Inspection on 18/01/07 for Baxter Close (1)

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 Adequate. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Baxter Close (1) 07/11/08

Baxter Close (1) 22/11/07

Baxter Close (1) 23/06/06

Baxter Close (1) 08/03/06

Baxter Close (1) 19/12/05

Baxter Close (1) 03/02/05

Baxter Close (1) 18/10/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Baxter Close (1) 1 Baxter Close Crownhill Milton Keynes Bucks MK8 OBE Lead Inspector Sue Smith Unannounced Inspection 18th January 2007 10:30 Baxter Close (1) DS0000015080.V329698.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 Baxter Close (1) DS0000015080.V329698.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. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Baxter Close (1) Address 1 Baxter Close Crownhill Milton Keynes Bucks MK8 OBE 01908 262835 01908 695643 macintyrecharity.org www.macintyrecharity.org MacIntyre Care 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) Mrs Amanda Anstey Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 2 people with a learning disability. Date of last inspection 23rd June 2006 Brief Description of the Service: Numbers 1 and 15, Baxter Close and 6, Marley Grove are three separately registered services located in Crownhill, Milton Keynes. They form a small service group providing accommodation and support to nine adult service users with learning disabilities. The homes are located within a short walking distance of each other in a small close in an area with reasonably good public transport to the city centre. There is a corner shop at the end of the road. The service is part of the MacIntyre Care organisation, an established provider of care for people with learning disabilities. At the time of the inspection the residents of Baxter Close included two married couples. The group of homes is managed from Marley Grove, which also provides accommodation for three service users requiring higher levels of support. The staff team works as one group, flexibly covering the needs of service users in all the three settings, rather than being specifically allocated to one or another. Together, Marley Grove and Baxter Close aim to enable people with learning disabilities to live as independent lives as possible. Please note that although the three units are currently separately registered they are all included in the scope of this one inspection report, which has been replicated for each of the three separate services. Fees range from £24,401.52 per annum to £ 44,110.04, according to information supplied with the questionnaire. Items such as toiletries, trips out and sundries would be additional charges to service users. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection of the service since the implementation of IBL2 (Inspecting for Better Lives). The inspection was undertaken on the 18th January 2007 by Sue Smith (Regulatory Inspectors) over 7 hours. The Manager was available on the day of inspection. The Inspectors used triangulated methodology to complete this inspection, pre-inspection information such as the previous report was used in the planning process to ensure hypotheses were formulated to support the inspector to explore issues of concern and verify practice and service provision. During the inspection a variety of documentation was assessed, which included Careplans, Risk Assessments, Menus, Rota’s, Training records and Recruitment records. An environmental tour took place, with issues of concern evidenced in the main body of this report. The Inspector identified three Service Users for Case tracking (over the three services), observing these Service Users and their interactions with others including staff at the home, assessing the available information held in the home relating to the care provision, checking this against observed practice. In addition one Inspector spent the day of inspection speaking with service users to gain their views on the service provided. Feedback received during the inspection provided evidence that Service Users and are happy with the care and support offered by the staff, they were complimentary of the friendly, sensitive and respectful approach of the team. The Inspectors observed positive practice throughout the day, finding 1 Baxter close to be a relaxed and pleasant home. The inspector would like to thank the Service Users and Staff for their hospitality and their support in completing this inspection. What the service does well: Individual Careplans are in place which outline the care needs of service user and the manner they prefer care to be implemented. All service users have risk assessments in place, which enable them to maintain their independence safely. Activities are provided which are both age appropriate and support the service user to be part of the local community. Families and friends are welcomed to the homes of the service users with restrictions in place requested by the service user. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 6 Service users are supported to maintain their independence, managing the day to day running of their flats with staff support. The physical and emotional healthcare needs of service users are met with staff support in place should it be required. Robust medication procedures are in place with self-administration policies and guidance to support both staff and service users. The Organisation takes complaints seriously with a comprehensive policy, which is reflective of timescales in place. The home aims to protect the service users through its policies and procedures, which include the protection of vulnerable adults. There is an effective recruitment procedure in place. Training is provided to staff to support their professional development. The home is managed by a suitably qualified and experienced manager. The home has an effective quality assurance system, which ensures the views of service users are obtained and acted upon. The home operates health and safety policies and procedures, which aim to protect service users and staff. Service Users are happy with the care provided and find the staff and management of the home approachable, supportive and friendly when carrying out their duties. What has improved since the last inspection? The individual Careplans are now up-to-date and reflective of review. Individual risk assessments are now reviewed and revised as necessary. Health and medical needs reflected in the Careplan have improved to a good standard. Appropriate guidance for the self-administration of medications is now in place. An accurate log of complaints is now maintained. A full range of recruitment checks is available in the Marley Grove Office. