Inspection on 05/06/07 for Bedrock Court

This inspection was carried out on 5th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bedrock Court 11/11/08

Bedrock Court 27/11/07

Bedrock Court 07/11/06

Bedrock Court 14/06/06

Bedrock Court 16/02/06

Bedrock Court 11/10/05

Bedrock Court 24/03/05

Bedrock Court 02/12/04

Bedrock Court 28/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Gables 3 New Road Stoke Gifford South Glos BS34 8QW Lead Inspector Paula Cordell Key Unannounced Inspection 5th June 2007 09:30 DS0000003366.V336157.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 DS0000003366.V336157.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. DS0000003366.V336157.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 3 New Road Stoke Gifford South Glos BS34 8QW 0117 9798746 01454 772171 angelinegay@gmail.com 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) Mr John Michael Gay T/A Nightingale Care Homes Mrs Angeline Linda Gay Miss Angela Joy Lake Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (1), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (1) DS0000003366.V336157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 6 persons aged 19-65 years requiring personal care only May accommodate up to 1 person with Mental Disorder who may be 65 years or over. 20th December 2006 Date of last inspection Brief Description of the Service: The Gables is one of three homes operated by Nightingale Care Homes. All three homes are owned and operated by the proprietors, Mr and Mrs Gay. The other homes within the group are Bedrock Lodge and Springfield. The Gables is a mature detached house and is registered with the Commission for Social Care Inspection to provide personal care and accommodation for six people with a learning disability aged between 18 and 65 years of age. The home is situated within close proximity of the Avon Ring Road. There are bus routes approximately 300 yards from the home. There are local shops and the home is within easy reach of Bristol Parkway railway station. Accommodation is on two floors. The registered manager is Ms Angela Lake. The fees at the time of the publishing this report range from £641.86 to £1374.27 per week. DS0000003366.V336157.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the service. The purpose of the inspection was to monitor the progress to the requirements and recommendations from the visit in November 2007 and to review the quality of the care provided to the four people living at the Gables. There have been three additional visits to the service since November 2006 and these were in respect of the general cleanliness of the home. It was evident that this has now been addressed. There have been no complaints since the last visit. The focus of this inspection visit was on the general care of a sample group of people who use the service, the environment, including an extensive tour of the premises and a review of the documentation held in the home. This provided a good opportunity to observe people who use the service as well as allowing for informal conversations with individuals and with the staff supporting them. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service and these were used as a focus for the site visit along with the pre-inspection questionnaire and the annual quality assurance audit completed by the home. In addition views were sought through surveys to relatives (2), visiting professionals (1) and people who use the service (4). The inspection was conducted over six hours. What the service does well: What has improved since the last inspection? People who use the service have benefited from more information being recorded in the plan of care ensuring a consistent approach and the plans of care have been kept under review. DS0000003366.V336157.R01.S.doc Version 5.2 Page 6 People who use the service can be confident that the home will respond appropriately to their health care needs. Individuals can be assured their safety, with risk assessments being developed and expanded. Individuals have benefited from their home being clean and free from odour. There has been a notable improvement in the homely appearance with pictures and ornaments being introduced to the home. Whilst the home has made progress to staff training including protection from abuse. Training still remains an area of concern. Due to the high staff turnover it means that often staff leave before further training is made available to them. The home has commenced a quality assurance initiative, which is looking at improving the quality of the service to the people living at the Gables. These actively seek the views of professionals and relatives and should be expanded to include people who use the service. What they could do better: There are still areas of concern relating to the environment with decoration required in some bedrooms to bring them to an acceptable standard and the replacement of some of the communal furnishings. The home should consider meaningful ways to enable people who use the service to influence the running of the home including the planning of the menu and annual holidays. People who use the service would benefit if staff had a training plan that developed core competence, which would address continual development both as individuals and as a team. Training must be linked to the needs of the individuals living in the home. People who use the service must be safeguarded and protected by staff attending training in food hygiene. People who use the service should have more control over their finances and this should be readily accessible to them with information available to their representative. Records relating to finances should be individual so as not to breach confidentiality. DS0000003366.V336157.R01.S.doc Version 5.2 Page 7 Supervision for staff should be clear and accountable and the supervisor must have knowledge of the staff member they are supervising. The manager must receive supervision and support from the provider. People who use the service must have confidence that the provider, on a monthly basis, is monitoring the quality of the service. 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. DS0000003366.V336157.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000003366.V336157.