Inspection on 19/12/05 for Baxter Close (1)

This inspection was carried out on 19th December 2005.

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 13 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) 18/01/07

Baxter Close (1) 23/06/06

Baxter Close (1) 08/03/06

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 Mr Rob Smith Announced Inspection 19th December 2005 10:00 Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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.V261939.R01.S.doc Version 5.0 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.V261939.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Baxter Close (1) Address 1 Baxter Close Crownhill Milton Keynes Bucks MK8 OBE 01908 262835 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) MacIntyre Care Ms Christina Tribble Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 2 people with a learning disability. Date of last inspection 3rd February 2005 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 disability. 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. 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. At the time of this inspection staff at the home were also supplying outreach support to two service users in another area of Milton Keynes. It was envisaged that responsibility for this support would shortly be transferred to another part of the MacIntyre organisation. 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. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two days and comprised the following activities • • • • • • • Submission of pre-inspection information by the acting manager Submission of questionnaires completed by service users Interviews with the acting manager and other staff in the home Discussion with all service users resident at the time of the inspection Scrutiny of individual services user and key establishment records. Examination of the physical environment Observation of practice Verbal feedback was given to the acting manager on the second day of the inspection. What the service does well: What has improved since the last inspection? Attention had been paid to addressing the requirements made at the last inspection. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 6 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. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: As no new service users had been admitted to the group of homes since the last inspection, or were likely to be in the immediate future, none of the above standards were inspected on this occasion. Previous inspection had indicated these areas of practice were well met. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Significant shortfalls in individual planning and review records meant that up to date service user needs and personal goals were not clearly identified. The service actively encouraged and supported service users in making decisions about their lives. Service users were appropriately consulted and involved in all aspects of their lives in the home. Considered risk taking on the part of service users was an integral part of the ethos of the service but the absence of up to date risk assessments was a concern. EVIDENCE: The inspector was concerned that the majority of service user files seen provided little evidence of effective and up to date care planning and current information on care needs. The following points were of particular concern. • The majority of files did not contain up to date individual care plans (or person centred plans as is the preferred process used within MacIntyre DS0000015080.V261939.R01.S.doc Version 5.0 Page 10 Baxter Close (1) homes). • There was equally little clear evidence of a consistent pattern of records of recent reviews and/or outcomes and goals set as a result of those reviews. Files contained a significant amount of old and outdated care needs information as well as unsigned/undated personal information profiles, and a range of records such as behaviour assessments, weight charts etc, the date and relevance of which were unclear. Individual risk assessments on most files were over a year old and some, for a service user presenting perceived higher levels of risk, appeared not to have been updated following a transfer from a previous home. • • These shortfalls were pointed out directly to the acting manager during the inspection and he could not provide any additional evidence to contradict these findings. The overall outcome of the above shortfalls was that files did not present for any of the service users a clear sense of current care needs, planning objectives, personal goals or management of risk. The last point was particularly crucial in a service where effective risk management was key to ensuring an appropriately independent lifestyle for the majority of service users. While discussion with staff and service users indicated a better day-today grasp of service users’ needs and concerns, the lack of formally recorded and updated plans, reviews, goals and personal information were unacceptable. Requirements have been made to address these issues. Discussions with staff and service users confirmed that service users were allowed due scope for independent decision-making in relation to the day-today management of their lives. The degree of independence allowed varied depending on staff perception of the abilities and confidence of the service user concerned. As a result the occupants of the Baxter Close flats were allowed considerable scope to organise their own lives, within an overall framework of staff support over key issues such as meals and medical care, and monitoring of their comings and goings. Service users based in Marley Grove were more dependent on higher levels of direct staff support and supervision to ensure their care needs were met consistently. With regard to longer-term decisions about their care planning and future placement needs, service users were said by staff to be actively involved in drawing up and reviewing their person-centred plans (PCPs), which were meant to be based on service users’ own wishes and perception of their care needs. However due to the patchy formal records on PCPs and reviews noted above this was difficult to evidence from service user files. The informal feedback from service users gained during visits to the flats was that they did Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 11 feel their views were taken into account appropriately in the planning