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 7 The staffing levels at the home have been reviewed, however further work is required. Regulation 26 monitoring visits are undertaken by the provider with records of these visits open to inspection. All fire prevention systems are up-to-date with all actions from the recent fire authority inspection actioned. What they could do better: The Manager has worked hard since her return from Maternity Leave to bring the home up to standard. Four requirements made of this report are directed to the Organisation and two are made to the Manager for action and will need to be met within the required timescales. It was found on inspection that the staffing levels for Marley Grove are also distributed between 1, 15 and 15a Baxter Close and Marley Grove, which is not an issue, however it has now been found that the staff are also supporting two services users living in a supported living service in Stoney Stratford. This practice needs to cease, as soon as is reasonably practicable as the staff are not employed as Domicillary Care workers. In addition the mandatory training required to ensure the staff are working safely is not at this time fully up-to-date. The manager has assured the Commission the training programme will be available to her by the end of February. She has already identified staff requiring updated mandatory training and has been given a requirement to ensure these staff are able to access a course before the end of July 2007. One of the service users at 1 Baxter Close requires more support than the other, this support is offered by staff however due to the ratio of staff there are times when support cannot take place in line with his personal preferences to time. A requirement has been made to ensure support is offered to this service user appropriately. During an environmental tour with the service users is was noted the flat was looking somewhat tired and in need of redecoration as well as repairs to broken fittings. Three environmental requirements have been made in this report to ensure the home is redecorated, the kitchen cupboards and floor are replaced and the washing line is fitted effectively. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 8 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. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users needs are thoroughly assessed prior to admission, ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. EVIDENCE: No new admissions had taken place since the last inspection, or indeed for some time, so direct evidence of the management of new admissions was not available for scrutiny. However discussion with staff and the manager confirmed that any new admissions would receive a full assessment by senior staff before consideration of placement and that introductory visits and overnight stays would take place prior to any final placement decisions. The views of existing service users would be taken into account. The assessment tool is called “Moving into Macintyre Care” and is comprehensive and detailed. Pictures are included alongside written information to enable the potential service users to understand the process. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Careplanning documentation has improved and provides staff with the information they need to satisfactorily meet service users needs. Risk assessments are in place, which outline individual vulnerabilities, which contain control measures that enable service users to live their lives as independently as possible. Care is implemented in line with the service users wishes however more attention to the allocation of staffing hours to support the more vulnerable service user needs to be addressed to ensure his needs are fully met. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home provides individual plans of care for each service user living at 1 Baxter Close, these plans have recently been modernised to ensure they acknowledge the holistic needs of the service users. These plans are in line with the service users current identified needs. Alongside these plans is a person centred plan, which is formulated by the service user and is a reflection of their wishes, goals and aspirations. The Careplan formulated by the staff are well detailed with good evidence of how service users prefer support to be implemented. Included in the Careplans is sections which identify such things as religious and cultural needs, physical needs, personal care, feelings and emotions, support needed to manage my behaviour, support needed to access the community and learning and day activities. All information contained was of a high standard and aided staff to provide appropriate support. There was good evidence of health screening taking place and how the home supports service users to access health advisors. The home is facing difficulties when accessing equipment to check the weight of service users who are wheelchair bound or unable to fully weight-bare. As this is not an issue solely found at this service it is recommended the Organisation purchase a set of sit on scales, which can be utilised as a resource for all of its services. Risk assessments are in place for personal care, medical and health support needs, physical support, relationships and emotional support, leisure and transport support, reducing vulnerability whilst accessing the community, scooter risk and stranger danger support. All risk assessments were found to be up to date, signed and dated by the author. The service users at 1 Baxter Close are a married couple and as such maintain their personal independence as much as possible, however there is varying levels of independence between the two persons which has to be addressed when implementing staff support and measuring risks. Presently 1 Baxter Close and 15 and 15a Baxter Close share carer hours with one Carer designated of an evening to meet all of their individual needs, this is not sufficient and must be addressed by the organisation. It would seem that the care hours are being distributed in a manner that would be more fitting to a supported living environment, however as the service users at 1 Baxter Close are not financed as a supported living service this is not acceptable practice. The Commission understands there are difficulties accessing the home due to the wishes of one of the service users, this was discussed during the inspection and the manager has agreed to explore solutions to this issue. This will need to be addressed as soon as is reasonably practicable to ensure the service is being managed within regulation as a registered Care Home. This is discussed further in standard 16 with a requirement made. Baxter Close (1) DS0000015080.V329698.