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information is available to individuals moving to the Gables. There are processes in place to ensure that the assessed needs of individuals can be met. EVIDENCE: An opportunity was taken to review the statement of purpose and the service user guide. The home has recently amended the statement of purpose to include restrictions imposed on people who use the service including the use of a keypad on the front door and the locking of the kitchen. These linked with individual risk assessments. The service user guide is available in plain English and includes pictures to enable this to be more accessible to individuals living in the home. There have been no new admissions to the home since the last visit and the home has two vacancies. Progress was discussed in relation to the filling of the vacancies. It was evident that the manager was aware of the criteria of registration and whom the home can admit and offer support and those that fall outside the category of registration. The home has an established group of DS0000003366.V336157.R01.S.doc Version 5.2 Page 10 individuals, the home must ensure that the home could meet the needs of any new person ensuring this does not compromise the care of the people already placed and that the staff have the necessary skills to the support the new individual. In addition prospective person needs to be made aware of the restrictions that are imposed on them for example the locking of the front door and the kitchen. From previous site visits it was evident that the home offers individuals a trial period of three months to ensure that all parties are happy and that the home is suitable to meet the care needs of the individual. It was evident from discussions with the manager that they would obtain as much information about the prospective person including speaking with professionals, the individual and or their relatives where appropriate which would inform the assessment process. The home has a policy to guide staff on the assessment process and this is detailed in the statement of purpose. All individuals have been reassessed by Social Services to ensure the home continues to be suitable. One individual has been assessed as requiring alternative accommodation by Social Services but still remains in the home eighteen months after this has been identified. The manager stated that some significant changes in the planning of the individual’s care have been instigated and she hoped that this decision could be reversed. As seen at the last site visit, there was information available to people who use the service and their representatives in the form of a contract and service user guide. The individual and or their representative had signed these. The contracts included details of the terms of conditions of the service, the fees payable and any additional costs. People receiving a care service contribute towards their transport cost and pay a weekly fee for toiletries. The individual or their representative had signed these. All these standards will continue to be a focus of future inspections in light of the two vacancies. DS0000003366.V336157.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 adequate. This judgement has been made using available evidence including a visit to this service. People who receive the service have benefited from the improvements in the care planning processes. Whilst there is some evidence that individuals are involved in some decision making such as day to day living and social activities this is limited in relation to the long term planning of their care. EVIDENCE: An opportunity was taken to review two individual’s care documentation. Information has been expanded and reviewed since the last inspection in response to a number of requirements. Care documentation had been reviewed and updated. The manager stated that she formally reviews the care on a monthly basis, six monthly and annually. All care plans had been updated in the last six months. The manager stated that the day care manager organises individual program plan meetings annually. The individual, relatives and professionals involved in the care are invited to a DS0000003366.V336157.R01.S.doc Version 5.2 Page 12 meeting to discuss and plan for the forth-coming year. There was no documentation in the home supporting this. It would be recommended that copies be kept in the Gables. Risk assessments are in place detailing how the home supports individuals in keeping safe. These have been updated and reviewed since the last inspection. It was noted that care plans and the manager or the key worker had not signed risk assessments or care plans. The manager stated that individuals are encouraged to make decisions on a daily basis re food, what to do and when to get up and go to bed. However, decisions tended to be about refusals rather than informed choices. For example there is limited choice at mealtimes but if an individual did not like what was on offer an alternative would be offered. The manager stated that the provider makes some decisions relating to the running of the home and individuals’ lifestyles. For example the manager stated that the planning of the annual holiday, menu planning and the purchase of furniture is done with little input from the individuals living at the Gables. A recommendation from the previous visit was for the home to consider meaningful ways to enable individuals to extend their influence in the running of the home including regular meetings, menu planning and the planning of activities and holidays. This remains outstanding. The manager stated that she has organised one house meeting but it was not successful with only one person really taking part, and is considering alternative ways of seeking the views of the individuals. This will be reviewed at the next visit to the service. DS0000003366.V336157.