and execution of their care, and observation of practice during the inspection period confirmed that staff were diligent in ensuring they consulted fully with service users over issues that would impact on the organisation of their lives. With regard to service user input into the running of the service, due to the varied structure of the service and the differing position and needs of the service user group, overall service user meetings were not felt to be appropriate. Group meetings for the service users in Marley Grove had been held, albeit infrequently, in the past year. Service users in the flats tended to be consulted in an informal and ‘ad hoc’ way as part of ongoing staff contact with them. On a broader level one of the service users was reported by staff to be actively involved in delivering training for MacIntyre staff on effective ways of planning and working with adults with learning disability, which is commendable. As will be evident from much of the above, service users, particularly those in the Baxter Close flats were encouraged to take risks appropriate to their abilities. This meant for example Baxter Close service users were largely free to go out and about as they wished, to plan their day and leisure time activities, manage their medication and to conduct their lives within the flats with a minimum of staff input. The situation within Marley Grove was more tightly overseen by staff. So while the underlying practice in relation to risk taking was good, this did need to be backed up by more consistent updating and review of formal risk assessments as noted already above. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Service users were provided with opportunities for personal development and for appropriate daytime activities (Stds 11 & 12) Service users were able to be part of the local community Service user were able to take part in a range of appropriate leisure activities Service users were enabled to maintain appropriate family and personal relationships Good attention was paid to respect of service user rights Appropriate provision was made for meals EVIDENCE: Service users in the three homes had access to a range of day care services operated by MacIntyre Care in Milton Keynes. This offered different opportunities for service users to develop practical and social skills, meet the public, socialise with peers and earn a nominal weekly wage. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 13 The focus on personal development within the three homes themselves was relatively limited, in part due to staffing levels and recent changes in staffing, which had inhibited the development of focused time spent by keyworkers with individual service users. This, in other MacIntyre services, typically involved one ‘home day’ a month instead of attendance at day services. Alongside this development of key worker roles and responsibilities was at an early stage again inhibited by the significant level of staff changes. The lack of clearly recorded individual developmental aims and objectives noted earlier was also a factor. The acting manager indicated his intention to set up ‘home days’ and further develop the key working role. He was confident that this could still be managed within current staffing resources. In the view of the inspector the staffing adequacy issue was less clear but the idea of home days was fully supported, provided it tied in with development of key worker roles and clarification of personal aims and objectives for service users. The location of the homes was in the midst of a local housing development, which, in itself, provided a degree of community integration. Local facilities were somewhat limited but service users did make use of the nearby shop. Day service activities did potentially involve a good degree of contact with community and public, and service users made use of the usual range of community recreation and shopping facilities in central Milton Keynes. Relationships with the local community and neighbours did not appear to be unduly problematic, although in questionnaires some of the service users highlighted the discriminatory attitude of local youths as an occasional concern. Service user had access to a range of the usual entertainment and recreational pastimes such as TV, DVD/video and audio equipment either in their own rooms or as part of the establishment equipment. The more independent service users made full use of the recreational facilities on offer in the Milton Keynes area. The more dependent service users were reliant on the, at times, quite stretched staff availability to support them in attending community based activities. Service users were supported in the development and sustaining of appropriate personal relationships and, as noted earlier, two of the flats were occupied by married service user couples. Discussion with staff and service users confirmed that support was offered to ensure family contacts were maintained and it was good to note that a large number of service users were planning to visit or stay with relatives over the Christmas period. MacIntyre placed a clear emphasis on support of service users’ rights and this was seen to be operating in practice during this inspection. Staff were seen to be respectful of service users’ privacy at all times, both in terms of physical privacy and over matters such as private post. Staff supporting service users in Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 14 the Baxter Close flats took into account the additional elements of independence and associated right to decision-making that they enjoyed. The overall standard of food provided was seen as satisfactory. Service users in Marley Grove had input into menus but received a greater degree of direct staff assistance in the purchasing of foodstuffs and the preparing of meals. A sample of menus appeared to indicate a satisfactory range of meals were provided; fresh fruit and vegetables were seen to be available. In the Baxter Close flats service users had a potentially greater direct role in the purchasing and preparation of meals, dependent on their levels of skill and confidence. Staff still assisted with key aspects of meal preparation when required and maintained a general oversight of the appropriateness of meals, alongside general health and dietary issues. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Individual support was available to service users but this was limited at times due to staffing levels. Immediate health care needs were met appropriately but care planning shortfalls meant proactive and documented planning on health care needs was limited Medication processes and procedures were essentially sound but needed further attention to ensure service user interests and safety were appropriately safeguarded and promoted. EVIDENCE: Due to the nature of the service the levels of support and input to service users varied considerably. As noted already, the more dependent service users in Marley Grove received the highest level of staff support around a range of personal and emotional care issues, finance and aspects of general care over the management of the house and preparation of meals, etc. The support around these practical aspects of care appeared to be provided in appropriate ways and to the preferences of service users. Individual support around less tangible personal, emotional and developmental issues tended to be supplied on an ‘ad hoc’ basis as and when required. A more proactive input via the Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 16 planned development of the key worker role, alongside more effective individual care planning will therefore be of significant benefit. Support and input for the more independent Baxter Close residents was primarily focused on very practical aspects of food preparation and maintenance of appropriate health and safety standards in the flats. There appeared to be limited dedicated time to focus on other needs and developmental issues, as was confirmed in feedback from staff spoken with. Requirements have been made to address these issues. Again structured individual key worker time would help to tackle this shortfall, provided staffing resources are sufficient to allow this. On a positive note it was good to see the level of help and support offered to one of the Baxter residents who was unwell at the time of the inspection. It was also good to note the input that was being arranged from community health services to support one resident in Marley Grove over specific aspects of his behaviour. From observation of practice and discussion with staff and service users it appeared that immediate health care needs were being met appropriately. Service users were registered with local GPs, dentists, opticians etc and files indicated regular checkups were arranged. What did not appear to be in place though, as part of the general shortfall on care planning, was any up to date detail on individual health care needs and how they would be met. The acting manager indicated that this would normally form part of the person centred care plan. Files did contain various strands of information on aspects of health care needs but much of this appeared as part of outdated personal profiles, or random records relating to weight monitoring or other aspects of personal health. The acting manager was in the process of addressing a number of identified shortfalls in the management of medication and the securing of a better standard of service from the pharmacy currently supporting the home. The proposed structures for recording, in a more coherent and logical way, medication that staff were responsible for administering, were outlined to the inspector and appeared satisfactory. Medication for those residents who did not self-administer was safely stored in the office area of Marley Grove. A solution was also being sought from the pharmacy to packaging up smaller amounts of medication for one resident in Baxter Close, who although retaining some responsibility for self-administration, did not wish to manage larger amounts of medication. Residents in Baxter Close were usually responsible for managing their own medication, with general oversight from staff to ensure undue risks were not being taken. Risk assessments were on file to cover these situations although these again were in need of updating. The acting manager had already identified, however, a lack of clear guidance leading on from those risk Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 17 assessments about how medication would then practically be managed and monitored for each of the service users concerned. For example one service user wished to maintain a record of administration for her own benefit whereas others did not. As part of the overhaul of medication procedures the acting manager indicated an intention to develop individual medication management guidelines to address this shortfall, which the inspector would fully endorse. Given the actions being planned or undertaken by the acting manager no requirements or recommendation have been made in relation to medication issues on this occasion but progress in practice will be reviewed at the next inspection. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Clear complaints procedures were in place to enable service users to express any concerns about the service. Appropriate procedures and staff training systems were in place around issues of adult protection although notification of abuse allegations arising had not been consistently notified to CSCI. Systems for management of service users finances were being inadequately administered. EVIDENCE: MacIntyre had a formal complaints procedure in place, which had been subject to previous central approval by CSCI. The acting manager confirmed that information on the procedure was made readily available to service users in formats they could understand. No formal complaints had been recorded as received since the last inspection. At a more informal level discussion with staff and service users confirmed that the latter group were free and able to voice their views at all times so that matters of concern were often resolved promptly and informally. MacIntyre also had a range of policy, procedure and guidance in place dealing with matters of adult protection, which again had been centrally approved by CSCI. These procedures were supported by regular access to mandatory training on these matters for staff, although staff take-up was not verified during the course of this particular inspection. Scrutiny of individual service user records indicated that since the last inspection an allegation had been made by a service user against a member of staff for inappropriate practice. Detailed records of the subsequent investigation were not available to see but additional evidence in files indicated Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 19 these allegations