Inspection on 13/03/08 for Badger`s Croft

This inspection was carried out on 13th March 2008.

CSCI found this care home to be providing an Good service.

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

Badger`s Croft 10/10/06

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 Badger`s Croft Pear Tree Close Chipping Campden Gloucestershire GL55 6DB Lead Inspector Mr Richard Leech Unannounced Inspection 13 & 14 March 2008 10:30 th th Badger`s Croft DS0000066768.V360310.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 Badger`s Croft DS0000066768.V360310.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. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Badger`s Croft Address Pear Tree Close Chipping Campden Gloucestershire GL55 6DB 01386 841219 01386 841219 pamela.harridine@brandontrust.org www.brandontrust.org The Brandon Trust 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) Ms Pamela Ann Harridine Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6), Physical disability (2), of places Physical disability over 65 years of age (2) Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability- Code LD Physical disability- Code PD Learning disability over 65 years of age- Code LD(E) 2. Physical disability over 65 years of age- Code PD(E) The maximum number of service users who can be accommodated is 6. Date of last inspection 11/10/2006 Brief Description of the Service: Badger’s Croft is a detached home in a residential area of Chipping Campden. Care and accommodation is provided for up to six people with a learning disability, some of whom may also have physical disabilities. Accommodation is provided on the ground and first floors. Each person has their own bedroom. There is a lounge and kitchen/dining area. The home also has a back garden. The home is next to a day centre which some of the people living in the home attend. The home is operated by the Brandon Trust, which also runs a number of other care services in the county and other parts of the region. Up to date information about fees was not obtained during this inspection. People who may be moving into the home and their representatives are provided with information including copies of the Statement of Purpose and Service Users Guide. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The home was visited twice, on a Thursday and a Friday in March 2008. We did not tell the home that there would be a visit. Before the visits took place the manager completed an Annual Quality Assurance Assessment (AQAA) providing information about the service. Surveys were also sent out to people with an interest in the home and several of these were returned. During the visits different records were looked at including examples of care plans, healthcare notes, risk assessments, daily records, medication charts, training information and staffing files. Discussion took place with the manager and several members of staff. General observation of life in the home took place, including some mealtimes. The people living at Badgers Croft who were present at the times of the visits were not able to verbalise their views. Evidence of the standard of care came from sources such as observation, discussion with staff and external feedback (including from relatives). What the service does well: The home continues to be well run. There are checks on the quality of care. Efforts are made to continually improve. There is a good approach to referrals and admissions. This helps to ensure that the service should be able to meet the needs of people who move in. People’s individual needs are identified and met. Efforts are made to establish people’s wishes and preferences, and to understand what is important to them. Staff are good at communicating with the people that they support, which helps them to feel listened to. Staff have access to good training, helping to equip them with the knowledge and skills that they need. Support is provided for people to take part in different activities in the home and community according to their needs and interests. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 6 People’s personal and healthcare needs are well met. Staff have a good understanding of the support that people need. A healthy diet is provided and people have the help that they need with eating and drinking. Appropriate steps are taken to protect people from harm and abuse. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good approach to referrals and admissions, helping to ensure that the service should be able to meet the needs of people who move in. EVIDENCE: One person had moved into the home since the previous inspection. Detailed notes were seen of a number of visits and overnight stays made by the person to Badger’s Croft. There were also records of visits to the person in their home at the time and of contact being established with family. Staff spoken with confirmed that the person had made many visits to the home before moving in. Records were also seen of the manager accompanying the person during an activity. Action plans drawn up at various stages of the move were seen, providing evidence that the process was taken step by step and was subject to careful thought. Reference was made to how the person’s needs would be met at Badger’s Croft, including areas such as family contact and activities. An advocate had been involved to help ensure that the person wanted to move into the home. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 9 Background information was seen on file, including care plans and assessments from the previous setting. There was an assessment from the placing authority, although this had been written shortly after the person had moved into the home. The manager explained that this had been requested well before the move but had been subject to substantial delays. In the meantime it had been assessed that the service would be able to meet the person’s needs through the visits and background information. Positive feedback was received from a relative regarding the home’s admissions process. For example, they commented that staff had organised the move slowly and smoothly, that their relative had improved immensely since moving in and that they were greatly appreciative of the staff. Records were seen of referrals for other people. The manager outlined the reasons why they had not been accepted for a service, providing evidence of a commitment to ensuring that only appropriate referrals would be accepted. The manager indicated that there had been some pressure from the Trust to fill the vacancy quickly, but that she had felt able to say no in cases where the referrals were clearly not appropriate. The home’s Statement of Purpose and Service Users Guide were briefly checked. These had been reviewed and updated since the last inspection. However, they needed a further update due to a change of the service’s ‘Responsible Individual’ (a representative of the organisation who is registered with us) and amended contact details for the CSCI local office (Commission for Social Care Inspection). It was agreed that these would be done a part of the next routine review of these documents. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s individual needs and choices are identified and responded to, helping to ensure that the service is person-centred. Significant risks are identified and managed so that people remain safe, although a recent development was resulting in the need for some further work to promote people’s wellbeing. EVIDENCE: Some of the staff had undertaken training about facilitating person centred planning (a form of care planning which puts the individual’s needs and wishes at the heart of the care planning process). They would then work in other services run by the Trust to support the development of person centred plans. The manager was expecting to hear about a reciprocal arrangement whereby staff from other homes would come to support the team at Badger’s Croft to develop their person centred planning. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 11 Existing care plans for two people were looked at. These took the form of a series of specific plans describing the need and the intervention, accompanied by ‘Essential Lifestyle Plans’, which focussed more on what was important to the person and their likes/preferences. The documentation was seen to be clear and to cover significant areas such as personal care, diet, mobility, safety, activities and health. The plans were linked directly with risk assessments where a significant risk had been identified. The risk assessments were also clear and relevant. Care planning files included detailed information about how each person communicated. There was also a clear emphasis on promoting choice. Daily records provided evidence of care plans being followed. Discussion with staff and observation of life in the home provided further evidence of awareness of, and adherence to, the care plans. Staff demonstrated a commitment towards establishing people’s wishes and to respecting their choices as far as possible. A behavioural support plan was yet to be drawn up in respect on one person. There was discussion with the manager and staff about how the person was being supported when they presented challenging behaviour. A recent change in one person’s behaviour was resulting in some potentially significant risks to the other people living in the home. It was agreed with the manager that this needed urgent consideration through the risk assessment and risk management process. The missing person’s proforma for the same person included an out of date photograph which should be replaced with a new one. There was a discussion about advocacy and representation. The manager was aware of the IMCA (Independent Mental Capacity Advocate) service as established under the Mental Capacity Act 2005, and of when it would be appropriate to seek their involvement. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are being supported to access a wider range of facilities than in the past, helping the service to better respond to people’s individual needs and wishes around how they spend their time. Appropriate support is offered to people to help them to maintain relationships with important people in their lives. The rights and responsibilities of people using the service are respected, contributing to their self esteem and dignity. A varied and balanced diet is served which takes into account people’s needs and preferences, promoting their health and wellbeing. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 13 EVIDENCE: Two people’s activity programmes were looked at in detail. The home supports people to complete activity scrapbooks, with write-ups and photographs of the different activities that they have taken part in. These were checked for February 2008 and provided evidence of people taking part in a variety of different activities in the home and community. These included art, cookery and music sessions, helping around the home, going for walks, visiting shops and cafes, having foot and hand massages/aromatherapy sessions, attending college, going to a day centre, bowling and visiting local places of interest. Care plans and person centred plans outlined people’s needs and interests around how they spent their time. Daily records provided further evidence of people having varied and appropriate activity schedules. Staff spoken with felt that people’s needs in this area were generally being met, although there was some comment made about short staffing at times impacting upon the ability to offer people activities, particularly on a one to one basis (see ‘staffing’ section). However, there was a general feeling that activity provision had improved and that people were accessing a wider range of facilities than in the past, backing up comments that were written in the AQAA. The manager explained how new links were being made with different activity providers in order to