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. There have been some improvements across this group of standards and individuals have available to them meaningful activities. However, the senior management team is making some fundamental decisions that people receiving care service could be supported to make. EVIDENCE: Individuals have a structured activity plan. Three out of the four individuals receive day care from staff working in the home whilst the fourth attends a day centre four days a week. Activities were varied and reflected the different interests of the individuals and included arts and crafts, cooking visiting shops and swimming and relaxation in the multi-sensory room. DS0000003366.V336157.R01.S.doc Version 5.2 Page 14 Individuals were seen to be taking part in the organised activities, one person was offered swimming but had refused and a shopping trip had been organised instead. Staff confirmed that the activities were regularly taking place. However this was not captured in the daily records. The manager stated that trips are now being organised in the evening and weekends at least once a month. This was confirmed in daily records. An individual stated that they had been to the circus and it had been a good evening. Further activities and trips were being organised. Family contact was noted in the plans of care. Completed surveys from relatives gave positive feedback about the care received, including making them welcome when they visited. One area for improvement was noted which was to keep relatives informed about finances, without being asked. As discussed later in this report this information is not readily available in the home but kept at Bedrock Lodge. The menus were viewed. Whilst these demonstrated that residents were offered a varied and healthy diet, the provider drew these up in consultation with a nutritionist. It was difficult to ascertain how people receiving a care service are involved in the menu planning although the manager was very clear that if there was anything that a person did not like an alternative would be provided. A record was maintained confirming that alternatives were offered to the planned menu. A concern was raised at the last, and this visit, that the night staff had prepared the sandwiches for the lunchtime. This does not promote individuals having choice or involvement in the making of their lunch. As there are only four individuals this practice should cease ensuring people can have choice and some level of involvement. DS0000003366.V336157.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): 18,29,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that their personal and health care needs are being met and they are safeguarded in relation to the administration of medication. Daily records do not fully capture the service being provided or the individual’s emotional wellbeing, which could lead to shortfalls not being addressed or reviewed. EVIDENCE: There have been significant improvements to the plans of care relating to personal and health care monitoring. People receiving a care service now have a health action plan detailing their support needs and a personal care statement pertinent to them. Evidence was provided that these were being continually reviewed and monitored. Records had been maintained up to April 2007 in relation to personal care. However, these had not been fully completed since. Staff stated that all DS0000003366.V336157.R01.S.doc Version 5.2 Page 16 individuals are offered a bath on a daily basis and in accordance with their personal care statement. The manager stated that this would be followed up to ensure that all staff are aware. The manager felt the reason was that the home has a number of new staff in post. Good evidence was provided that individuals were attending health-screening appointments with the GP, dentist and opticians. In the past the home has sought advice from a continence advisor. The home has responded to the requirements from the last visit and expanded some of the care plans offering staff more guidance. Staff stated that the key worker role is in operation in the home and each person has a named staff member to support them with purchasing of clothes and to support them to maintain contact with relatives. Health professional feedback was positive in relation to seeking and acting upon advice. However, a concern was raised about the skills of the staff. It was noted that there has been a high staff turnover of staff and the manager has stated this has made it difficult to ensure that training is in place. This will be discussed further in the standards relating to staffing. Accident records were seen. The home is informing the Commission for Social Care Inspection of incidents that affect the wellbeing of the individuals living in the home in accordance with regulation 37 of the Care Homes Regulations. Records relating to stock and the administration of medication were found to be satisfactory. All medication was stored appropriately. Each person had a medication profile and risk assessment relating to the administration of medication. The information was informative and detailed to enable new staff to support individuals. Staff competence is routinely checked in respect of safe administration of medication. This was evidenced via conversations with the manager and the home’s records. The home has responded to a recommendation from the last site visit to ensure that records of competence were maintained. The manager stated that some of the individuals are administered vitamins as part of the home’s homely medication policy. In response to a recommendation the home has clearly documented the reason for the vitamins and consultation with the prescribing GP has taken place. Discussion with the manager took place in relation to the use of as required medication to sedate individuals when having medical interventions and the ability of the individual to consent. The manager was able to articulate and provide documentation supporting the decision process, which included consultation with the GP and the psychiatrist. The manager stated that this was only used as a last resort and in the best interest of the individual and in DS0000003366.V336157.R01.S.doc Version 5.2 Page 17 consultation with the professionals. The manager stated that she is attending a course on the new Mental Capacity Act, which will offer further guidance and inform the practice in the home. People who receive a care service are supported to access a consultant psychiatrist. Letters were seen confirming this. The manager stated that a psychologist referral has been made in respect of one individual to review the support in relation to the behaviours that are exhibited. A concern is that there is no guidance for staff in relation to this specific behaviour. The manager stated that the behaviour has decreased but it was not clear if staff were fully capturing the incidents, as the inspector was lead to believe that this was a daily occurrence by staff on previous visits. There were some inconsistencies in the recording of episodes of challenging behaviour. An incident was reported to the Commission for Social Care Inspection by the home and it was tracked through the home’s documentation. It was noted that there was documentation in the daily diary but not on the behaviour-recording chart in accordance with the home’s standards. DS0000003366.V336157.