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, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users can take part in age, peer and culturally appropriate activities, which support and enrich service users social and educational opportunities. Families and friends are welcomed to the individual’s homes with no restrictions unless previously requested by the service user or significant others. The service users at 1 Baxter Close are supported to maintain their levels of independence with staff support available on request, however the Organisation needs to ensure there are sufficient numbers of staff available should a request be made. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 14 Service Users prepare and cook their own meals with support provided as required, the service users at 1 Baxter Close enjoy a varied, appealing and nutritious menu, however due to the insufficient numbers of staff on duty the scheduling of meals is orientated around the needs of the staff rather than the service users. EVIDENCE: Service Users are supported to take part in a variety of activities both in their home and in the local community. Both Service Users at 1 Baxter Close attend a local day centre. There is good use of community resources with both service users able to access these resources independently with the use of their mobility scooters. Both Service Users are well supported by the home and Macintyre Care in pursuing appropriate activities. Service Users are supported to maintain contact with their families dependent on their own circumstances and personal wishes. There are no restrictions on visiting times with the Service Users at 1 Baxter Close able to entertain family and friends as they wish. Additional work has been undertaken by the staff to ensure the identified and changing needs of the service users at 1 Baxter Close are met, special attention has been made to ensure the needs of one service user are addressed whilst still supporting both service users as a married couple to maintain their independence. Clear documentation of the changed needs of this service user was evident in the Careplan with additional support plans for such things as meal times in place. It has been noted however that this is difficult to implement when required by the service user due to the way staff hours are delegated at these times of the day, e.g. one member of staff to provide support to three separate living accommodations. A requirement is made to ensure staffing provided at 1 Baxter Close is reviewed to reflect the care needs of the most dependent service user at times preferred by this service user. Additional support has been offered to the service users at 1 Baxter Close, which enables one of the service users to maintain his dietary requirements. The use of a dietician has proved a positive initiative for this service user with a varied and appealing menu produced which will support both service users. The service users at 1 Baxter Close has a range of cooking skills, which enables them to prepare their meals independently with support available if required. During the inspection one service user was observed independently making soup for lunch which was greatly enjoyed. Baxter Close (1) DS0000015080.V329698.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 adequate. This judgement has been made using available evidence including a visit to this service. Service Users needs are outlined in their individual plans ensuring the manner in which they are supported and cared for by staff is appropriate and promotes their preferences, however staff allocation does not fully promote the recorded needs. The physical and emotional healthcare needs are generally met, however further development needs to be addressed to ensure the nutritional needs of one service user are satisfactorily met. The organisation has robust medication procedures in place with selfadministration guidelines, which support the service users at 1 Baxter Close. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 16 EVIDENCE: With the updating and modernising of the Careplan format the needs of service users are now sufficiently reflected. Information regarding personal care is recorded in the individual Careplans. Service users are very independent and choose when they like to go to bed, have a bath, have their meals and take part in other activities. The Careplans set out in detail the service users preferred routines, likes and dislikes and partnerships with families and friends. The service users at 1 Baxter Close are a married couple and as such maintain their personal independence as much as possible, however there is varying levels of independence between the two persons which has to be addressed when implementing staff support and measuring risks. Presently 1 Baxter Close and 15 and 15a Baxter Close share carer hours with one Carer designated of an evening to meet all of their individual needs, this is not sufficient and must be addressed by the organisation. It would seem that the care hours are being distributed in a manner that would be more fitting to a supported living environment, however as the service users at 1 Baxter Close are not financed as a supported living service this is not acceptable practice, this is evidenced further under standard 33 in the main body of this report. There was good evidence of healthcare screening with evidence of annual health checks, dentist appointments, podiatry, and optician and physiotherapy appointments. There has been a lot of recent input from the PCT Dietician who has been supporting one service user with an increase in weight loss, which was evident through regular monitoring records. This work needs to be further supported by the management of the home by implementing sufficient numbers of staff to support the service user around meal times that suits the service user and ensure equipment is provided to support the regular weight monitoring of service users. The service users at 1 Baxter Close are able to self-administer their medication. A self-administration policy is in place with weekly audits of MAR sheets and medication stocks maintained. All completed MAR sheets are then stored in the office of Marley Grove for administration purposes. There were no out of date medications held in the service users home with a returns procedure in place. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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. The Organisation has a robust complaints procedure which is accessible to service users and significant others, enabling them to make a formal complaint appropriately. Policies and Procedures are in place, which aim to protect service users from all forms of abuse, ensuring staff training is undertaken which enables staff to support vulnerable service users. EVIDENCE: The home follows the Organisations complaints procedure, which is reflective of timescales for action. A complaints log is in place, which is used to record all complaints, received at the home. It has been recommended this system be updated to ensure all complaints remain confidential, discussion on how to best achieve this took place with the manager. A recommendation to this effect is made. There have been no complaints received directly at the Commissions offices since the last inspection of this service. All staff receives regularly updated POVA training, which is reflective of current guidance. The home follows the Milton Keynes Inter Agency Policy for the Protection of Vulnerable Adults (Safeguarding) and its reporting systems. There have been no reported or alleged POVA issues in the past 12 months. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is adequate, providing service users with a homely place to live, which could be improved with decoration, and prompt attention to the maintenance of the home to ensure it remains safe, comfortable and accessible to the people living there. Standards of cleanliness in the home are adequate, further staff support is required to ensure the service users are able to live safely and comfortably in their home. EVIDENCE: 1 Baxter Close is a 2-bedroom bungalow set in a residential estate. The home is maintained by the housing association that will ensure necessary repairs are undertaken once a request has been issued. The general cleanliness and daily upkeep of the home is the responsibility of the service users with staff support. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 19 On inspection it was found that the home is not maintained to a sufficient standard, Kitchen: - cupboards and drawers are ill fitting. New flooring is required in this area to ensure the safety of the service users. In addition the worktops were very worn with the area in need of repair where clumps of plaster had come away from the wall. The kitchen also needs to be completely redecorated. Toilet: - There are areas in this room where the plaster had fallen off the wall requiring repair and decoration. Lounge: - The lounge was tired and tatty looking where paint had been either chipped or scraped off, necessitating decoration. In addition this area was very cluttered and cleaned to a poor standard, both service users have mobility issues and could sustain an injury whilst trying to negotiate passage through piles of magazines and other items. Bathroom: - The bathroom was clean and tidy with no issues of concern in the maintenance of this area found. Garden: - The garden area was adequately maintained as would be expected during the winter months. The washing line recently erected has fallen down and needs to be repaired as soon as is reasonably practicable to ensure the needs of the service users continue to be met. Overall the home requires general decoration. In addition the service users need additional support to maintain their home, the Commission appreciates their need for independence however at this time the level of support offered is insufficient to meet their needs safely. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34,35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides adequate staffing levels to meet the needs of service users, however staff vacancies and the changed needs of service users could leave service users at risk. There is affective recruitment procedures in place to ensure service users are protected from harm. There is a full programme of staff training and development, however some staff still require mandatory training to ensure the ongoing safety of service users. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 21 EVIDENCE: This service is currently supported by staff and management based at Marley Grove, therefore this part of the standards is reflective of the findings for Marley Grove, 1 Baxter Close and 15 and 15a Baxter Close. The home presently has vacancies for a full time Deputy Manager, which has recently been advertised with no successful applicant, found. The Organisation will soon be re-advertising this post. In addition the home have a 30-hour vacancy for a senior support worker and a 30-hour vacancy for a support worker. The home presently covers these hours using their own staff or relief staff who are familiar with the service users. There is no use of agency at the home due to the lone working arrangements. The staffing numbers at Marley Grove are also used to support the 5 service users living at the Baxter Close services. It has also been brought to the commission’s attention that in addition to this staff are also supporting 2 service users living in a supported living service in Stoney Stratford (one of which is not funded by the Organisation). As the homes staff are not employed to provide Domicillary Care Services this practice must cease as soon as is reasonably practicable. A