Inspection on 18/01/07 for April Court

This inspection was carried out on 18th 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

April Court 17/02/06

April Court 20/10/05

April Court 24/01/05

April Court 12/07/04

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 April Court 186 Poole Lane Kinson Bournemouth Dorset BH11 9DS Lead Inspector Heidi Banks Key Unannounced Inspection 18th January 2007 13:45 April Court DS0000031997.V328874.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 April Court DS0000031997.V328874.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. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service April Court Address 186 Poole Lane Kinson Bournemouth Dorset BH11 9DS 01202 576110 01202 570093 april.court@bournemouth.gov.uk 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) Bournemouth Borough Council Lindsay Ann Divall Care Home 18 Category(ies) of Learning disability (18) registration, with number of places April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Manager must not directly line manage the day to day activities of the day centre located in the building. Service users to be admitted to the first floor must be ambulant and able to manage stairs. 17th February 2006 Date of last inspection Brief Description of the Service: April Court is a Local Authority retained residential home for eighteen adults with learning disabilities. The home is managed on behalf of Bournemouth Borough Council by Ms Lindsay Divall. April Court is a purpose-built home located in the Kinson area of Bournemouth. It is situated a residential area with shops, churches and other amenities nearby. The main bus route between Poole and Bournemouth is easily accessible. Residents’ accommodation is provided in twelve single and three twin bedrooms on two floors. The communal areas consist of a lounge, smaller lounge and dining room, all of which can be used for various activities. There is a training kitchen that is available to residents with support from staff. There is a separate flat facility on the first floor which can be used for the assessment of service users’ independent living skills. There is a pleasant patio area at the rear of the building which is accessible to all service users. The Registered Manager is experienced and well qualified to NVQ Level 4 standard and the home is staffed by a team comprising a Deputy Manager, three Assistant (Duty) Managers, Care Assistants and Night Care Staff. There is a part-time cook and domestic and clerical support. The current weekly residential fees at April Court range from £720 - £753 which include a client contribution. Fees can vary depending on individual need. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The purpose was to assess the home’s compliance with key national minimum standards and the progress made in relation to one requirement and one recommendation made at the last inspection. The inspection was conducted over nine hours on two days in January 2007. April Court currently provides accommodation for fifteen service users. The current group of service users are aged between 28 and 63. The inspection included discussion with the Registered Manager, Lindsay Divall, Deputy Manager and three members of the care team. Time was also spent observing service users in their daily life in the home, talking to two service users and inspecting a sample of staff and service user records including medication records. A tour of the home was also taken. Prior to the inspection, a completed pre-inspection questionnaire was received from the Registered Manager of the home. A total of thirteen completed service user surveys were received in addition to eleven comment cards from relatives, two comment cards from GPs, two comment cards from Care Managers and four comment cards from health care professionals. A total of twenty-two standards were assessed at this inspection. What the service does well: April Court has achieved a consistently good standard in many aspects of the care provided to service users. Service users are well-supported during the admissions process and there was evidence that the home liaises well with placement teams to ensure that they can meet their needs. Staff are aware of service users’ individual needs and choices and these are clearly detailed in Essential Lifestyle Plans. This helps ensure that service users’ preferences are taken into account in care delivery, that risks to their safety are managed and their independence is promoted. Regular meetings are held which give service users the opportunity to be involved in decisionmaking about their lives in the home. There was evidence that service users take part in group and individual leisure activities and they are supported in accessing their community on a regular basis to promote their right to an ordinary life. Friends and families of service users are welcomed in the home which means that they benefit from a wider circle of support. Service users are enabled to make choices about what they April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 6 do each day, their holidays and what they want to eat with appropriate support from staff to ensure that their needs are met. The personal and health care support offered to service users was seen to be of a high standard. Support plans contain enough detail to ensure that staff are aware of the assistance that is required by each individual. The home also works in close partnership with health care professionals to ensure that service users receive enough support to maintain good health. Several positive comments were received from relatives of service users and health and social care professionals about the standard of care in the home; ‘April Court is a well-organised home and staff have a professional, caring and enabling approach to service users’; ‘Staff are always very helpful, supportive and caring’; ‘We can find no fault with April Court. X is coming on in leaps and bounds’. The home has a complaints procedure and some systems in place to ensure service users are listened to. There are policies, procedures and training for staff on abuse awareness to ensure that staff are aware of how to respond in the event of a service user being at risk of harm. The home is clean and health and safety procedures in place at the home mean that service users are protected from infection. All