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some improvements, in relation to staff training and guidance on the protection of the individuals living in the Gables. Confidentiality could be breached in relation to their financial affairs. EVIDENCE: According to the home’s records, there have been no complaints since the last inspection and the Commission for Social Care Inspection has received none. The home has a policy on protection of vulnerable adults, which meets the National Minimum Standards as seen at the last inspection. It was noted that the home has copies of the local authority’s procedure on protection. This is good practice. The home has a plan for ensuring all staff attend a course in protecting people receiving a service from abuse. The home has demonstrated that four out of the seven staff have received this training. Three staff have only started working in the home within the last month. Reassurances were given that this would be undertaken at the earliest opportunity. The manager stated that she is completing a course for managers, with the local council, on protection of adults from abuse. Staff files demonstrated that they have received training in supporting individuals that challenge and this has been updated annually for four of the seven staff. Again three of the staff have only been working in the home for DS0000003366.V336157.R01.S.doc Version 5.2 Page 19 less than a month. The manager stated that this training would be given promptly but as yet no date was available. Two of the staff are under eighteen years of age and are unable to attend the training. Consideration should be taken whether working in the home is appropriate in relation to the level of challenging behaviour. A risk assessment must be devised giving clear clarity to their role in that they make up the staff numbers. An opportunity was taken to review the record of restraint. It was noted that the use of restraint has been reduced and the manager confirmed that this was only used as a last result. It was disappointing to note that the restraint record had the organisation’s old policy and not the up to date and current policy, which had been amended in response to a requirement at the last site visit. This was addressed at the time of the inspection. At the last inspection it was noted that there is no money in the home that belongs to the people who receive a service. This is held at Bedrock Lodge. The manager stated that individuals can have money at all times and this is taken from a petty cash budget and the home is reimbursed by the individual’s funds. Whilst this may be deemed as safe practice by the organisation, this means that individuals have little control over their overall finances and the staff are not fully able to assist them with budgeting, as information relating to their accounts is held at Bedrock Lodge. The manager stated that individuals are free to see this information whilst they are at Bedrock. As already mentioned a relative commented that they would like to receive regular information about the financial affairs of the person receiving a care service. It was noted that the records held in the home contained all the names of individuals and there could be a breach of confidentiality if this was shared with relatives. The home must ensure that each person has their own record of expenditure rather than all four persons contained on one sheet along with the household expenditure. DS0000003366.V336157.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a significant improvement in this area, the home was clean and free from odour and provided a safe place to live. However, the staff must continue to explore ways that the home can be more homely and a comfortable place to live. EVIDENCE: The Gables is a detached property in keeping with the local neighbourhood. The home has responded to a requirement to remove the padlock from the front gate and a doorbell has been fitted to the front door. This assists with the home having a more ordinary appearance. The front door is fitted with a key code so in theory residents cannot leave the building unsupervised. Documentation was in place in the form of individual and organisational risk assessments on the use of the keypad for the front DS0000003366.V336157.R01.S.doc Version 5.2 Page 21 door. In addition the locking of the front door is now written in to the home’s statement of purpose, which states that if individuals were assessed as able they would be given the key code. The manager stated that presently all the people receiving a service need support when out in the community. Concerns were raised about the cleanliness of the home in November 2006. This led to the Commission for Social Care Inspection completing further random visits to the service as part of the inspection process. It was noted at this inspection that the home was clean and free from odour. The four bedrooms presently in use were viewed. Furniture was looking old and worn out. Two of the bedrooms were in need of re-decoration as noted at the last inspection, one in particular felt cold due to the lack of furniture, the choice of colour scheme and the flooring. Two of the bedrooms had borders that were child like as noted in November 2006 and again on this visit. Staff stated that the individual or their family had chosen the border. There is a risk that individuals would be perceived not as an adult and in one individual’s