were seen as unfounded. It appeared however that this allegation and investigation had not been reported to CSCI. A requirement has been made to address this issue. These events took place before the acting manager took over and will therefore be followed up for further clarification with senior MacIntyre managers. Records of service user finances were examined and, while the overall systems in place appeared potentially sound, a number of concerns were identified. On two service user files unbanked, unprocessed cheques were found, one dating back to May 2005. There was no indication of what these related to or what had been done about them. Upon checking balances and receipts for another service user a discrepancy was found. Although this was subsequently resolved satisfactorily in discussion with the acting manager it indicated a need for a more detailed recorded link between receipts and amounts noted as spent on the finance recording sheet. On another service users’ records an error was noted in the transfer of balances between one record sheet and the next. Immediate action needed to be taken to sort out the cheques found and more care in the completion and effective monitoring of resident finance records was clearly necessary. A requirement has been made to address these issues. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,30 The accommodation for service users was appropriate to their needs and provided a comfortable and homely environment although some areas needed development, repair and/or decorative attention. Service user bedrooms were suited to their needs, lifestyles and promotion of independence. (Stds 25 & 26) Toilet and bathroom design promoted privacy and they were equipped as required with specialist equipment. Although overall standards of cleanliness were satisfactory aspects of the home’s approach to matters of hygiene needed improvement. EVIDENCE: The three separate units provided, between them, a suitable range of accommodation and facilities for the differing needs of service users living either as couples in self-contained flats, or as individuals in shared accommodation. The homes appeared comfortably furnished and adequately lit, heated and ventilated. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 21 The standard of decor on the Baxter Close flats appeared generally satisfactory, however in Marley Grove the decorative standards in the communal lounge and hallway areas were looking rather tired and dated with, additionally, several cosmetic, rather than structural, cracks at wall and ceiling joins. Redecoration of these areas should be integrated into next year’s planning. The carpet in the main lounge was also badly stained in some areas and the inspector indicated that if regular cleaning could not remove these, replacement must be programmed into the next financial year’s refurbishment schedule. A requirement has been made to address this issue. The kitchen area in Marley Grove was scheduled for complete renovation in the near future to address its rather worn and outdated design and equipment. The inspector also advised that the more substantial cracking noted in the wall between kitchen and laundry areas be checked out at this time. The garden area outside the ground floor flat at 1 Baxter Close was raised as an area of concern by the service users there. Due to their mobility limitations they could not make use of the current sloping and grassed garden area. The property was not owned by MacIntyre and there had apparently been a longrunning debate with the property owners about getting this sorted to provide a more accessible and usable area. While it appeared some resolution might soon be in the offing this did need to be expedited as quickly as possible. A requirement has been made to address this issue. Service users had either single or shared double bedrooms, within the three properties, as appropriate to their relationship arrangements. Bedrooms appeared suitably personalised and equipped to the preferences of service users. All the properties were equipped with satisfactory levels of toilet and bathroom facilities. Those in Marley Grove were equipped with specialist bath and hoisting equipment. These were in need of repair and servicing respectively, which the acting manager indicated he had in hand. The inspector also noted that the flooring in both the bathroom and separate toilet was cracked at the corner seams, leading to possible leakage and problems in maintaining hygiene standards. The floor area behind the specialist bath was also noted to be dirty and in need of cleaning. Outside of the bathroom and toilet areas, with some exceptions noted below, the overall standards of tidiness and cleanliness were seen to be acceptable. It was recognised that maintenance of acceptable standards in the self-contained flats was in part the responsibility of the service users living there and that staff worked hard at sensitively ensuring appropriate hygiene and cleanliness without unduly undermining services users’ independence, choice and responsibility. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 22 Areas for attention included the need for better adherence to cleaning schedules for Marley Grove, as records there indicated these were not always being followed; an example of the lack of attention was a fungal growth in the back of the refrigerator which had been overlooked by staff. It was also noted that facilities for hand washing and drying in Marley Grove appeared to rely on the use of communal hand towels both in the kitchen and bathroom/toilet areas. Given the number of potential users of the towels, and possible resultant cross contamination the use of soap dispensers and disposable paper towel dispensers was advised. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 The staff team had been subject to considerable disruptive change since the last inspection and concerns remained about the adequacy of the staffing establishment to fully support the differing needs of service users. The staff team had a suitable range of experience and skills in working with the identified service user group. Good levels of training and development opportunities were available to staff. Written recruitment procedures were satisfactory. EVIDENCE: The small staff team of five at the home had been subject to considerable change at all levels since the last inspection. The former registered manager had left the previous year and the replacement manager, who was yet to be formally registered by CSCI, was on maternity leave until early 2006. Her post was being covered by the acting manager present at this inspection, who had been redeployed from another MacIntyre home in November 2005. He was contracted to work at the home until June 2006. Two staff had left from permanent positions in the last year, two new staff had been appointed, one also on a redeployment basis, and one existing member of staff had just returned from a long period of sickness absence. The service Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 24 currently also had a vacancy for 20 hours. There had therefore been considerable disruption to the continuity of management and staffing since the last inspection, which may in part have contributed to the practice shortfalls noted in this report. Previous inspections have highlighted the need to get more firmly to grips with assessing the level of staff needed to run the service effectively, and the acting manager was unclear whether this formal re-assessment had yet been carried out. This will be followed up separately by CSCI with senior MacIntyre managers. However it was evident during the inspection that, even with a full existing complement of established staff, effective coverage of all service users’ needs was stretched to the limit. Points have already been raised in this report about the limited scope for working individually with service users, particularly those in the less obviously demanding Baxter Close services, but the more dependent service users in Marley Grove needed at times significant levels of practical assistance with personal care that it appeared difficult to manage consistently with the current level of staff. Factors such as service user choice as to whether male or female staff assisted with personal care were also difficult to factor in with a limited staff pool. On the staff side of matters it appeared that very few formal staff meetings with adequate attendance took place, which may be another reflection of the limited staff hours available. It also appeared that the funding for the staff team covering the three services was unduly complex, drawing on elements of each of the three units’ nominally separate budgets, rather a central consolidated staffing budget. Currently it appeared that only via staff willingness to do occasional extra hours, often at short notice, and ongoing support from relief staff was the staffing input maintained at an acceptable minimum level. The acting manager was confident that the proposed release of the hours currently spent in the support role to former service users in Stony Stratford will ease the situation. However a full and detailed re-evaluation of staffing needs and, hopefully, some simplification of staffing budgets was still necessary to ensure service users’ differing types of support needs could consistently be met alongside adequate provision of time for staff to attend staff meetings, training, supervision etc. A requirement has been made to this effect. Within the current staff team there was considerable experience and background training in working with adults with learning disability, although working with more independent and self-managing service users was a change of focus for some. MacIntyre provided good training and development opportunities for staff with a view to working towards NVQ qualification, where relevant, once initial induction training and probation processes had been successfully completed. Currently however only two of the five permanent staff had achieved the Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 25 expected NVQ 2. Additional specific training was available on a range of relevant subjects. Staff feedback on training availability and quality was positive. Recruitment policies and procedures had been approved previously by CSCI centrally. Staffing recruitment records for permanent and relief staff were maintained centrally within MacIntyre and so not inspected on this occasion. A spreadsheet provided by central personnel indicated necessary checks had been undertaken. CSCI will be putting in place arrangements to directly check a sample of central records subsequent to this inspection. The service did not make use of agency staff, making use instead of MacIntyre relief staff, overtime hours or, in emergency situations, support from other local MacIntyre units. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39, 40,41,42 The managerial situation had been subject to considerable instability leading to shortfalls in consistent leadership and development of practice. (Stds 37 & 38). Service user views were taken into account in review and development of the home but overall quality assurance systems needed further development. An appropriate range of central policies and procedures were in place Overall record-keeping and maintenance of information on individual services users was not satisfactory. Overall attention to health and safety matters helped ensure the safety of staff and service users. EVIDENCE: As already noted the managerial and team staffing situation had been subject to significant changes over the past year or so, with apparent implications for the consistency and development of a number of aspects of practice in the Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 27 home. The acting manager appeared aware of many of the shortfalls and was in the process of addressing them in the relatively short timescale he was contracted to work at the home (due to finish in June 2006). He was not qualified to the expected level under the standards but was suitably experienced and evidently competent in the role. The appointed manager, currently on maternity leave, had not yet been formally registered as manager by CSCI. This issue, and the need for future, more stable and effective management at the home, will be discussed for further clarification separately with MacIntyre senior managers. No requirements have been made at this stage. Quality assurance processes were not examined in depth at this inspection. It was however clear that the views of service users were sought on an ongoing basis as part of the day to day running of the service and the organisation of their care. The inspector was advised that more formal service user surveys were also carried out as part of MacIntyre internal quality assurance processes. It was not however clear how the views of other stakeholders