staff are given a comprehensive induction programme at the start of their employment at the home. They are supported to do nationally recognised qualifications which give them the knowledge they need to work effectively with service users. A range of other courses are offered to staff that are relevant to their role and promote their confidence in specific areas of service users’ care. The Registered Manager has a sustained track record of managing the home with competence and demonstrates a commitment to continuous improvement. This is reflected in the support available to staff in their work with service users. The home has a robust quality assurance process and regular audits take place to ensure that the service meets its objectives and provides a consistent service for its users. Health and safety policies and procedures are in place and promote service users’ welfare in their home. What has improved since the last inspection? The provider has taken appropriate action to review the delivery of fire safety training in the home. This helps ensure that all staff receive a level of training that enables them to respond effectively in the event of a fire and keep service users safe. A review of the medication policy, procedures and training has been undertaken and suitable training for all staff is being rolled out. This will equip April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 7 staff with the knowledge they require to understand medication and their role in supporting service users with this aspect of their care. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home works closely with care management teams to ensure that only individuals whose needs can be met by the service are admitted. EVIDENCE: There has been one new admission to the home since the last inspection. This was an emergency admission and due to exceptional circumstances there was very little information available about the service user concerned at the time of the admission. Examination of the service user’s records indicated that the home is in the process of making an assessment of her needs and abilities with support from various health and social care professionals. Discussion with staff at the home indicated that they are able to meet her needs at the present time while simultaneously demonstrating understanding that the service user may benefit from a more independent living environment in the future. The service user is therefore being given opportunities to practice her independent living skills within April Court and attention is being given to meeting those needs which differ from those of other service users. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans contain sufficient detail to identify how service users’ needs will be met by the service. Service users’ understanding, participation in and ownership of their Plans could continue to be promoted. The home has systems in place to ensure service users’ have opportunities to make decisions in their daily lives. Risk assessments are in place to promote the welfare and independence of service users. EVIDENCE: The individual plan of one service user was examined. This gave an overview of the service user’s personal history and offered the reader essential information about what is important to them and the arrangements in place to make that happen. For example, the identified need ‘I must have contact with April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 11 my Mum.’ would be met by ‘Mum visits every two weeks on a Monday evening’. The plan identified details of personal care needs and preferences, communication skills and preferred activities. There was evidence of a goalsetting process in place and monthly reviews had been undertaken to monitor the progress being made to support service users in meeting their objectives. The home has clearly made an effort to put information in the plan in simple text and pictures and therefore, the minimum standard has been met. However, the format of plans are not individualised for each service user and it is suggested that the home now looks towards making every plan meaningful to the service user who owns it. Observation of an evening meal in the home showed that service users are supported to make choices about what they eat. It was noted that staff had the skills to communicate with service users and understand what they wanted. In addition, minutes of the monthly service user meetings show evidence that they are given opportunities to contribute ideas about individual and group activities. It was discussed with the Deputy Manager of the home that it is important for the home to evidence that service users’ ideas are followed up with appropriate action. For example, if a service user has expressed a wish to go to a museum during a meeting then it is suggested that there is a system for tracking this and including it in the service user’s goal plan. The Deputy Manager reported that at the present time suggestions are followed up in future meetings. At present service user meetings in the home are chaired by a senior member of staff. It is suggested that the home looks towards making use of an independent advocate at meetings to ensure that service users’ views are heard. Discussion took place with the Registered Manager about how the home encourages the independence of service users. Due to the level of learning disability of many service users at April Court the Manager reported that there was a fine balance between promoting the independence of service users and managing risks. For example, in the past a pot of coffee would be put on the dinner tables to encourage service users to help themselves. This practice had been changed as it was assessed as presenting too many risks to the current group of service users. A sample of risk assessments was seen. These clearly identified the nature of the risk, the degree of hazard, the probability of it occurring and an overall risk rating. Precautions already in place had been listed with further information about any additional control measures required. All risk assessments were dated and signed and there was evidence to indicate that reviews take place on a regular basis to ensure that information remains valid and up-to-date. A specific risk assessment had been put in place for one service user with some challenging behaviour. It was clear from the documentation that staff received training in a technique to support the service user in managing this, April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 12 that strategies were in place to ensure that incident records were completed each time the technique was used and that these had been monitored by the Registered Manager. In addition, appropriate intervention from the Community Learning Disability Healthcare team had been sought. Discussion and review of the individual plan for one service user indicated that where her needs differed from other residents, staff were undertaking specific pieces of work with her to meet these needs and support her with greater risktaking. This promotes her independence in her home and community. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to activities that meet their needs for appropriate occupation and leisure. Service users are supported to be part of their local community which promotes their right to lead ordinary lives. Service users’ families and friends are welcomed into the home which enables them to maintain and enjoy positive relationships with those people who are important to him. The home is responsive to the individual needs of service users and promotes their rights to make choices about their everyday lives. Systems are in place to ensure that there is a balance between promoting choice and giving service users the support they need to eat a healthy diet that meets their individual requirements. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 14 EVIDENCE: The majority of service users living at April Court attend day services either on a part-time or full-time basis which provide them with opportunities for occupation. Many service users commented in surveys that they enjoyed attending their respective day centres, one also commenting that he knows he can stay at April Court if he wishes but prefers to go to the Centre. Records indicated that one service user who is currently being assessed by the home with regards to her independent living skills is being given opportunities to access the community on a regular basis with individual support. This included trips to the bank, hairdresser, medical appointments and shops. Minutes of the most recent service user meeting indicated that service users are consulted on activities they wish to do in the future. Suggestions made included pub visits, discos, trips to wrestling and speedway and visits to local animal parks. As suggested in the previous section, the home could consider tracking this in such a way to ensure that suggestions are followed through. The majority of service users indicated that they ‘always’ made decisions about what they do each day, one service user commenting ‘I like going out on the bus, going shopping and spending my money. I like going to Bournemouth Gardens, to see my friends in the park, on the bandstand and at the Show Bar...sometimes we go out in the bus and stop and have a cup of tea or an ice cream’. Another service user reported that she can go out at the weekend but chooses not to and she prefers to stay at April Court rather than go to a Centre. This service user was spoken with at the inspection and stated that she enjoyed writing. She had a desk, paper and pens in her bedroom to enable her to do this. The home keeps records of service users’ participation in activities which show they go to regular discos on site, a local Gateway Club, pub visits and shows. On the second day of the inspection, a group of service users were going bowling. There was also evidence in minutes of service user meetings that service users were being consulted about visits by a Drama Group to the home. Of particular note was evidence that one service user who wishes to lose weight is being supported in doing so by weekly visits to a local gym with a Support Worker. Their outing includes going out for a healthy lunch. Another service user reported in a survey that he likes to go to Church on a Sunday and somebody takes him. However, the majority of activities taking place appear to be undertaken in groups and therefore it is suggested that the home continues to work towards a more individualised approach to activities to ensure that the lifestyle needs of all service users are met and they have equal opportunities for individual support in this area. Service users have the opportunity to go on holiday once a year. Discussion with the Deputy Manager and the minutes of service user meeting showed that April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 15 this year two groups of service users are going to the Isle of Wight and three service users are going on a train holiday. The home has access to a mini-bus in the evenings and at weekends but public transport is also used on a regular basis. Records indicated that some service users had received support from staff to apply for a bus pass. As the home is within walking distance of Kinson, service users are also encouraged to walk to local shops. Many service users at the home are reported to have regular contact with their families. The nature of this contact is clearly documented in Essential Lifestyle Plans and discussion with staff demonstrated that this is clearly considered an important part of service users’ welfare. This was also highlighted in comment cards received from relatives, all of whom indicated that they feel welcomed in the home at any time and were able to see their relative in private; ‘We are involved with X’s life at April Court’. Service users were observed to have free access to their bedrooms at any time and also access the dining room and two lounges as they wish. Staff were seen to knock on service users’ doors and wait for a response before entering so as to respect their privacy. The Registered Manager also ensures that service users are supported to complete surveys about the home by a person who is not employed at April Court so that their confidentiality is protected. Service users are able to personalise their bedrooms as they wish and are encouraged to participate in tasks such as tidying their bedrooms and clearing away their crockery after dinner. Discussion with staff demonstrated that the service strives to be responsive to individuals’ needs as demonstrated by the support they are providing to a new service user who is working towards a more independent living