diversify the range of opportunities on offer and to respond to individual needs and wishes. For example, one person was now accessing college. A sensory facility had been booked on a regular basis after a successful trial. At the time of the visits two people were on holiday for the week at a seaside resort. Staff accompanying them had contacted the home and reported that the holiday was going well. During the visits to the service one person was supported to do some baking. On a different day one person went for a walk to the local village and people also accessed the nearby day centre. Some staff felt that there was a need for a new vehicle, stating that the current one could get very hot in summer, and that one person living in the home found it quite awkward to access. As noted, care plans referred to family relationships. Discussion with the manager and staff along with daily records provided evidence of people being supported to maintain relationships with their families. Files included contact details and dates of family members’ birthdays. Care plans referred to issues around sexuality and to respecting people’s privacy and dignity. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 14 Observation, daily records and discussion with staff provided evidence that the routines in the home were flexible. For example, staff described different times for getting up and going to bed according to people’s wishes, flexibility around provision of personal care, and people choosing whether to be in company or to retire to their rooms. As noted, there was evidence of people being involved in the running of the home, such as through cooking and cleaning. Documentation made clear reference to people’s rights, and to important principles such as respecting people’s choices, accessing the local community and the adoption of communication systems according to individual need (Total Communication). Discussion and observation provided further evidence of these principles being put into practice in the home. Some mealtimes in the home were observed. The atmosphere was relaxed. People were given appropriate support and appeared to be enjoying their food. They were offered a choice of drinks with their meal. Staff explained that there were no set menus in the home, but that they would decide what to prepare on the basis on what food was available and what had been served over the previous few days. Records were seen of the food served in the home, providing evidence that this was varied and balanced. Staff spoken with demonstrated awareness of different people’s needs and preferences around food, including in relation to particular conditions and risks. There was information available in people’s care plans about dietary considerations. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal and healthcare needs are being met, promoting their wellbeing, although there is scope to improve aspects of recording to help ensure that no aspects of people’s healthcare needs are overlooked. Generally good systems are in place for handling medication, helping to keep people safe and well. EVIDENCE: During the visits people were seen being supported with personal care in a discreet and respectful manner. Staff spoken with described how they promoted people’s privacy and dignity when providing personal care. As noted, care plans also made reference to these principles, as well as to the practicalities of how to support each person. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 16 People living in the home were dressed smartly and individually. Staff confirmed that people were supported to use make-up and to wear accessories if they wished to, and that people used hairdressing services in the local community. Staff also confirmed that people chose their own clothes each day where possible and that they were supported to go shopping for clothes. Healthcare records for two of the people living in the home were checked. These demonstrated that people were receiving a wide range of routine and specialist healthcare support, including from members of the local Community Learning Disability Team. There was evidence of the team being proactive in referring people for assessment and review where it was thought that there may be additional unrecognised needs. It was agreed that records of appointments and significant outcomes would benefit from being better ordered. Some were divided into separate records according to the healthcare intervention whilst others were written up in a chronological list. In other cases it was difficult to establish when the person last had certain routine healthcare appointments such as a dental check-up. The manager and staff said that there were plans to reorganise healthcare notes so that they were clearer and to make it easier to quickly see when people had last had routine check-ups and were due another. This had been an observation at the last inspection for the service, and was also identified as a need by the manager in the AQAA. No weight records could be found for one person who had been living in the home for nearly a year, even though this monitoring had been recommended by a visiting healthcare professional. Another person had just one weight record for 2006 and one for 2007. People’s weights should be taken at suitable intervals as part of general healthcare monitoring. Some work had been done on Health Action Planning (a way of assessing people’s healthcare needs in detail and deciding what help they need to remain healthy). However, this remained work in progress as had been case at the last inspection. Care plans described the support that people needed around managing particular healthcare conditions. Information was seen on file about some of the conditions experienced by the people living in the home. Notes included an observation from a specialist nurse that one person’s condition was being well managed by the team. A healthcare professional completing a survey form wrote, “staff appear to monitor the clients’ healthcare needs and refer on to other agencies/GP as necessary…staff appear to show and offer clients dignity and respect”. Another healthcare professional expressed similar sentiments. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 17 The manager talked through how medication was handled in the home, and showed the storage facilities and associated records. It was agreed that the home would benefit from having a larger cabinet as the existing one was relatively small. Medication administration records were sampled and appeared to be in order. A check on the systems for handling medication had been conducted by the supplying pharmacy on March 10th 2008, as part of the service that they offer to homes. This indicated that medication was being well handled by the service. Discussion with the manager and staff, along with sampling training records, provided evidence that the team received appropriate training about handling medication. The home had a medication reference guide, although this dated from 2004. The team should consider obtaining a more up to date reference book. Since the last inspection the Trust had revised and updated the medication policy. This provided a detailed and up to date framework for the safe handling of medication. There had been a medication error in December 2007. This had been reported to us. However, medical advice had not been sought in respect of nonadministration of some medications. The manager explained that this was because the omission of the tablets in question was not judged to be significant in terms of people’s wellbeing. The Trust’s policy states that this needs to be done, and this would also be our expectation since it is not the role of staff to make this judgement. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for recognising and responding to concerns and complaints, helping people to feel listened to. Appropriate steps are taken to safeguard people living in the home from harm and abuse. EVIDENCE: The service has a complaints procedure. This is available in text and symbol format and reference is made to it in the Statement of Purpose and Service Users Guide. According to the AQAA there had been no complaints in the last 12 months. The manager confirmed that this remained the case. The manager and staff described how different people in the home expressed dissatisfaction and unhappiness, either verbally or non-verbally. They talked through how they responded, giving examples. They were confident that they were able to establish and respond to these indications, although it was acknowledged that agency staff may not be so attuned to this (see section about staffing). As noted earlier, care plans included information about how people communicated. Information from survey forms indicated that people with an interest in the home felt able to raise issues and were confident that they would be listened to. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 19 Financial records (including receipts) and cash balances were checked for two people living in the home. These appeared to be fully in order. Staff spoken with talked through the safeguards in place to protect people’s financial interests. The Trust has procedures covering whistle blowing and adult protection. The home also has a copy of the ‘Adults at Risk’ procedures from the local authority. Records and discussion with staff provided evidence that appropriate training was being provided about adult protection. Staff spoken with demonstrated good knowledge of procedures and of their responsibilities in this area. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, homely and pleasant environment with suitable aids and adaptations is provided, promoting the comfort and safety of people using the service. EVIDENCE: All of the bedrooms and shared areas were looked at. Each person has their own bedroom with a washbasin. Bedrooms were seen to be personalised and well decorated, with appropriate furnishings and adaptations. Shared areas were pleasantly decorated and furnished. It was agreed that parts of the home would benefit from redecoration as general wear and tear was beginning to show. The manager understood that during 2008 the Housing Association would be undertaking major redecoration of the home. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 21 The ground floor bathroom contained an adapted bath. The cabinet in the room was becoming tatty. The manager explained that she was hoping to replace this with a unit that would allow for separate storage for each person’s items. As noted in the last inspection, the team were hoping to make the garden more accessible, perhaps by levelling some areas and through the addition of a summerhouse. One bedroom had a flickering light. This was reported during the visit. All of the bedrooms have glass panels in the bedrooms doors. This has been discussed during previous visits and it has been agreed that screening and net curtains will be used to protect people’s privacy. One bedroom had an opaque covering but did not have a net curtain. This should be fitted. The home was clean throughout during both visits. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support is provided by a skilled and appropriately trained staff team, helping to ensure that people’s needs are consistently met. The impacts of a shortage of permanent staff are being minimised, but may be compromising some aspects of the running of the home. Appropriate recruitment and selection procedures help to protect the people living in the home. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 23 EVIDENCE: Staff spoken with demonstrated a good knowledge of people’s conditions and support needs. Interaction was observed to be respectful, attentive and caring. Staff felt that the team was very committed and motivated. The AQAA, along with discussion with manager and sampling training records provided evidence that more than half of the staff team had attained relevant NVQs (National Vocational Qualifications), with other staff being part way through their programmes. Senior staff were accessing the NVQ 4 in health and social care. There was positive external feedback about the staff team. For example, a healthcare professional stated that the team knew the clients well and managed to maintain a calm environment even though the behaviours expressed could at times be challenging. They commented on the good working relationship that they had with staff. One form noted that the staff had ‘positive regard’ for the people they supported. As indicated earlier, concerns were expressed by the manager and staff about ongoing staff shortages. This had been identified at the last inspection. Although one person had just joined the team, it was proving difficult to recruit locally. The manager described the efforts that had been made to recruit new staff and the future plans to do this. Staff spoken with felt that, generally speaking, there had not been any significant impacts on the people living in the home. They stated that regular bank staff were working there. A bank member of staff spoken with confirmed that they had undertaken many shifts in the home and knew the people living there well. However, staff acknowledged that, at times, there had been some impacts on activity provision, particularly when working with agency staff. People also commented on agency workers, understandably, not being as familiar with the support needs and communication methods of the people living in the home. Some staff felt that there should be more people on shift at weekends in order that a greater and more individualised range of activities could be provided. Concerns were also expressed about needing to provide extra supervision for one person in the home due to some issues around behaviours which may put others living in the home at risk. Some people felt that higher staffing ratios may be needed, at least on a temporary basis. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 24 Whilst great efforts had clearly been made to recruit new staff, this should continue in order that the permanent staff team is brought back up to full strength. The manager said that consideration was being given to different ways of recruiting, such as being more creative with where vacancies were advertised. The Trust has policies and procedures covering different aspects of recruitment and selection. The manager talked through the recruitment and selection process, demonstrating understanding of what needed to be in place before a person could start work. Just one person had been taken on since the last visit. Their file was reported to still be at the Trust’s office pending forwarding to Badger’s croft (although a copy of the application form was available for inspection). The manager gave a verbal assurance that all necessary documentation was in place and that she had visited the office to check this prior to the person starting work in the home. This was accepted. The standard had been met during the last visit. On the AQAA it was noted that all senior staff had undertaken training about recruitment and selection. One senior staff member’s training record was checked and this training had been recorded as done over two days in 2007. Another person confirmed that they had attended this training. Staff spoken with were happy with the training that they received from the Trust. People commented on the wide range of courses available. In addition to mandatory courses, staff reported having input in areas such as the Mental Capacity Act 2005, dementia, loss and bereavement, total communication and intensive interaction. As noted, staff receive training about the safe handling of medication. The manager said that an Occupational Therapist was coming to talk to the team in April 2008 about falls. One person was booked onto a course about autism in April 2008. Training records for some staff were sampled. These provided evidence of people accessing a range of appropriate training courses, with refresher training provided at suitable intervals. It was noted that some team members had last received formal fire training in January 2007. The manager said that a she had devised a fire safety questionnaire for all staff in the Summer of 2007 and was now trying to arrange for formal fire safety training at the earliest opportunity. A new staff member described their induction to date. This included formal training in core areas having been provided at an early stage. They expressed satisfaction with the induction they were receiving from the Trust and within the home. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 25 Training certificates were distributed through staff records, having been filed when received. It was suggested that these be separated from other paperwork and put into a dedicated training section or file. The manager was also keeping an electronic training summary. Examples were seen and the record up to date. Discussion with staff indicated that there may be benefits in people accessing additional specialist training in some areas, particularly where they had not previously had any specific input or where this had been some time ago. Areas included about diabetes or epilepsy. Some staff were not able to say which type of diabetes one person living in the home was experiencing, although as noted staff generally demonstrated a very thorough understanding of people’s needs and conditions. Records indicated that staff meetings were taking place about every two months and that discussion was wide-ranging and focussed on the needs of the people living in the home. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, helping to ensure that standards of care remain high. Systems are in place which help the team to monitor and improve the service they provide. Appropriate measures are also taken to ensure that people’s health and safety is looked after, although some further work could be done in this area. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager trained as a nurse specialising in learning disability, and has obtained the Registered Manager’s Award. She described how she kept up to date with best practice, guidelines and legislation. Staff spoken with were positive about the management and running of the home. Senior staff also work in the home, providing an additional tier of management. The manager was on special leave from the home between July and October 2007. Whilst there was notification of being away ‘for a few weeks’ there does not appear to have been any subsequent notification of this period of absence extending beyond 28 days, as required under regulation 38. Reports from visits made by representatives of the service provider are being sent to us about once a month. These are required under our regulations and must be unannounced. The manager confirmed that they are not told when these visits will take place. The Trust has a series of standards against which a self-audit takes place. Senior managers check this and an action plan is developed. The home’s action plan for 2007/2008 was seen. This was being kept up to date with reference to whether the goals had been achieved and when. The notes suggested that good progress had been made with achieving the objectives set. A new audit had been done and an action plan was seen relating to 2008/2009. The objectives/actions were clear and realistic and had timescales attached. They included widening activity provision, further developing person centred planning and filling the vacant posts. Records relating to health and safety were sampled, including for fire, gas and electrical safety and servicing of equipment. These were found to be generally satisfactory although the following was noted: • One hot water temperature taken in a person’s bedroom in March 08 was recorded as 47°C. This exceeds recommendations. No action was apparent. It was agreed that the manager would look into this and that the form would be modified to include acceptable parameters and what to do if these were breached. The last fire drill recorded took place in August 2007. It was agreed that another should be done and a regular frequency be maintained. Although the temperature of the main household fridge was being checked, a second smaller fridge used by one person living in the home was not being monitored in this way. This should be done. • • Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 28 Staff spoken with felt that the health and safety of the team and of the people living in the home was well managed, although as noted some people expressed concern about a new behaviour being expressed by one person. The Trust’s health and safety policies were briefly looked at. These cover general principles as well as specific areas such as moving and handling. Training records provided evidence that staff were receiving appropriate health and safety training. Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 29 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 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 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 x 3 x x 3 x Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 30 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 YA37 Regulation 38 Timescale for action Ensure that when the manager is 31/03/08 absent from the home for a continuous period of 28 days or more notification is given, along with supplementary information, as per Regulation 38. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations Urgently assess the risks presented by the recent change in one person’s behaviour, as discussed during the visits. Take any necessary action to safeguard the other people living in the home. Renew photos on missing person’s sheets where there has been a significant change in the person’s appearance. Consider whether a new vehicle(s) should be provided which better suits the needs of the people living in the home. People’s weights should be taken at regular intervals as part of general healthcare monitoring. DS0000066768.V360310.R01.S.doc Version 5.2 Page 31 2 3 YA13 YA19 Badger`s Croft Reorganise healthcare records so that they are clearer. Include information about when people last had routine check-ups and when these are due again. Develop health action plans for all of the people living in the home as early as possible. A larger medication cabinet should be provided. Consider obtaining a more up to date reference book about medication. Ensure that medical advice is always sought in respect of medication errors, such as missed doses. Move forward with plans to redecorate areas of the home which are showing wear and tear. Replace the cabinet in the ground floor bathroom, ideally with more individualised storage facilities. Take steps to make the garden more accessible for the people living in the home. Fit a net curtain to the glass panel in the bedroom door of the person who has most recently moved into the home. Continue with efforts to recruit in order to bring the staff team back up to full strength, thereby reducing reliance on bank and agency workers. Consider whether some or all team members would benefit from specialist training in areas which relate to the needs and conditions of the people they support. This may, for example, include input about diabetes and epilepsy. Check that hot water temperatures in people’s bedrooms are within acceptable limits (see example in text). Consider modifying the form for recording these temperatures to include acceptable parameters and what to do if these are breached. Conduct another fire drill. Maintain a regular frequency of drills to help ensure that people are prepared for a real fire. Monitor the temperature of the second smaller fridge in use in the home. 4 YA20 5 YA24 6 7 YA33 YA35 8 YA42 Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Badger`s Croft DS0000066768.V360310.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!