meeting to discuss this and other issues is scheduled with the Responsible Individual and the Operations Manager of the Organisation. In the interim a requirement is made that within 3 months the support given to the Service Users at Stoney Stratford’s supported living service is no longer to be provided by the staff employed at Marley Grove/Baxter Close. There has been one staff member recruited since the last inspection, the recruitment procedure for this staff member was assessed as satisfactory with all security checks in place which included a CRB (criminal records Bureau) disclosure and two written references. All recruitment is undertaken centrally with the Manager playing an active role during the interview process and checking the suitability of references. The Manager has developed a training matrix which highlights what mandatory training has been undertaken and when review courses are due. At this time some staff are awaiting updated manual handling, fire safety and medication training. A new contract has recently been agreed for an outside training provider to facilitate all mandatory training, the training programme is due to be distributed to the homes at the end of February 2007 which will support the manager to ensure all mandatory training and updates can be accessed. A requirement is made to the Manager that all outstanding or out of date mandatory training is to be undertaken by the 31st July 2007; this includes manual handling, fire safety and medication training. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. 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 manager is supported well by the staff team in providing clear leadership and demonstrating an awareness of their roles and responsibilities to the benefit of the service users. The home has implemented a quality assurance system to ensure they are being proactive in identifying issues that may affect the wellbeing of service users. There are systems within the home, which are used to ensure that service users health, safety and welfare are protected and promoted. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 23 EVIDENCE: The Manager is suitably qualified and experienced in her role; staff report her as approachable and supportive with regular staff meetings and 1:1 supervisions provided. Since her return from Maternity Leave she has worked hard to ensure the requirements of the last inspection report were complied with. There has been a noticeable improvement in the maintenance of the administration systems of the home since her return. Service Users spoken with are happy with the management arrangements and are able to talk openly to the Manager and her staff. The home has improved its quality assurance systems since the last inspection, ensuring systems already in place have been brought up-to-date and new monitoring tools implemented. An annual service user survey is undertaken with feedback used to support the manager to make changes to the way the service operates. An annual service development plan is produced which is reflective of the annual service aims and objectives formulated by the Manager with the Operational Manager. Service users meetings take place, however these are ad hoc meetings with no minutes held. Regulation 26 visits are taking place with the last report reflective of November 2006. The home has robust health and safety procedures in place, which are reflective of current legislation and guidance. Six monthly health and safety inspections take place with the last recorded inspection December 2006. Monthly health and safety representative meetings are taking place for all Milton Keynes services, which are scheduled annually. Service records for equipment, gas servicing, PAT testing, C.O.S.H.H., hoists and specialist adaptations and equipment are taking place with records open to inspection. All three services have an individual fire risk assessment, which is updated annually. Regular fire monitoring is taking place with all requirements of the last Fire Authority inspection actioned. Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 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 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 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 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 3 X X 3 X Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? 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 YA16 Regulation 18 Requirement A requirement is made to the Organisation to ensure staffing provided at 1 Baxter Close is reviewed to reflect the care needs of the most dependent service user at times preferred by this service user. The Organisation is required to ensure the kitchen and flooring at 1 Baxter Close is replaced with suitable and functional fittings. The Organisation are required to ensure the internal environment is repaired and decorated to provide a suitably comfortable and homely living space for service users to enjoy. The Manager is required to ensure the external washing line is erected in the garden of 1 Baxter Close and made safe for use. A requirement is made to the Organisation that within 3 months the support given to the Service Users at Stoney Stratford’s supported living service is no longer provided by DS0000015080.V329698.R01.S.doc Timescale for action 16/05/07 2. YA24 23 (2) b 16/08/07 3. YA24 23 (2) b 16/08/07 4. YA24 23 (2) b 16/05/07 5. YA33 18 (1) a 16/05/07 Baxter Close (1) Version 5.2 Page 26 6. YA35 18 (1) c, i. the staff employed at Marley Grove/Baxter Close. A requirement is made to the Manager that all outstanding or out of date mandatory training is to be undertaken by the 31st July 2007; this includes manual handling, fire safety and medication training. 31/07/07 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 YA17 Good Practice Recommendations It is recommended the Organisation purchase a set of sit on scales, which can be utilised as a resource for all of its services. It is recommended further support is offered to the service users at 1 Baxter Close to maintain a safe, clean and hygienic environment to enjoy. 2 YA24 Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Baxter Close (1) DS0000015080.V329698.R01.S.doc Version 5.2 Page 28 - 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!