environment and has been supported to prepare meals for herself at the home. The menu at the home is drawn up with consideration to the likes and dislikes of service users and a cook is employed to prepare main meals so that this does not detract from the personal support of service users. Service users are given choices about what they want to eat on a daily basis and are enabled to do this by the use of pictures and objects of reference. There is always a vegetarian option and salad option available to service users who prefer this. A member of staff spoken with confirmed that where a service user wishes to have an alternative to what is on the menu, this is accommodated, and a service user who dislikes most vegetables is offered those vegetables that she enjoys. One service user commented in a survey; ‘I don’t like foreign food so the staff make me something else’. There was evidence in Essential Lifestyle Plans and on notices in the kitchen area of service users’ individual dietary needs being considered. Yoghurts and fruits are available at every meal. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal care that meets their individual needs and preferences. The home promotes service users’ access to a range of community services to ensure their physical and emotional health needs are met. The home’s medication policy and training programme need to be fully implemented to ensure service users are fully protected in this area of their support. EVIDENCE: Essential Lifestyle Plans contain information about ways in which service users need and wish to be supported with their personal care. For example; ‘X needs assistance when drying her hair to ensure temperature controls are appropriate.’; ‘X needs minimal verbal prompts to encourage her to wash thoroughly – face / back’. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 17 All comment cards received from relatives at this inspection indicated that they are satisfied with the overall care provided by the home; ‘X…has received great care and kindness always’; ‘Both my husband and I are very happy about the care X has at April Court. She is well looked after’. In comment cards, all eight health and social care professionals, including GPs, who have had contact with service users at the home indicated that staff demonstrate a clear understanding of the care needs of service users. All professionals also indicated that the home communicates clearly with them, works in partnership with them and notifies them of changes to service users’ well-being. Several positive comments were received from health and social care professionals including ‘April Court provides a caring service and shows understanding of the needs of service users. They are willing to consult and act on advice given’; ‘Staff at April Court are always friendly and professional, they provide appropriate support of a high standard to service users’; ‘Very pleasant and attentive staff’. Service user records seen demonstrated that service users access generic and specialist health care services to meet their individual needs. There was evidence to show that a service user recently admitted to the service had registered with a local GP where she had received a general and ‘Well Woman’ health screen and attended appointments with a dentist, chiropodist, optician and audiologist. On the second day of the inspection, a chiropodist was visiting the home to deliver foot care to service users. Comment cards from service users’ relatives indicated that they have been kept informed of important matters affecting their relative and they have been consulted, as appropriate, about their care; ‘I have been well-informed of visits to the doctor, dentist etc. The care is excellent, as are the staff who I shall always be grateful to’. One service user file reviewed showed a comprehensive assessment of his health needs with information about his allergies, current medication and dosages, a brief medical history, level of comprehension and capacity to consent and information about how to undertake medical interventions with awareness of his particular needs. There was information to tell the reader how they would know the service user was in pain ‘I may become agitated and point to / rub area where pain is occurring’. The medication policy for Bournemouth Borough Council’s community care services is currently under review. Training has been developed to meet the needs of service users and at the time of the inspection was being rolled out to all staff at the home. At the present time, only senior members of staff administer medication to service users. The home uses a monitored dosage system to administer medication to service users. This is provided by a local pharmacy. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 18 During the inspection a sample of medication administration record (MAR) charts were seen. These specified the allergies of individual service users and photographs of service users to aid identification. MAR charts seen had been signed appropriately to indicate that medication had been given as prescribed and a sample of medication was checked to ensure that there were no gaps. An audit trail is in place for the administration of paracetamol and a check on the number of tablets left in the box at the time of inspection corresponded with the number in the records. April Court DS0000031997.V328874.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure that service users and their representatives have opportunities to express their views about the service they receive. Procedures and training with regards to the protection of vulnerable adults are in place to inform care workers of the action they must take to keep service users safe. EVIDENCE: The home has a complaints procedure which enables service users or their relatives / representatives to air their views and know that their complaints will be responded to formally and within a given timescale. The complaints procedure is available in symbols format. Information is given on how to contact the Commission for Social Care Inspection so that the complainant is aware of the options available to him or her when raising concerns about the service. Review of the home’s compliments and complaints record showed that there have been no complaints received by the home since the last inspection. A compliment from a relative of a service user was on file. Discussion with the Deputy Manager indicated that any other issues or concerns highlighted by relatives or visitors to the service would be recorded in the home’s logbook. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 20 Entries in the logbook are read by the management home each day and communicated to staff at shift handover. The majority of service users responding to the survey indicated that they always felt that their carers listened to them and acted on what they say. Most service users also indicated that if they were unhappy about something they would speak to staff; ‘I won’t do things I don’t want to do and the staff listen to me…I cry if I am unhappy and the staff help me to feel better’; ‘I will talk to the staff on duty and ask them to help me with the problem’. Minutes of service user meetings showed that staff asked service users for feedback on the staff, food and home environment. The home follows the local multi-agency adult protection procedure. The home also has a whistleblowing policy. The Deputy Manager confirmed that there have been no adult protection issues arising at the home since the last inspection of the service. All staff attend compulsory abuse awareness training during their induction programme. April Court DS0000031997.V328874.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Continued refurbishment of the home is needed for it to provide accommodation that is smart and homely for service users. Measures have been implemented to reduce the risk of cross-infection in the home and promote a clean environment for the service users who live there. EVIDENCE: Discussion with the Registered Manager indicated that there is an ongoing plan for refurbishment of the home. In the past year pipe work in the home has been replaced to ensure there is a reliable supply of hot water for service users. Plans are also in place to install CCTV outside the home to improve security. Plans are in place to purchase new carpets and redecorate certain areas of the home including a number of service users’ bedrooms and the office. A tour of the home indicated that some carpets are stained and suffering some wear and tear. Some of the décor in the home would also April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 22 benefit from updating, in consultation with service users, to provide a smarter, brighter environment for them. A visit to one service user’s room showed that one corner had been ‘boxed in’ with temporary cladding where pipe work had been carried out and the environment made safe but redecoration had not taken place. Discussion with staff indicated that the replacement of pipes had also resulted in damage to the ceiling of another bedroom which also required redecoration. The Registered Manager demonstrated awareness of these shortfalls and reported that she would be submitting a Capital Bid in the next financial year to have adequate funding to address these issues. A part-time cleaner is employed by the home to ensure that standards of cleanliness are maintained. The majority of service users responding to the survey indicated that the home was always fresh and clean. The home has an infection control policy and there is provision of aprons, gloves and handcleaning gel for staff who are supporting service users with their personal care. The laundry facilities in the home have been improved to meet the requirements of service users. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are actively encouraged to achieve qualifications that give them underpinning knowledge about working with people with learning disabilities. Recruitment procedures within the home are robust to ensure that only suitable people are employed to work with the service user group. Minor shortfalls were identified in relation to maintaining sufficient documentation on file which need to be addressed for the standard to be fully met. Staff have access to appropriate training to be able to meet the needs of service users with knowledge and skill. EVIDENCE: Staff training records showed that the home is committed to enabling staff to undertake National Vocational Qualifications (NVQs) in Care or Management, as relevant to their role. Of the four Assistant Managers, two have an NVQ qualification at Level 3 while one is currently working towards achieving this. The majority of Support Workers are either working towards an NVQ Level 2 or April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 24 have already achieved this. The home benefits from having four staff who are trained NVQ Assessors. Discussion with the Registered Manager demonstrated that recruitment of staff is undertaken by the management of the home with the support of Bournemouth Borough Council’s Human Resources Department. The Manager confirmed that it is the Council’s policy that care workers do not commence in post until satisfactory checks have been received. These include two written references and an enhanced disclosure from the Criminal Records Bureau. Records for one member of staff employed by the home since the last inspection of the service were seen. These showed evidence of proof of identity, a declaration that the care worker is fit to work from Occupational Health, two appropriate written references and a probationary report. The Registered Manager reported that disclosures from the Criminal Records Bureau are received by the Council’s Human Resources Department who then e-mail her with confirmation that they are satisfactory. Although all applicants are expected to complete an application form and attend for interview at the home, in the staff record inspected there was no evidence of these processes taking place. Issues around maintaining sufficient documentation on file was discussed with the Registered Manager at inspection. Following the inspection, a copy of ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ published by the Commission was forwarded to the home for the information of the Registered Manager. The Registered Manager expressed her commitment to ensuring that best practice is followed at all times and has agreed to review procedures accordingly. All staff attend a comprehensive six-day induction programme at the commencement of their employment at the home which comprises all mandatory health and safety training and training in abuse awareness. Ongoing