situation does not promote choice, which has been made by his relatives. Consideration should be taken to make these areas more homely. Communal areas contained a mixed match of furniture however, the staff have made efforts to make these areas more homely with pictures and ornaments being introduced. This must continue. Good practice would be for the home to have a budget to purchase new furniture in the communal areas and that the individuals living in the Gables had some choice and involvement in this process. The manager stated that the sofa in the smaller lounge has been put in the larger lounge as the old one was in a poor state of repair and had been removed. This meant that the smaller lounge looked empty of furniture. It was noted that the dining chairs are of a type, which would normally be found in the garden, as noted at the last inspection. The home has adequate bathroom facilities and these contained toilet rolls, soap and hand towels in response to a requirement from the last inspection. In addition the home has alleviated the damp to one of the ensuite bathrooms. The repair book demonstrated that there was a good response to repairs. The laundry facilities were seen and found to be clean and well ordered. Staff stated that they were adequate to meet the needs of the residents. DS0000003366.V336157.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staff support the individuals living at the Gables. The high staff turnover means that there is an inconsistency in training which links to the needs of the individuals living in the home. There have been some improvements since the manager has commenced in post. There are systems for staff and direction. EVIDENCE: Since the last inspection three members of staff have left and a further staff member was leaving the month after the inspection. Three staff have left due to personal reasons/career changes and one person was dismissed due to work performance. The manager stated that new staff have been appointed and are now completing their induction. One member of staff was working her second shift. The manager stated that the new member of staff would work alongside a more experienced member of staff for the first two weeks. This was confirmed on the duty rota and was in addition to the staffing numbers. DS0000003366.V336157.R01.S.doc Version 5.2 Page 23 Two staff are under eighteen years of age. The manager and staff confirmed that they were not left in charge of the home and were not involved in personal care and their main focus of their role was social activities. As discussed early in this report the home must complete a risk assessment in relation to their role. The home has adequate staffing to meet the needs of the people receiving a care service both individually and collectively. The home has three staff in the morning and two staff in the evening with one member of staff providing waking cover at night. This was in accordance with the statement of purpose and evidenced via the home’s duty rota. Recruitment records were not viewed on this occasion as these are held at Bedrock Lodge and will be subject to inspection on the next visit to Bedrock Lodge. Inductions were taking place for the new staff with records being maintained. This included a three-day course conducted by the provider and this covered a wide range of areas. The manager stated that further training was planned for the three new staff on supporting individuals that challenge and the protection of abuse organised by the local council, as yet no dates were available. It was noted that no members of staff have a recognised qualification in food hygiene and only five of the eight staff have a current first aid certificate. Training has been an outstanding requirement in relation to ensuring that staff individually and collectively have an ongoing training plan. Due to the high staff turnover this has been an ongoing issue as staff leave and the home has to complete the cycle of training from the beginning. However, there was still no evidence that staff have attended any training in mental health, autism or specific training relevant to the needs of the individuals living in the Gables. This is an outstanding requirement. The manager stated that she is in the process of completing appraisals for the staff she is responsible for supervising. However there was no evidence that this had informed the training plan for the staff member or the home. Two staff have an National Vocational Qualification, which includes the manager. The manager stated that the intention is for staff to commence their NVQ once they have completed their induction however due to the high staff over, achievement to this standard has been hampered to ensure that 50 of the workforce has an NVQ in care. A review should be completed on the reasons for the high staff turnover. It was noted that the home is not completing the Learning Disability Award Framework in line with the National Minimum Care Standards and Sector Skills Council (Skills for Care) Standards. Supervision of staff has been an ongoing requirement and due to records being held at Bedrock Lodge the inspector was unable to ascertain whether DS0000003366.V336157.R01.S.doc Version 5.2 Page 24 compliance has been achieved. This will remain a requirement and followed up at the site visit to Bedrock Lodge. Discussion with the manager highlighted that she does not supervise all her staff and that this may fall to other senior management from within the organisation. The manager stated that she does regularly meet individually with her staff team to discuss progress and issues relating to the care of the individuals but this is done informally with no records being maintained. Consideration should be taken to ensure that the appropriate manager is supervising staff, as the registered manager or a person working in the home would normally conduct this responsibility. DS0000003366.V336157.