CARE HOME ADULTS 18-65
Addington Close (12) 12 Addington Close Devizes Wiltshire SN10 5BE Lead Inspector
Malcolm Kippax Key Unannounced Inspection 10th May 2007 09:25 Addington Close (12) DS0000028256.V339974.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 Addington Close (12) DS0000028256.V339974.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. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Addington Close (12) Address 12 Addington Close Devizes Wiltshire SN10 5BE 01380 720001 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) Ordinary Life Project Association Mrs Helen Patricia Morgan Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 3 service users with learning disabilities at any one time. Date of last inspection 11th May 2006 Brief Description of the Service: 12 Addington Close is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). 12 Addington Close is a detached bungalow in a residential area of Devizes. The home fits in well with the neighbouring properties. Each service user has their own room. There is a lounge and a dining room for communal use. The home has a domestic style kitchen. 12 Addington Close is the service users’ long-term home, for as long as this remains appropriate to their needs and wishes. The service users receive support from a manager and a permanent staff team. There is at least one person working in the home throughout the day. Extra staff are deployed at certain times. The range of fees is £860.62 - £986.35 per week. Information about the service is available in the home’s ‘Statement of Purpose’. Copies of inspection reports are available from the OLPA head office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. They are also available through the Commission’s website: www.csci.org.uk Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home, which took place on 10 May 2007 between 9.25 am and 4.35 pm. Evidence was obtained during the visit through: • • • • Time spent with the service users. Meetings with two members of staff. Observation and a tour of the home. Examination of records, which included the service users’ personal files. A photo-story book was used to help explain the inspection process to one of the service users. The home’s previous main inspection was in May 2006. Another, shorter inspection took place in January 2007, to follow up matters arising from the inspection in May 2006. Some of the findings from the inspection in January 2007 are referred to in this report. Other information has been taken into account as part of this inspection: • • • • A pre-inspection questionnaire that the manager completed about the running of the home. The comments made by three of the service users’ relatives, who completed surveys about their experience of the home. A letter that was received from OPLA’s Chief Officer after the visit, concerning the use of an alarm on the home’s front door. A telephone conversation with the home’s manager after the visit. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well:
The service users’ needs and personal goals are discussed with them, which helps them to make decisions about what they want to do in the future. The information is recorded in individual plans, which ensures that staff know what the service users want to do and how this can be achieved. Recently, one service user has enjoyed going to the theatre and having some days out, as part of their goals. A ‘tenants’ meeting is held every month, so that service users can talk about the things that concern or interest them. At the last meeting, one service user said that they would like to have a new table in the garden. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 6 Service users have their own routines and different interests. One service user in particular spends a lot of time going out to different activities. Staff talk to service users if there are risks involved in what they want to do, to ensure that they do not come to harm. Service users receive support from staff, which enables them to keep in touch with their families. The relatives who completed surveys feel that the home keeps them informed of important events and supports people to live the life that they choose. Service users enjoy their meals. They can choose what to have and the mealtimes are flexible to fit in with what they are doing. Service users manage many things themselves, but need assistance or reminders with some tasks. Each service user has a care plan, which gives staff good information about the support that is needed in areas such as personal care and keeping healthy. The plans also say why this is important to the individuals concerned. Staff help service users with managing their medication. They do this in a way that ensures that service users are not put at risk and that the medication is well looked after. Relatives feel that the home always meets the service users’ different needs and provides the care that they expect. Staff members provide good support with keeping the house clean and well maintained, so that service users live in homely and attractive surroundings. There is an experienced staff team who know the service users well, which has enabled good relationships to be established. Service users benefit from staff who receive regular training and feel supported in the home, which helps staff to feel confident about their work. Staff members meet together, so that they can discuss the service users’ welfare and keep up to date with changes in their needs. The manager has relevant experience and qualifications. There is a management approach which ensures that service users benefit from a well run home. Plans are produced, so that improvements can be made over time, for example with modernising the kitchen and with giving service users the opportunity to have more days out. Service users can feel confident that their views are taken into account and acted upon. The health and safety of service users and staff are generally well protected in the home. What has improved since the last inspection?