in the service, for example placing authorities or relatives, were formally elicited and what structure was in place to pull together all strands of service quality information into one coherent quality development plan. Given the number of more urgent improvements to practice highlighted in this report no requirements have been made in this area on this occasion. This will be discussed separately with senior MacIntyre managers and covered more fully in future inspections. Arrangements were in place for external MacIntyre managers to visit the service to carry out monthly monitoring as required under Regulation 26. The records of these visits were seen in the course of the inspection and a number of points emerged. It was noted that no records were held in the home for visits covering the period 28/04/05-29/07/05 but is was unclear if this meant the visits had not taken place or simply that the reports were missing. The records of visits seen did not clearly indicate whether the visits had been unannounced, as required by regulation and discussion with the acting manager suggested that they might not always be and they were sometimes tagged on to planned supervision visits. Copies of reports were also not being consistently being sent to CSCI as expected under regulation. The range of central policies procedures and guidance provided by MacIntyre to support staff had been previously centrally approved by CSCI and deemed satisfactory. They were not re-examined on this occasion. Previous sections of this report have already highlighted aspects of unsatisfactory record keeping, for example with regard to service user individual files and financial records. Requirements or recommendations have already been made relating to the specific shortfalls noted. Similarly specific aspects of health and safety practice requiring attention have been raised under earlier standards. Apart from these points the overall Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 28 physical environment was seen to be generally safe and appropriately maintained. Fire safety appeared appropriately addressed apart from occasional gaps in regular testing or checking noted earlier in the year. The propping open of doors noted at previous inspections had now ceased with the introduction of approved door retention devices. Hazardous chemicals were safely stored, where it was deemed service users should not have access, and COSHH information was available to staff. One minor additional point was the potential risk of burns from unshielded pipes in the large airing cupboard in Marley Grove to which service users had free access. The acting manager was advised to risk assess this situation and take action accordingly. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 3 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 x x 2 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 2 2 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Baxter Close (1) Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 1 2 x DS0000015080.V261939.R01.S.doc Version 5.0 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 YA6 Regulation 15 Requirement That urgent attention is paid to putting into place up to date and comprehensive care plans for all service users and to ensuring reviews both take place and accurate records are maintained of their outcomes. That service user files are audited and updated to ensure they contain relevant and up to date information on service users. That individual risk assessments on service users are reviewed and revised as necessary That adequate staff time is set aside to provide opportunities for individual developmental support work with all services users as indicated in their updated care plans. That as part of the required updating of care plans attention is paid to ensuring clearer indication of services users health and medical care needs. That notifications are consistently made to CSCI in line with the requirements of regulation 37 with regard to DS0000015080.V261939.R01.S.doc Timescale for action 31/03/06 2 YA41 17(1) 31/03/06 3 4 YA9 YA33 13(4) 18(1) 31/03/06 30/04/06 5 YA19 13 31/03/06 6 YA23 26 31/01/06 Baxter Close (1) Version 5.0 Page 31 7 YA23 17 8 YA24 23(2)(d) 9 YA24 23(2)(a) 10 YA27 16(2)(j) 11 YA30 16(2)(j) 12 YA33 18(1)(a) 13 YA39 26 allegations of misconduct by staff That urgent attention is paid to addressing the shortfalls in the management and recording of services user finances detailed in the body of this report under this standard. That if attempts to clean the lounge carpet in Marley Grove prove unsuccessful that replacement is scheduled for the next financial year. That in conjunction with the property owners the planned redevelopment of the garden area of 1 Baxter Close is completed as quickly as possible. That repairs are undertaken to the corner flooring seals in the bathroom and toilet of Marley Grove and that the area around the specialist bath is thoroughly cleaned. That better attention is paid to regular cleaning schedules in Marley Grove and that more hygienic arrangements for hand washing and drying in kitchen, bathroom and toilet areas are put in place. That MacIntyre care undertakes a formal review of the staffing levels required to adequately meet the needs of service users in the three separate units and provides a copy of the findings and intended actions in response to CSCI. That MacIntyre Care ensures visits under Regulation 26 take place at the required interval on an unannounced basis, records of such visits are maintained in the home and copies are consistently sent to CSCI. 31/03/06 31/03/06 30/04/06 31/03/06 31/03/06 30/04/06 31/01/06 Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA24 YA24 YA42 Good Practice Recommendations That thorough redecoration of the communal corridor and lounge areas of Marley Grove is scheduled for the next financial year That the nature of the cracking in the wall between the kitchen and laundry room is checked and treated as part of the planned kitchen refurbishment. That the risks posed by unshielded pipes in the airing cupboard in Marley Grove are formally assessed and action taken accordingly. Baxter Close (1) DS0000015080.V261939.R01.S.doc Version 5.0 Page 33 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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.V261939.R01.S.doc Version 5.0 Page 34 - 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. 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