Inspection on 16/01/07 for Abacus House

This inspection was carried out on 16th January 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abacus House 22/01/08

Abacus House 15/12/05

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 Abacus House Abacus House 55 Victoria Road Swindon Wiltshire SN1 3AY Lead Inspector Stuart Barnes Unannounced Inspection 16 January 2007 09:15 th Abacus House DS0000064394.V324998.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 Abacus House DS0000064394.V324998.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. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abacus House Address Abacus House 55 Victoria Road Swindon Wiltshire SN1 3AY 01793 511181 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.holmleigh-care.co.uk Holmleigh Care Homes Ltd Suzanne Hanratty Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the two bedrooms on the second floor and the single bedroom leading from a single staircase off the rear lounge are not to be used by service user or staff until a fire safety sprinkler system has been installed. 15th December 2005 Date of last inspection Brief Description of the Service: The home is close to Swindon Old Town centre on a busy road. It is one of a number of homes owned by Holmleigh Care. It offers care and accommodation to adults aged between 18 and 65 years who have a learning disability and may have associated needs that challenge. It was first registered in August 2005 for 7 service users. The accommodation is on three floors and all of the bedrooms have an ensuite shower room with a toilet and hand washbasin. On the ground floor, there is a dining room, a kitchen with a separate utility room that leads to a sitting room and a staircase for another bedroom. There is also a small garden and patio to the rear of the home and car parking space. Abacus House is staffed twenty four hours a day including awake staff at night time. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days. The first day was unannounced. The second day planned so the manager could be available. On the first day the inspector examined relevant policies and procedures that were in use and examined case documentation in relation to three residents selected at random. Two services users were spoken to in private and gave their views on the home. Two staff were also interviewed and their training and recruitment records were checked. On the second day more time was spent talking informally to the service users, observing staff at work and asking them questions about the home and how they meet peoples needs. Time was also spent with the manager progressing the requirements and recommendations made at the previous inspection and viewing most of the accommodation. After the inspection the home was asked to provide additional information and the Commission wrote to a small sample of social workers, health care workers, family members and other interested parties to obtain their views. What the service does well: What has improved since the last inspection? What they could do better: Assessment and care planning documentation needs to be in a ‘person centred’ format. The risk assesment of residents are not being done soon enough. Those working in the home need more awareness raising of issues such as Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 6 Aspergers, self harm and suicide intentions. Urgent attention is needed to ensure staff can quickly access National Vocational Qualification. There is now a need to have a deputy manager in place that can carry out managerial and supervisory tasks when the manager is absent. The home would benefit from having a computer. Care needs to be taken to ensure that protective measures undertaken by care workers do not undermine the promotion of a being ‘adult’ when addressing challenges. 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. Abacus House DS0000064394.V324998.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 Abacus House DS0000064394.V324998.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. 3. 4. Quality in this outcome area is good. This relatively new service is already providing good overall standards of care, but there is scope to further improve documentation by making it more person centred. Sometimes a more adult focus is needed when responding to service users wishes. All service users appear to be benefiting from living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This relatively new service, which seeks to meet a number of complex needs, is still finding its direction. Service standards are under pinned by a detailed philosophy of care, which promote rights, choice, independence, and responsibility for ones own actions and provides a dedicated staff team. However in practice there appears some ambiguity as to whether the aim of the service is to offer life style options, or to manage behaviours that challenge, or to offer a therapeutic experience, to bring about changes in behaviour. This ambiguity emerged at a recent adult protection meeting and in further discussion at the inspection with the manager about dealing with selfharm and how the service responds to one of the service users. Another illustration that suggests there is some confusion or lack of clarity about the homes main purpose, was a reported reluctance to support a service user to apply for social housing, which if allocated may require years on a waiting list; something the service user wants but something the manager feels she should not have until certain behaviours changes occur. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 9 Never the less the needs of all the service users are being met quite well, because they are kept comfortable and warm in a caring environment, which allows then to grow emotionally so that can feel relatively safe and enjoy life. They also benefit from supportive and dedicated care workers who are well managed. Three case files were selected at random. Examination of these files confirms that the service has detailed assessment documentation from peoples’ previous placements including information provided by parents. There was evidence of ‘transition plans’ being actioned so that the service users were provided with the necessary support to settle into their new surroundings. However in one case the assessment documentation had not been updated to reflect changes arising from the move to Abacus House. Neither was there evidence to show that the company had written to each service user confirming the extent to which the service could or could not meet any assessed needs. The manager said she was not aware of this requirement. These are small deficits and the overall standard of assessment and the gathering of pre placement information is quite good, especially planning around risk and general safety considerations. However the assessment documentation does not yet fully equate to a ‘person centred’ format and opportunities are being missed to capture what services users need or can expect from the placement; or to validate that they are adults who have choices to make. One review included a comment that a person’s mail would be opened in the presence of staff to “ensure we (staff) are aware of the correspondence they are receiving.” This well intentioned response suggests an over protective measure that undermines planning for independence and conveys insufficient awareness of the need to obtain and document the service users agreement and consent to such controls. There is scope to further improve staff understanding of issues arising from some behavioural challenges such as self harm/Aspergers as some of these challenges need more action planning in the assessment/planning process, setting where appropriate measurable objectives as these were not evident in three case files seen. Following an assessment of needs the assessment and planning documentation needs to move towards action planning the future rather than merely describing the past. The assessment process needs to go beyond a description of problems and circumstances to one that captures service users expressed needs (and wants) within an action plan that is person centred and goal orientated. An example that illustrates such a deficit is a statement made by a service user that they want a double rather than a single bed, and more furniture and who also wants more freedom to go out or do their own thing. (The company’s policy includes the statement that it will provide a bed that meets service users needs). Case files confirm service users are supported to access a full range of support services, including specialist services covering health, behavioural management, community inclusion and discrete services and services providing day activities. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 10 One relative who completed a ‘Have Your Say’ comment card prised the home for it keeps them informed, while another said it was good at caring for their family member. Service users views about their experience of living at Abacus House are mixed. Two people commented they liked the home and confirmed the home is benefiting them greatly; while another was critical of the restrictions that they felt were being imposed on them and said they did not like the home and that they felt it was not helping them enough to be independent. Further discussion with the manager and the person’s care manager suggest these restrictions are derived from best intentions and a genuine desire to keep the person safe, as well as improve their quality of life. The relevant care manager confirms good progress is being made in the placement but that some challenges need to be better managed, within a multi disciplinary forum and more specialist input. Discussion with the manager of the home also confirmed good progress, sandwiched between periodic set backs for this person but gave hints that opportunities for extra freedoms and responsibilities will only depend on the service user reaching certain goals. Thus conveying that the service user was to be controlled like a child – something the service user objects too. Another issue emerged during the inspection that is having an impact on the function of the service. It is the accommodation of people within the age range of 27 and 64 years some of whom have needs arising from having a straightforward learning disability and other people with more complex needs and challenges. This is a complex mix presents challenges for everyone. Two service users reported some anxiety about the current mix of residents and the impact this has on them. For example two person said they did not always feel safe or at ease due to the amount of aggression or noise. One person wanted more people of their age to relate with. But the mix is also strength because it compels staff to notice and better respond to people as individuals and personalities in their own right – something the care workers are doing quite well. All service users are offered a residency agreement, which sets out their rights and responsibilities. It confirms any placement is subject to a trial period and details the fees to be charged. However this agreement does not include how to contact the Commission’s local office. Service users state they had an introductory visit, which the manager confirm is structured according each person needs and wishes. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6. 7. 8. 9. Quality in this outcome area is good. The planning of care is quite well done but could be further improved but using a more person centred format and separating out health care needs from other documentation. Service users are actively supported and encouraged to active participants in the decision making process including how the home is run. Overall risk is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users have a ‘plan of care,’ which specifies identified needs, aims and objectives, current circumstances and the actions to be taken. As previously stated they are not in a fully person centred format. The manager said there are plans to introduce a new person centred format in the coming months, along with a new and separate person centred format to assess health care needs. It was observed that one service user already had contributed to her health care assessment/plan by inputting some of the information themselves. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 12 Discussion with this service user indicates that they felt much more involved by this process and had used it to seek clarification on their health care needs. It is hoped other service users will be offered this option so they can benefit in the same way. Some care plans record some restrictions or control mechanisms are in place. Some of the imposed restrictions included not being allowed out without an escort, or having to return to Abacus House at a specific time, or if going out only going for limited periods or staff controlling when a person can access their money. Another control was a requirement placed on staff to check on a named service user every 10 minutes when in the lounge. While such restrictions may be appropriate to the circumstances there was little evidence in the documentation as to the reasons why they were needed. Nor was it clear who else has also agreed that such restrictions might be necessary or whether the service users had consented to them. Much better recorded were restrictions associated with medication where there is evidence of these being agreed with health care workers and in some cases the users of the service. Examples were seen during the inspection of a service user being encouraged and supported to travel independently on the bus and for another service user to go to church without staff support. Individual care plans made quite good links to some challenges such those arising from a condition known as Aspergers and those who engage in self harm. The service is becoming experienced at supporting people with these difficulties. The manager is commended for seeking specialist support, including support from specialist user groups and specialist workers but it needs some more help, quicker responses from the care and health care management systems in understanding these challenges. Other challenges where care workers would benefit from having more help include managing occasional incidents of aggression, threatening behaviour and threats of suicide intentions. Comments were made by one health care professional that some aspects of behavioural management would be better managed by having a behavioural plan put in place and closer liaison re the following through of treatment suggestions. This health care workers praised the home the way it strives to meet the health and social care needs of the residents. A care manager has praised the home for the way it works with his client. There is evidence to show that care plans are periodically reviewed and updated. According to three staff and two service users, service users are involved in decisions that affect them. This starts with their involvement in choosing the home and for some choosing which room they have. There are structures in place such as house meetings, a key worker system and care planning meetings that support active communication and decision making such. Care plans differentiate between what support a person needs from staff and what they are expected to do for themselves. The service also maintains a constructive dialogue with parents. Subject to risk assessments service users can manage their own medication or finances. They also input into menu planning and how they want to spend their Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 13 daytime. It was observed service users take their breakfast at a time of their own choosing in a very relaxed manner and that one person planned their own afternoon activities and birthday plans. House meetings notes confirm that all service users are encouraged to attend, but attendance is not compulsory. Those attending are supported by staff to have their say. However if the frequency of such meetings were increased to say every 2/3 months it would further service user participation. Discussion took place as to the extent service users are active participants in the recruitment of staff. While service users views about their preferences may be noted there is more scope to involve service users in this process in a way that is more active and meaningful. Risk is quite well managed. There is a detailed risk management policy in place and case files include individual written risk assessments covering areas such as personal safety, medication. However not all case files show that a new risk assessment is carried out prior to admission. There is a tendency to rely on risk assessments carried out in previous care setting. While such risk assessments can be of help in the new setting these should not be seen as substitute for not having a full assessment before the person is admitted and updated soon afterwards depending on its outcome. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11. 12. 13. 14. 15. 16. 17. Quality in this outcome area is good. Care workers are being successful at supporting service users to maintain a community presence and to keep safe when out and about. While some people are supported to have opportunities for social inclusion and scheduled day activities more could be done to support people with job coaching or other forms of paid work. Most service users like the food arrangements. The service is good at working in partnership with family members. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is ideally located to access a range of civic and leisure activities, many of which are in walking distance or are only a short bus ride away. Assessment documentations shows that service users appear to have a range of interests, which the service does it bests to facilitate. The service is working hard to support service users to have a community presence, as observed on both days of the inspection when service users were supported in a variety of ways to go into town, to attend their day activity programme, to visit family and to attend church. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 15 Case documentation shows that care staff frequently support service users to access shops and leisure facilities. However some service users report being bored during the day or restricted in the evenings and week ends in what they can do. Two service users report concerns that they have limited cash to pay for the activities they need. This problem reflects current government policy but more could be done, over time, to support service users to have paid work through access to therapeutic earnings or job coaching. The inspector observed one worker encouraging a service user to attend a day centre suitable to their age and to go to church more often, by travelling independently. Service users report that as well as using a local drop in centre they attend the local Gateway Club and Special Olympics Club, which are local discrete clubs for people with a learning disability. A feature of the service is that users are encouraged to plan their own holiday preferences, within their own budget limitations. Other day activities available to service users include attending horticultural and environmentalist activity groups. One service user showed the inspector some of their college work. It was noted that care workers were supporting her in an innovative way to complete a health and safety project for college. It can be seen from correspondence on two case files that the home welcomes the involvement of parents and other family members and strives to work in partnership with them. Two relatives of current residents said the home was good at supporting service users to access a range of community activities and is meeting their needs always or mostly. A strong feature of this service is the way the service respects those who live at the home. Service users are offered a key to their room, subject to an assessment of risk. Staff were observed to speak in an appropriate manner with a respectful tone at all times. Bedroom space was respected as private space. It was observed that there a couple of occasions when service users asked personal questions or raised personal problems with staff in public areas. The staff response was to provide some immediate reassurance while noting their concerns and at the same time inviting them to discuss their worries in a more private place later. This shows respect for the individual, sensitive management and the application of common sense. Service users report good satisfaction with the meal arrangements. There appears to be a good balance between encouraging healthy eating options and understanding that some individuals have preferences that reflect a different life style choice. Assessment details and care plans cover food fads and any hints of eating disorders. Meal times were observed as unhurried. The last resident meeting noted that service users wanted some changes to the menu and also wanted, on occasions, alcoholic drinks with their meal – both requests were actioned. Service users report that they are involved in the task of food shopping. Service users also report that they some times cook meals themselves and sometimes meals are cooked for them. One service user offered the inspector some cheese straws, which he had baked earlier – and very tasty they were too. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 16 Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19. 20. Quality in this outcome area is good. This outcome area is one of the strongest and is not far away from being excellent. People living at the home are benefiting from their placement and are getting good support from staff with their health, social care and personal needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service and the style of management promote care practices that ensure privacy, respect, choice and independence. Service users confirm that staff treat them with respect. Policies underpin a right to privacy. Bedrooms offer privacy. Care plans show that service users are offered choice. Staff who work at the home strive to offer service users individualised personal support. Staff impress as having a good understanding between supporting people who may need help with some aspects of care but enabling them to do what they can for themselves. For example one person needs help with washing their hair but can manage to bath independently and this is made clear in the care plan. This is a service where people’s difference shines through. It is personified by the way bedrooms are personalised, the way care plans including activity plans Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 18 and risk assessments are individualised and the fact that some service users access specialist services which others do not because they do not need them. Service users talked about having different life style options and different support needs to other residents and it can be seen that key workers recognise this and do what they can to respect difference. Service users confirm they are supported to attend preventative services such as the dentist, optician, chiropodist and preventative health clinics if needed. They also are assisted to access specialist health care services. Case files verify that this is a fact. The manager speaks passionately and caringly about supporting service users to access more specialist services, citing the example of successfully advocating for the involvement of a worker specialising in Aspergers. The service is also good at supporting people who are anxious or who are frightened, to access the medical care they need. There is scope to further improve the way health care needs are assessed and recorded; to make them even more person centred and to ensure that these documents capture and record each service users views about their own health care needs. The manager has met with a specialist health planning advisor and has plans to introduce a new a health assessment tool in the coming month, which, once introduced, will improve health care planning. The medication procedures in respect of three service users were randomly checked and were found to be satisfactory. Medication is kept securely in a locked cabinet with the key kept in a different room, for extra security. Staff are expected to follow a detailed procedure that is designed to ensure medication is managed safely. There are examples in this service where people manage their own medication but in the majority of cases it is the staff that manage and administer medication. It is policy that any ‘over the counter’ medication is only used if the person’s general practitioner agrees to its efficacy. Case files provide evidence that this is so. Staff confirm that they receive relevant training before they are allowed to administer any medication, including training provided by a local chemist in the safe handling of drugs. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22. 