The health of one of one of the service users has been of concern during the last year. The service user’s usual routines and activities had been affected.
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 7 It was reported at the inspection in January 2007 that the service user was responding well to the support that they received. The service user was met with during the visit. They were spending more time up and about. The service user was enjoying doing things in the home. They had recently started going out to a new club, which staff felt was a very positive development. Another service user has also received good support following an operation. This is reported to have gone well and the service user was back to their usual routines. The service users have continued to receive good support with keeping in touch with their families. One service user has received support with arranging a special trip to Scotland, when they would be meeting up with relatives who they had not seen for a while. Some facilities in the home have improved. Service users said that they liked a new television that has been bought for the lounge. Drainage around the driveway and front door has been improved during the last year. This has meant that service users can get to the front door more easily. Since the inspection in January 2007, a ramp has been added, so that the door threshold is less of an obstacle to service users. Staff members have thought for a while that the kitchen is in need of refurbishment. This is closer to happening, as staff said that the work had been agreed and they were now planning to get some quotes for this. Areas for improvement and some new objectives for the home have been identified in the latest house development plan. During the last year, the home’s manager has achieved a National Vocational Qualification in Care at level 4. What they could do better:
The home needs to ensure that any changes in a service user’s needs are fully assessed, so that suitable arrangements can be made for their safety. A situation had arisen recently when staff should have been alerted to a service user leaving the home. When a safety measure needs to be implemented, its usefulness must be fully assessed, to ensure that it can be relied upon and is effective in reducing the risk to the service user. There are times when the deployment of staff results in a lack of flexibility in what service users are able to do and the level of support that they receive, such as with being able to go out at the weekends. During the morning of the visit, staff had contacted a surgery to make a GP appointment for one of the service users. The surgery was able to offer an
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 8 appointment that day, although this had to be declined because a staff member would not be available to take them at the specified time. The involvement of a GP appeared not to be of an urgent nature, however staff recognised that it was not in the service user’s best interests to wait a day for the appointment. OLPA could look at how additional staffing might be arranged from within the organisation to provide the staff cover that is needed in such circumstances. Staff also said that there had been an occasion during the previous week when a service user had a podiatry appointment and another service user had needed to accompany them. This was not the service user’s choice but there was no second member of staff on duty at the time who could remain in the home. It was recommended at the last inspection that the need for two staff members to be deployed between 8 am and 9 am is reviewed. Staff members normally work alone until 10.00 am each day. However they feel that the period between 8.00 am and 8.30 am is a busy time, when they would like to be able to spend more time with the service users. After the visit, the manager said that recruitment would be undertaken for a new staff member, working 130 hours a month. The manager said that she expected this to address the lack of flexibility, which existed in the current staffing arrangements. The home has a staff training plan for the year ahead, which focuses on OLPA’s mandatory subjects. The training plan could be expanded to include more specialist and skills related areas of training. This will help ensure that service users benefit from staff who have attended a wider range of training courses. 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. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Standard 2 did not apply at the time of this inspection. No new service users had moved into the home during the last year. The current service users have lived together for a number of years. EVIDENCE: Addington Close (12) DS0000028256.V339974.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 and 9 Quality in this outcome area is mainly good, however there was a shortcoming in how the risk to one service user had been managed. This judgement has been made using available evidence including the visit to the home. Service users can be confident that the staff team have good information about their needs and personal goals. Service users can make decisions about their lives. They benefit from the approach of staff, which promotes risk taking as part of an independent lifestyle. However, the safety measures in place in response to a particular risk have not been as effective as they need to be. EVIDENCE: Each service user had a ‘Person Centred Plan’ (P.C.P.), which included details of their personal goals and how these would be achieved. The plans had been written with the service users during the last year. The service users had keyworkers, who co-ordinated the P.C.P.s and monitored the progress being made. Staff meetings were being held when the staff team discussed the service users’ goals.