training that is relevant to care workers’ roles is also made available to staff, for example ‘Diversity and Supervision’ training for senior staff and training in Essential Lifestyle Planning and Person-Centred Planning Awareness. In August 2006 staff at the home undertook Breakaway training in response to increasing challenges presented by one service user. Two staff are also nominated as ‘total communication co-ordinators’; they have undertaken a five-day course in total communication and have responsibility for disseminating this training to all staff within the home. Two care workers spoken with during the inspection indicated that they had received instruction in this area. In the past two years there was evidence that eleven staff have undertaken training in dementia. It was suggested to the Registered Manager that the uptake of specialist training could be improved in some areas. This means that the home will need to look to ensure there is adequate ‘backfill’ so that staff can attend when events are scheduled. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Consistent and effective management of the home has achieved a sustained track record of positive outcomes for service users. Systems are in place to ensure that the home is monitored internally in relation to objectives set in the Business Plan and their progress in meeting National Minimum Standards. The home operates safe systems of working which promotes the welfare of service users in their living environment. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 26 EVIDENCE: Previous inspections of the service have evidenced that the home has achieved consistently good outcomes for service users over a sustained period of time. Requirements and recommendations made at inspection have been responded to promptly and effectively by the Registered Manager demonstrating that the home is committed to improvement. The Registered Manager has also been conscientious in keeping the Commission informed of any issues affecting service users’ welfare. One member of staff spoken with reported how much he enjoys working at April Court and spoke positively about the support he has received from the Manager in his role and the good working atmosphere and sense of team-work in the home. There was evidence to show that where there have been concerns over the performance of individual staff this has been responded to promptly and effectively. Records showed that the Manager has achieved a National Vocational Qualification (NVQ) in Care to Level 4 standard and the Registered Managers’ Award. She continues to attend internal training courses, for example, in management development, continuous improvement and service transformation to equip herself with the up-to-date knowledge needed to undertake the responsibilities of her role. The home has a comprehensive quality assurance strategy which includes seeking the views of service users, their families, day centres, purchasers of the service and social and health care professionals on a regular basis. There was evidence that where issues had been highlighted in responses, plans had been put in place to address them. Senior managers at Bournemouth Borough Council undertake monthly visits to the home to monitor that procedures are being followed consistently and to check on the general safety and welfare of service users. The Registered Manager reported that procedures within the home are subject to regular audits, for example, audits on the supervision of staff and their Personal Achievement and Development Reviews. April Court has an annual development plan in place which links with the business plan of Bournemouth Borough Council. The Registered Manager reported that the plan was due to be reviewed and a new plan produced in preparation for the new financial year. A sample of fire safety records were checked. These showed that tests on fire alarm points, emergency lighting, fire extinguishers and fire doors had taken place at regular intervals and were up-to-date. Where any issues had arisen, for example, a problem with one door closing fully, there was information to indicate that this had been addressed promptly. Since the last inspection of the service in February 2006 there have been eight fire drills in the home. Records showed that the times of the drills and details of who was present in the home at the time of the drill had been recorded. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 27 Records indicated that systems are in place to ensure staff receive regular training in fire safety. This comprises formal training with the Borough’s fire Officer, scenarios, videos and questionnaires throughout the course of a year. Staff receive mandatory training in health and safety including moving and handling, emergency aid, basic food hygiene and infection control at induction and through regular updates. Discussion with the Manager highlighted that the Borough’s training department does not currently track when staff are due for updates and it was suggested that a system is put in place by the home to ensure that staff attend updates before their previous training expires. It is also suggested that backfill hours are made available to the home so that there is no conflict between enabling staff to attend courses and ensuring the home is fully staffed. April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 2 X 4 X 3 X X 3 X April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 29 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 YA20 Regulation 12 Timescale for action The registered person shall make 31/05/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered provider must ensure that the home’s medication policy is finalised and procedures and training are fully implemented. Requirement April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations The registered provider should ensure that continued refurbishment takes place in the home to ensure that it provides a comfortable, bright, cheerful and airy environment for service users and remains in good decorative order. The registered provider should ensure that there is adequate documentation available in the home to fully evidence that recruitment procedures are robust. 2. YA34 April Court DS0000031997.V328874.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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