23. Quality in this outcome area is good. This is a service where staff work very hard to protect service users from their vulnerabilities and where they seek to manage some challenging behaviours in a protective and supportive way. Staff try to tune in to what residents feel and convey but there is scope to further improve formal communication by having more house meetings. Some worries people have about the behaviour of others needs to addressed, perhaps within the complaints procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The company has both a detailed complaints policy and a whistle blowing policy. According to the manager no complaints have been received since the last inspection. The service is good at sharing information about incidents that occur which effect service users, but it appears there is some confusion and an apparent lack of clarity about whether comments made by service users about the conduct of other service users or the conduct of staff should be captured under the complaints procedure or not. However these shortcomings do not mean that staff do not notice or take action to address any niggles service users raise. The manager has working knowledge of the local adult protection protocols and takes seriously any allegation of abuse or harm. The way the service carried out recruitment checks in respect of two randomly selected staff were examined. They were found to be in good order. Policies and procedures are in place to deal with behavioural incidence, including threats or actual violence and staff undertake a 3 day “positive behavioural management” (PBM) course. A note on a case file recorded a person was Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 20 restrained. Discussion about this suggests some staff are confused as to what constitutes restraint (which the manager says is not used), what is meant by PBM and how to record such incidents. Overall the standard of recording is satisfactory but those working in the service would benefit from having a computer to help them better record and format important documentation. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24. 25. 26. 30. Quality in this outcome area is excellent. This newly acquired building which provides ensuite facilities, is well maintained and furnished to high standard This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall the home provides high standards of accommodation and is ideally situated for those who like to be in easy access of shops, civic amenities, leisure outlets and a large modern town. All communal rooms and all, but three, of the bedrooms were seen. Fire safety is taken seriously. The home benefits from having an upgraded fire detection system that includes a sprinkler system. The home appeared to be exceptionally clean, safe and well maintained. Staff and service users show a pride in the home. However the place used to store medication is considered too small and the shelving and storage facilities in one service users room are considered inadequate to house her personal possessions. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31. 32. 33. 34. 35. 36. Quality in this outcome area is good. This is a service where staff are carefully selected and well managed. Relevant training is provided, however provision of National Vocational Qualification needs improving and more attention is now needed to some aspects of induction ensuring that it covers equality and diversity awareness. Now the home has more residents it is a good time to introduce a deputy manager to assume some of the managerial and supervisory tasks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of two staff were randomly selected. They both provided evidence that staff complete a detailed application form and that the company obtains two written references including a reference from the immediate past employer, proof of identity and pre-employment health checks. There was evidence to show that a relevant CRB (Criminal Record Bureau) check had been undertaken though in one case the level of the check had not been recorded. It has subsequently been confirmed. It is evident from discussion with the manager and examine staff files that staff are carefully selected for both their personal and professional qualities. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 23 The company provide detail job descriptions and care workers appear to have good understanding their role and that of other staff. However the absence of a deputy manager means that the current manager’s ‘span of control’ are challenging and are hindered by the lack of a computer. Staff confirm they are provided with the local ‘No Secrets’ guidance and the G.S.C.C (General Social Care Council) code of conduct, copies of which were seen in the office. Staff report that they receive relevant training in areas such as fire safety infection control, basic food hygiene, medication, moving and handling, positive behavioural management. One person had undertaken an awareness training course in understanding abuse. They also report they have a 3 day induction course, but the manager was not able to confirm whether this course was compliant with the relevant skills council criteria. Furthermore of the ten training records examined four did not confirm that they had undertaken the ‘Learning Direct’ induction programme. Examination of 10 training records also shows that only one person has a relevant National Vocational Qualification. Training records also show that to date no one has received any dedicated training in equality and diversity, but most have been provided with basic training covering fire safety, manual handling, food hygiene and first aid. Seven staff have yet to undertake infection control training Examination of rotas show that staff are deployed in sufficient numbers in a flexible way. Extra staff are deployed when for example someone needs support to attend an appointment or at busy times. The mostly all female staff team includes a good mix of age, experience and skill. Staff report that team meetings take place on a regular basis. Examination of the minutes of team meetings show that relevant items are discussed including the needs of each service users, but such meetings are only every three or four months instead of every two months. The two care staff that were interviewed praised the company and the manager for the support they receive. They both described a staff communication system as being open, honest and working well in the interests of service users. They also confirmed that they meet with their supervisor from time to time. Records show that the frequency of such meetings vary from person to person. The manager said that staff supervision did not really take off until the home had several people resident and that not having a deputy manager to share this task means that some meetings have been difficult to fit in. Examination of the supervision records show that relevant issues are discussed and that there is focus on improvement. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37. 38. 39. 40. 42. Quality in this outcome area is good. Taking into account this service has only been up and running for less than a year it is a well managed service where staff are guided by a comprehensive range of policies and procedures, which are aimed at providing high standards of care to meet the relevant national minimal standards. Health and safety is taken seriously. Some policy files would benefit from thinning out or review to reduce duplication, which might cause confusion. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager is deemed a fit person by the Commission to manage this service and brings to the post a commitment and a passion to providing quality services. The company has been accredited with the ‘Investors in People’ award. It carries out monthly checks on specific service standards. The most recent Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 25 check being on the standard of accommodation and health and safety issues. Where necessary corrective action is identified and actioned such as ensuring there is a first aid box for use and that a loose banister is repaired. Other regular safety checks are carried such as recording water temperatures, fridge and freezer temperatures and safety checks on equipment including fire safety equipment. There are also monthly audit checks on medication stocks. However some of these checks are more of an audit than a detailed quality assurance system, as they do not detail any qualitative findings with measurable targets and action planning. The proposed introduction of comment cards and the surveying of key stake holders will help improve quality assurance, as will a quality report with targets for improvement done at least annually. The company’s policy and procedure file was examined. It provides a comprehensive range of relevant policies and general guidance which staff are expected to follow. These cover risk management, expected staff conduct, reporting mechanisms, planning care and managing complaints. More care is needed to ensure that all policies are being followed. For example the policy on supervising staff says supervision meetings should be every 2 months and last a minimum of 90 minutes. This is currently not happening. The policy on gifts prohibits staff being a beneficiary of a service users will but there is lack clarity in the policy about whether they can receive gifts including token gifts of appreciation. The policy on staff qualifications includes a statement that the am is to, “provide the highest possible quality of care – by a well trained … staff team; yet few people are trained to National Vocational Qualification level 2 or above. So it appears some of the policies are aspirational more than standards, which are being delivered, and this needs guarding against. There is scope to reduce the number of policies to avoid a tendency toward repetition or fragmentation and to assist staff to assimilate the detail. Health and safety is taken very seriously and there is allow level of accidents occurring. Records show that fire safety checks are routinely carried out including fire drills that involve service users. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 2 3 X Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 (6) Requirement Timescale for action 27/06/07 2 YA32 18(1)(a) 3 YA2 13(4)(c) The adult protection policy and procedure must be revised to reflect local policy guidance with regard to multi disciplinary meetings about referrals. (This requirement was made at the previous inspection. It was to be complied with by 22/02/06) Since the requirement was first set the local policy now called ‘safeguarding adults’ has been amended. Any such revision should take account of such changes. The company is required to 01/04/07 inform the Commission how it intends to ensure that at least 50 of care workers can access and successfully complete a relevant National Vocational Qualification The service must ensure they 01/03/07 undertake an assessment of risk on each person before they are admitted to the home which is subsequently reviewed shortly after their admission and periodically thereafter. Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 28 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 YA2 YA6 Good Practice Recommendations It is recommended assesment documentation should be in a format that reflects person centred values and engages the person who is being assessed in the process. It is recommended that the care planning documentation should be in a format that reflects person centred values, is goal orientated, forward looking and engages the person whose plan it is. It is recommended that the health care plan is a separate self contained document in a format that reflects person centred principles. It is recommended that when controls or restrictions are placed on any service user the reason why such controls are necessary is recorded and where possible the service is asked to agree them. It is recommended that those service users who need more shelving or storage facilities in their bedroom is provided with these facilities. It is recommended that service users who want to sleep in a double size bed be provided with one. It is recommended the service recruits a deputy manager able to assume and managerial supervisory responsibilities when the manager is absent from the home. It is recommended more attention be given to raising awareness about equality and diversity during the induction of staff and at other times. It is recommended that the company undertakes a review of the contents of its policy manual eliminating any unnecessary duplication and ensuring it is updated. 3. 4. YA6 YA6 5. 6. 7. 8. 9 YA25 YA25 YA36 YA32 YA41 Abacus House DS0000064394.V324998.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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