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 12 The goals were personal in nature and covered a range of subjects. Some concerned the service users’ ideas about new things that they wanted to do, such as going to the theatre and getting a television listings magazine each week. Other goals were significant for the service users’ long-term health and welfare. These included having a hospital operation. This had taken place during the last year and the service user concerned was pleased with the outcome. Staff confirmed that this had been very beneficial for the service user’s overall well being and what they were able to do. The service users’ personal files included a range of assessments and guidance for staff about personal support and preferred routines. Staff members had signed a form to confirm that they had read the service users’ personal care and support plans. The service users met together at monthly ‘tenants’ meetings. The most recent meeting had taken place on 28 April 2007. Each service user had brought an agenda of items to discuss at the meeting. The minutes showed that service users had ideas about what they wanted to do and made decisions about things that affected them. For example at a recent meeting one service user had mentioned that they would like to have a new table in the garden. Service users had talked about places they would like to go to and one service user thanked staff for arranging some days out. The three relatives who completed surveys confirmed that they felt the home always met the service users’ needs and supported people to live the life that they choose. One of the service users went out of the home by themselves and did a lot of things independently. This person went into Devizes town centre during the visit. Other service users received support from staff when in the community. Although accompanied when outside the home, one service user had spent time without a staff member while attending a college course. There was an assessment of the risk to a service user’s independence, if not able to leave the home unaccompanied or unsupported. Guidelines about this had been produced for staff. The assessment in respect of one service user was reviewed following an incident in April 2007 when they left the home without staff’s knowledge and was deemed to be a missing person. The guidelines for staff were rewritten and it was confirmed that an alarm on the front door was to be used at all times. This was so that staff would be alerted if a service user left the home. This alarm had been in place for a while, but staff said that it had not been used for a while before the incident because the service user was not perceived to be at risk. The door arrangements were discussed with staff during the visit. Staff said that the service user’s mobility had now improved to an extent which made it
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 13 possible for them to leave the home independently. Staff said that the door alarm was needed, but queried whether it could be heard in some parts of the home. When tested, it was found that there would be areas of the home where the alarm could not be relied upon. Following the visit, the home’s manager and the OLPA Chief Officer were made aware of the situation. The Chief Officer reported that this had already been discussed with staff and that alternative methods of alerting staff were being considered. This included finding a system that would be effective, but unobtrusive and did not compromise the service users’ rights. Addington Close (12) DS0000028256.V339974.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): 12, 13, 15, 16 and 17 Quality in this outcome area is mainly good. This judgement has been made using available evidence including the visit to the home. Service users have daily routines, which reflect their different needs. However a lack of staff reduces flexibility and limits what the service users are able to do at particular times. Service users receive support, so that they can keep in touch with their family and with the wider community. Service users’ rights and responsibilities are generally recognised in their daily lives. Service users enjoy their meals. The mealtimes are flexible to meet individual needs. EVIDENCE: Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 15 12 Addington Close is in a well established residential area, with neighbours close by. One service user went out independently and was able to walk to many of their regular activities in Devizes. This included going to a resource centre on the day of the visit. They returned home later in the day and said that they would be going to a Gateway Club after tea. Details of each service user’s weekly activities were shown on timetables on a notice board in the kitchen. On the day of the visit, two service users were having home-based days. One of the service users did their laundry and room cleaning. They also went out for a chiropody appointment during the morning. On other days they attended college for a cookery course and went to activities arranged through a resource centre. As reported under the ‘Staffing’ section, there is a lack of staff at particular times, which reduces flexibility and limits what the service users are able to do. There had been concerns about a service user’s health during the last year, which had affected their usual routines and activities. It was reported at the inspection in January 2007 that they had responded well to the support received and were spending more time up and about. The service user was met with during the visit. They had a leisurely start to the day and then mainly spent time in the lounge. The service user said that they liked listening to a local radio station, which was on at the time. They also liked to draw and had made some very colourful pictures in a book. There was written guidance about this, which reminded staff