’ activity plans and health appointments. In the last year four care staff have left, two of which were full time workers. Three posts have been filled and there is one 30 hr care worker vacancy. Efforts to recruit have been unsuccessful but an internal transfer within the organisation is now being considered. The manager reported that covering the vacant shifts has not been difficult as staff are willing to work extra hours if needed. The cleaner has left and this post is due to be replaced. The staff spoken with reported that suitable staffing levels are being maintained to meet the residents’ needs. Staff induction and core training is managed centrally by the organisation. All Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 21 new staff are expected to complete the Learning Disability Award Framework and core training is included in this e.g. Food Hygiene, Fire Safety and Moving and Handling. Of the team of nine staff eight have a NVQ qualification. Three staff are currently working towards gaining an NVQ 3 and another is due to start this course. First Aid training has been increased and now eight staff have the full qualification. Staff do not take on sleeping in duties until they have attended epilepsy training. The level of medication training provided is being increased soon. Some specialist training has been provided to meet the residents’ specific health and dementia training is now also offered. Training in person centred planning has been accessed. A training co-ordinator is employed and staff are being called automatically to attend refresher courses as required. Disability equality training is not currently provided by a disabled person, as recommended in Standard 35. This should be considered. Recruitment records are held centrally. Details of the recruitment process followed for the newest worker were obtained over the telephone following the inspection. The Human Recourses officer reported that the worker had commenced employment when only one satisfactory written reference had been received and before a PoVA First check and full CRB disclosure had been received. The officer explained that the manager of the Home carried out a risk assessment and made the decision to start the worker under supervision until the other checks were received. This is a breach of the Care Home regulations as there is no scope for staff to be started prior to two written references and a PoVA First check being received. Even then workers are only permitted to start on receipt of a clear PoVA First check in exceptional circumstances. The providers need to be aware that employing a person who is on the PoVA List is an offence. Breaches of regulation have been found when recruitment records have been seen at previous inspections of the organisations Homes. It is not clear why these failings continue but the providers must take steps to improve standards to protect residents. It is recommended that if it is not feasible for recruitment records to be kept on site for inspection that a checklist be kept in the home that confirms that satisfactory checks have been received (including an application form with a full employment history) which the registered provider or manager has verified. There should also be details of each staff member’s starting date, role and contracted hours with other relevant documents. (Reference Schedule 4 paragraph 6 (d), (e), and (g) of the Care Home Regulations). Two staff on duty were spoken with in private. Both were relatively new, but one had relevant background experience in the care sector. Both workers reported that they felt supported in their role and found the manager and deputy approachable. They felt that they had been provided with appropriate training and found the regular supervision sessions and staff meetings helpful. They were positive about the service and felt the residents were experiencing a good quality of life. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are benefiting from a well run home. Arrangements to monitor the quality of the service have been improved and it is planned that this will include feedback from residents and their representatives. The residents’ best interests are being safeguarded by the home’s record keeping systems, however some areas for improvements were noted. The residents’ health, safety and welfare are being promoted. EVIDENCE: The management arrangements in the Home remain stable with the registered manager being supported by a deputy. The manager has relevant experience and has recently obtained an NVQ4 in Care and the Registered Managers Award. The manager and deputy work regularly providing direct care to the residents so they keep well informed about their care needs and wellbeing. Systems are in place to allow staff to give feedback through supervision and staff meetings. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 23 It is very positive that a line manager has been appointed to oversee the care homes and support the registered managers. This should help provide an overview of standards, processes, and consistency across the group. The providers have been carrying out their legal duty to visit the Home each month and report on their findings to the directors and the Commission. A new more formal quality assurance system has recently been introduced. The manager has received training and has started the auditing process. One of the senior staff in the organisation is taking the lead and coordinating this process. The manager has reported to the Commission events that have affected the wellbeing of the residents. The records are being stored securely in the office. Some have not been kept up to date. Inventories have been completed but the one seen had no date on it and no value against the items. A sample of the residents’ financial records showed that appropriate purchases are being made on the residents’ behalf such as toiletries and drinks on outings. The manager reported that the deputy checks these records monthly, however there is no evidence of this. The money tins were being stored securely. The organisation has a representative who takes the lead on Health and Safety matters. He is currently reviewing the fire risk assessment however this work started in August and has not yet been concluded. The manager has not agreed a timeframe for this work to be completed. The newest worker reported that he has taken part in a fire drill recently. Fire equipment is being serviced and tested at suitable intervals. Daily tests are made of hot water and fridge temperatures. Servicing arrangements are in place e.g. the bath hoist has been serviced on 28/8/06 and the gas installation on 5/06. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 24 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 2 4 3 5 2 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 4 27 4 28 4 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 2 X 2 3 x Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 YA23 Regulation 18 Timescale for action New staff must not commence 31/10/06 employment until two satisfactory written references and a CRB disclosure have been received. New staff can only be permitted to start work following receipt of a satisfactory PoVA First check pending the return of a CRB check in exceptional circumstances. Requirement 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 YA3 Good Practice Recommendations Assessment information should be summarised into an initial care plan to demonstrate how any potential new resident’s needs will be met. This should be agreed with the resident and their representative before the resident starts using the service. A representative for each resident should be asked to DS0000024688.V311597.R01.S.doc Version 5.2 Page 26 2. YA5 Chatsworth Road 94 3. YA6 YA41 YA19 agree to the Terms and Conditions of Residency. (Brought forward, not fully actioned). This document must contain clear details of any extra charges that may be made e.g. for specialist equipment. Old and out of date information should be removed from care plan folders and archived. Information should always be dated and evidence kept that it has been reviewed regularly. Person centred planning meetings should be linked into the review process. Include actions agreed at the PCP sessions in the care plan and follow these up as goals. Develop the level of daily recording so it includes details of whether a resident enjoyed or benefited from the activities they were offered during the day. 4. 5. YA7 YA20 Implement health action plans. Continue to develop communication systems appropriate to each resident. (Brought forward, it would be beneficial if work continued). All tablet stocks held in the Home should be included in the records and any auditing process. All medicines outside the monitored dose system should be dated when opened to assist in the auditing process. The contents of different packets should not been mixed. A competence assessment process should be introduced to evidence the manager’s decision to delegate the responsibility to administer medication to new staff. The manager must ensure staff implement the residents’ goal plans in a respectful way. Ensure staff offer choices around meal times in line with the care plans. Keep a checklist in the home that confirms that satisfactory recruitment checks have been received (including an application form with a full employment history) which the registered provider or manager has verified. There should also be details of each staff member’s starting date, role and contracted hours with other relevant documents. (Reference Schedule 4 paragraph 6 (d), (e), and (g) of the Care Home Regulations). Keep evidence that senior staff are monitoring residents’ financial records regularly. DS0000024688.V311597.R01.S.doc Version 5.2 Page 27 6. YA32 YA11 7. YA34 8. YA41 YA23 Chatsworth Road 94 9. YA42 Complete the review of the fire risk assessment as soon as possible. Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chatsworth Road 94 DS0000024688.V311597.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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