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has improved under the direction of the new manager. Concerns remain about the decisions processes, which could be cascaded from the provider to the registered manager and the individuals living in the home, which would empower and value the people in the Gables. EVIDENCE: Ms Lake the registered manager has been in post since February 2006 and was registered with the Commission for Social Care Inspection in May 2006. There have been some improvements since the last inspection in relation to the requirements that have been in her control and have been met. Ms Lake is in the process of completing her National Vocational Qualification 4 in care and the Registered Managers Award. DS0000003366.V336157.R01.S.doc Version 5.2 Page 26 Whilst the provider has developed an improvement plan this addresses only the requirements from the previous site visit and not how the service plans to develop and move forward to meet the governments philosophy of supporting individuals with a learning disability in a way which fully engages the individual, encourages independence and values the individual. Discussions with the manager and staff have provided evidence that some major decisions about lifestyles are being made by the provider as described early in this report and this dis-empowers individuals. The manager is seeking a course on empowerment, which she hopes to cascade to her staff team. This remains an outstanding requirement. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the people who receive a care service in respect of regulation 37. There has been a significant improvement in the Fire Records. All checks and training are being recorded in accordance with the fire brigade’s recommendations. However, the home must be mindful to keep the fire risk assessment under review. Policies and procedures have been through a process of review and newly implemented in May 2006. Quality assurance initiatives have been introduced since the last inspection, including reviews of the environment, medication and care planning audits. In addition the home sends annual audit questionnaires to relatives and professionals. Feedback seen was positive. Less apparent was provider visits in respect of regulation 26 monthly visits. The last report available in the home was January 2007. Whilst staff said they had regular contact with the provider at Bedrock Lodge less apparent was visits by the provider to the home. The provider has a legal responsibility to review the quality of the care provision provided to the individuals at the Gables. The manager could not recall the last time that she had received supervision from the provider in respect of her role. All staff should receive at least six supervisions per year. DS0000003366.V336157.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 2 13 2 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 2 3 3 2 X DS0000003366.V336157.R01.S.doc Version 5.2 Page 28 Yes 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 YA6 Regulation 15 (1) Requirement Develop a clear plan of care relating to one individual’s challenging behaviour ensuring a consistent approach. To review and give staff guidelines on what should/must be included in the daily care records demonstrating that individual’s social, personal and health care needs are being met. The registered manager shall undertake from time to time such training as is appropriate to ensure that she has the experience and skills necessary for managing the care home. (The registered manager to attend training in care planning and empowerment). (Outstanding 08/02/07) 4. 5. 6. YA28 YA28 YA25 16 (2) (c) 23 (2) (i) 16 (2) (c) 23 (2) (i) 23 ((2) (b) Provide comfortable seating to the lounge, which is suitable to the needs of the individuals. Replace dining room chairs and table. Decorate bedrooms as identified at the last inspection. DS0000003366.V336157.R01.S.doc Timescale for action 05/07/07 2. YA6 15 (1) 05/07/07 3. YA6 10 (3) 05/09/07 05/07/07 05/07/07 05/09/07 Version 5.2 Page 29 7. YA35 18 (1) (c) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. (Develop training plans for all staff to include mental health, epilepsy, autism and communication and ongoing health and safety training for the individual staff member and the home collectively. Ensure staff receive this training within a reasonable timescale ensuring that this training is delivered by a competent person by 08/03/07.) 05/08/07 8. YA36 18 (2) The registered person shall ensure that persons working at the care home are appropriately supervised. (outstanding since 08/01/07) Staff to attend an accredited training course in Food hygiene For the provider to complete monthly visits in respect of quality monitoring. Copies to be sent to the home and the Commission for Social Care Inspection. For the manager to keep the fire risk assessment under periodic review. For service users to have an individual record of their finances and for the finances to be held in DS0000003366.V336157.R01.S.doc 05/06/07 9. 10. YA35 YA39 18 (1) (c) 26 05/09/07 05/07/07 11. 12. YA42 YA23 13 (4) 12 (4) 05/07/07 05/07/07 Version 5.2 Page 30 the home. 13. YA32 18 (1) (a) For the home to risk assess the role of staff working in the home under 18 years of age in relation to supporting individuals that challenge and their role in the home. 05/07/07 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 YA7 Good Practice Recommendations The manager should consider meaningful ways to enable the residents to extend their influence in the running of the home including regular meetings, menu planning and the planning of activities and holidays. (Outstanding since inspection in January 2007) 2. YA23 The provider/manager should consider ways to enable people receiving a care service to have more control over their personal finances within the management of risk and that information and individual’s finances are held in the home. (Outstanding since January 2007) 3. 4. YA35 YA26 For staff to complete the Learning Disability Award Framework as part of their induction in line with Skills for Care. Ensure staff receive structured and recorded supervision at least six times per annum from a competent and relevant person. Devolve the responsibility for carrying out structured supervision to the registered manager. (Not followed up as records held at Bedrock) 5. YA36 For the provider to ensure adequate supervision and support to the manager. DS0000003366.V336157.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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