about the need for age appropriate materials to be used. This service user had recently started going out to a new club, which staff felt was a very positive development. Each service user said that they enjoyed their different activities during the week. Some of the service users’ personal goals concerned new activities, such as visiting the library to borrow DVDs. One service user was looking forward to having a holiday in Scotland when they would meet up with relatives. In their survey, a relative said that there had been a lot of communication with the manager and staff about the planning of this trip. The other service users had contact with their close relatives through regular visits and telephone calls. In their surveys, the three relatives confirmed that the home always helped them to keep in touch and kept them up to date with important issues. One relative commented that staff helped with making phone calls. Details of the service users’ family contacts and relationships were recorded on their individual files. There were birthday lists and other information about the arrangements for contact, that would help people to keep in touch. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 16 Service users had keys to their rooms. Subject to some agreed restrictions, they could come and go as they wished. It had been recommended at that last inspection that the ability and wishes of service users to take responsibility for their own medication is assessed. This had concerned one service user in particular; whom staff had felt could perhaps be more independent in this area. During the visit, the service user said that they were happy with the support they received and did not want to change the current arrangements. Service users had individual savings accounts and received support from staff with the safekeeping of their personal money in the home. A system of accounting was in place, which included staff obtaining receipts when they support service users with purchases. Service users decided what to have for lunch during the visit. This was after staff had checked what people had for their lunch on the previous day. Staff then made some suggestions, which included salad, sandwiches or ‘something on toast’. One service user chose to have corned beef on toast; another had lemon curd sandwiches, which they said was one of their favourites. Service users could help themselves to fresh fruit from a bowl in the dining room. There was a board in the dining room which showed what the evening meal was going to be. On 10 May 2007, this was quiche, new potatoes and salad or baked beans. At the last tenants meeting in April 2007, service users had talked about the meals they liked. There was going to be a change to a more ‘Summery’ menu. The service users’ needs had been discussed at the last staff meeting. It was minuted that staff had noticed that a service user was having a lot of fizzy drinks and that more squash and ‘nice juices’ would be bought, as an alternative. Addington Close (12) DS0000028256.V339974.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 and 20 Quality in this outcome area is mainly good. This judgement has been made using available evidence including the visit to the home. The service users’ care needs are well met by staff in the home. However, the way that staff are deployed could result in a lack of flexibility when appointments need to be made. Service users are protected by the home’s procedures for dealing with medication. EVIDENCE: Each service user had a care plan that had been written in the last six months. Recent reviews and amendments to the plans had been recorded. Staff members had signed the plans to confirm that they had read them. The plans covered a range of topics, such as personal care, general health, bathing, dressing and communication. Objectives were stated in the plans, for example in the case of communication, this was to support the service user with explanations when they find situations difficult to understand. There were also reminders for staff about good practice, such as ensuring that fingernails are cut in privacy.
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 18 Service users looked well supported with their personal appearance at the time of the visit. A staff member was heard suggesting to a service user that they changed their shirt for one that had been ironed. The service user was happy with this advice. Service users had their own rooms where personal care could take place in private. The rooms were close to a bathroom and toilet. The service users’ personal files contained health records, with details of their contact with GPs and other healthcare professionals. One service user had been to their GP independently. During the morning of the visit, staff contacted a surgery to make a GP appointment for one of the service users. The surgery was able to offer an appointment that day, although this had to be declined because a staff member would not be available to take them at the specified time. When the staff member explained the situation to the surgery, they were offered an appointment the following morning, at a time when there would be two staff working. The involvement of the GP did not appear to be of an urgent nature, although staff recognised that it was not in the service user’s best interests to wait a day for the appointment. The staff meeting minutes showed that the service users’ health and well-being were regularly discussed. Service users said that they were happy with the support they received. Relatives confirmed in their surveys that the home always met the service users different needs and provided the care that they expected. It was reported at the inspection in January 2007 that two service users were responding well to the support that they had received with their respective health conditions. One service user was up and about after an operation. Another person had being seen health specialists on a regular basis, although their involvement had now reduced. One of the service user’s care plans included support with doing some exercises for a few minutes each day. A staff member helped the service user with these during the visit. Staff members were supporting service users with the administration of their medication. There were suitable facilities in place for the safekeeping of medication. The ‘patient information’ drug leaflets were available, together with other guidance for staff about the service users’ prescribed drugs. Service users had signed consent forms confirming their agreement for staff to administer their medication. The records of administration and stock were up to date. Staff members who administer medication received training in the medication procedures on an ‘in-house’ basis from an OLPA Service Co-ordinator. There had been a recommendation at the previous key inspection that, in addition to
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 19 the ‘in-house’ training, staff members also received training in medication from a specialist outside the home. It was reported at the inspection in January 2007 that the in-house training had been revamped to include a video and training materials, titled ‘Medication in the Care Home’. An outside provider of training for the care sector had produced these. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. Service users are listened to by staff and their views are acted on. Staff have an awareness of abuse, which helps to protect service users. EVIDENCE: OLPA has produced a complaints procedure and copies of this had been given to service users to keep in their rooms. In their surveys, the relatives confirmed that they knew how to make a complaint if they needed to and felt that the home would always respond appropriately to any concerns raised. Service users had been reminded at one of the tenants’ meetings of how to make a complaint and whom they could contact. The meeting minutes showed that the service users’ views are listened to, with people identified as being responsible for following up any concerns that have been raised. A file for the recording of compliments and complaints was available by the front door. No complaints had been reported since 2003. In the preinspection questionnaire, the manager reported that there had been no complaints or adult protection investigations during the last 12 months. Abuse awareness was included in the OLPA training programme for support workers. It was reported that this training would take place once during a staff member’s employment.
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 21 Staff confirmed the training that they had received and that they had been given a copy of the ‘No Secrets’ booklet, which gives guidance about abuse and what to do if abuse is suspected. One staff member said that they had learnt about different forms of abuse when undertaking their National Vocational Qualification (NVQ). OLPA has produced a number of relevant policies, including one on whistle blowing. Protection for individual service users was also reflected in their care plans and risk assessments. This included the need for one service user to be protected from becoming a missing person. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including the visit to the home. The accommodation is generally homely and well maintained. The needs of service users are better met following the installation of a new ramp. Service users are well supported with keeping the home clean and tidy. EVIDENCE: 12 Addington Close is situated in a quiet cul-de-sac, within walking distance of Devizes town centre. The home looked like an ordinary domestic dwelling and its style was in keeping with the local area. There was a good-sized rear garden, with a patio area and barbeque. The accommodation was decorated in a homely and domestic manner. There was a spacious sitting room and a separate dining area. Each service user had their own room, which was close to a bathroom and toilet. The rooms varied in size. The smallest room had been well personalised, but had very limited space for socialising.
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 23 Another toilet was available by the front door. There was a kitchen, which was also used as a laundry area. The facilities for staff were not ideal, as they had to sleep in the lounge after the service users had gone to bed. There was a cover on a couch type bed which helped with the overall appearance of the room. The dining area was also being used as an office. The way that the facilities were arranged meant that the dual use of the room did not appear to create any practical problems. Some maintenance work and environmental adaptations had been undertaken during the last year. The need for this work was originally identified in 2002, after the home’s manager had requested an Occupational Therapy (O.T.) referral. The O.T. had recommended that certain works are carried out in order to improve the access through the front and back doors. This was needed because of the increasing frailty of two service users. Drainage around the driveway and front door had recently been improved when the home was inspected in January 2007. Since that inspection a portable ramp has been provided for use by the front door, so that the threshold is less of an obstacle to service users. The priorities for refurbishment were mentioned in a House Development Plan (Oct. 2006 – Oct. 2007). These included redecoration and the replacement of cupboards in the kitchen. At the inspection in January 2007, staff had said that they would like the lay out of the kitchen to be changed in order to create more space for preparing food. Staff had suggested that this could be done by moving the washing machine into the garage. Staff said that the immediate priority was to fix a leak in the roof and that quotes for this work had been obtained. Staff confirmed during the visit on 10 May 2006 that the roof had been repaired. They also said that the refurbishment of the kitchen was being planned. They hoped that this would be an opportunity to reorganise the space and to create a separate laundry area. Laundry was being done in the kitchen and the change could reduce the risk of cross-infection. The home looked clean and tidy. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate but good in respect of the support that service users receive from individual staff. This judgement has been made using available evidence including the visit to the home. Service users are well supported by staff they like and who know them well. They would benefit from a more flexible approach in the deployment of staff. Staff members receive the training that is expected for working in a care setting. Service users are protected by the way in which the staff have been recruited. EVIDENCE: In addition to the manager there was a permanent staff team of four support workers. One support worker had achieved a National Vocational Qualification (NVQ) at level 3 and another had achieved NVQ at level 2. Two other support workers were reported to be undertaking their NVQ. The staff team included support workers who had worked in the home for several years. The most recently appointed staff member had started in August 2005. This person’s recruitment records were looked at during a
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 25 previous inspection of the home, when it was found that the required checks had been undertaken. All staff had been police checked. The deployment of staff was discussed with staff during the visit. Staff members usually worked alone with a handover period between 10 am and 10.30 am. Additional staff were normally deployed on Mondays and Fridays, when shopping was done for the house. Single staff cover at the weekends meant that there were limitations on what could be done outside the home because of the level of support that two of the service users needed. A staff member said that there had been an occasion during the previous week when a service user had a podiatry appointment and another service user had needed to accompany them. This was not the service user’s choice but there was no second member of staff on duty at the time who could remain in the home. The staff member acknowledged that there had been a lack of forward planning in this instance. It was the intention to make appointments on Mondays or Fridays when it was known that two staff or the manager would be working. As reported under the section ‘Personal and Healthcare Support’, a situation arose during inspection when a GP appointment needed to be delayed for a day because a staff member was not available to support the service user. The staff rota for the month ahead showed that the deployment of staff was being planned around some regular events and planned meetings. A staff member had left during the last year. OLPA relief staff were providing some staff cover at the time of this inspection. After the visit, the manager said that she had discussed staffing with the OLPA service co-ordinator. It was agreed that recruitment would be undertaken for a new staff member, working 130 hours a month. The manager said that she expected this to address the lack of flexibility, which existed in the current staffing arrangements. During the visit, the relationships between service users and staff appeared to be friendly and easy-going. Service users said that they got on well with staff. In their survey, one relative described staff as ‘wonderful, professional and caring’ with a ‘cheerful disposition’. All the relatives felt that staff had the right skills and experience to look after people properly. During the last year, OLPA has started to provide Learning Disability Award Framework (LDAF) accredited training to new staff members. Each staff member had an individual training record in the home. There was a written plan for mandatory and annual training during 2007. This covered OLPA’s mandatory subjects such as Health and Safety, First Aid, Food Safety, Fire Training, Abuse Awareness, Manual Handling, Person Centred Planning and Infection Control. Dates had been identified on the training plan when staff would attend annual refresher training as this became due. Two staff were
Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 26 due to attend infection control training on May 14 2007. All staff were up to date with first aid training and had attended fire training since last inspection. There was also information in the home about skills training that was available to staff. This included Mental Health Awareness and Communication. These subjects were not shown on the written plan for staff training in 2007. Staff training was generally provided by OLPA, ‘in-house’. During the last year the manager and two support workers had also attended a course titled ‘Death, Dying and Bereavement’. This had been arranged with OLPA’s involvement at a local hospice. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is mainly good and excellent in respect of the home’s approach to improvement and annual development. This judgement has been made using available evidence including the visit to the home. Service users benefit from the management approach within the home, which is inclusive and encourages service users to contribute their views. The health and safety of service users and staff are generally well protected in the home. EVIDENCE: The home’s manager, Helen Morgan, has a specialist nurse background and is suitably qualified for her role. Helen Morgan has gained the Registered Managers Award and said that she had completed a National Vocational Qualification in Care at level 4 during the last year. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 28 The manager divided her time between management tasks and supporting service users in the home. There was an on-call system, by which staff could contact an OLPA manager outside office hours or when the home’s manager was not working. The oncall rota was displayed in the office. There was a friendly atmosphere in the home during the visit. Service users looked relaxed and confident in the home. In their surveys, the service users’ relatives confirmed their satisfaction with the home and the way in which service users are supported. One relative commented that 12 Addington Close is ‘an excellent care home and cannot be faulted’. Other relatives mentioned that they had good communication with the home and were kept well informed. Staff members said that they had regular supervision meetings with the manager and felt well supported in the home. There were monthly staff meetings, with comprehensive minutes kept. These showed that the manager and staff team were well focused on supporting service users and on enhancing their quality of life. At the most recent meeting in April 2007 there had been discussion about what individual service users might like to do, such as inviting a friend back to the house and making a special trip to remember their mother on Mothering Sunday. Four entries had been made in the home’s complaints and compliments file during the last year. These were all complimentary. In November 2006, a visitor had commented about a birthday: ‘staff made it very special and welcoming, this is a very caring household’. Two agency carers commented in April 2007: ‘friendly house, caring staff, so organised’. OLPA has carried out a survey of its service users and stakeholders during the last year. This has given some indication of standards within the services that the organisation provides. The results of the survey have been collated although a report of the action to be taken has not yet been produced. The manager was developing a system of quality assurance that was relevant to the home. This focussed on consulting with service users, staff and stakeholders and incorporating their views into house development plans. Methods of consultation with the different parties had been identified. For service users, this included surveys and the monthly tenants meetings. The latest surveys had been completed in September 2006. The minutes of the tenants meetings showed that service users had been asked to contribute to the house development plan. The guidance about the plans stated that the tenants meetings would also be reviewed in order to identify any issues that had not been addressed at the time. A staff member said that ideas about improvement were discussed at the team meetings. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 29 The objectives in the 2005 –2006 plan had been reviewed in September 2006. Some objectives had been met. Others, such as refurbishment of the kitchen had not yet been achieved, but it was reported that this would continue to be saved for. A new house development plan (Oct. 2006 – Oct. 2007) had been produced. The objectives were well set out and covered a range of areas, such as staff training, redecoration of the lounge and supporting service users with having days out. There was instruction to staff about ensuring that the days out were included within the system of person centred planning. Information about health and safety, including the maintenance and servicing of equipment, was received from the home in a pre-inspection questionnaire. Some health and safety matters were also followed up during the visit. The home’s fire log book was looked at. A fire risk assessment had been carried out in January 2007. Fire drills had taken place in February and April 2007, with full details recorded about the outcome of these. Data on the Control of Substances Hazardous to Health (C.O.S.H.H.) was kept on file and readily available to staff. There was a ‘Daily Schedules and Routines’ file, which included records of routine maintenance and safety checks. Weekly and monthly tasks had been identified, covering matters such as vehicle checks, water filter changes and food stock rotation. Records of these checks were up to date. The home looked well maintained, with no hazards apparent. There was a carbon monoxide alarm in the kitchen. Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 30 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 31 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 YA9 Regulation 13(4) Requirement Changes in a service user’s needs must be fully assessed and suitable arrangements made for their safety. When a safety measure needs to be implemented, its usefulness must be fully assessed, to ensure that it can be relied upon and is effective in reducing the risk to the service user. That staff are deployed in a way that will provide the greater flexibility that is needed at particular times of day. (The manager has said that this situation will be resolved in the long-term by the appointment of a new member of staff). Timescale for action 11/05/07 2 YA33 18(1)(a) 11/05/07 Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 32 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 YA23 Good Practice Recommendations That staff members have the opportunity to receive abuse awareness training more than once during their employment. This will help to ensure that they are familiar with changes that are made in the policies and procedures for safeguarding adults. That the home’s plan for staff training is expanded to include more specialist and skills related areas of training. This will help ensure that service users benefit from staff members who have attended a wider range of training courses. 2. YA35 Addington Close (12) DS0000028256.V339974.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AP 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
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