Inspection on 06/06/07 for Boxgrove

This inspection was carried out on 6th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Boxgrove 12/02/07

Boxgrove 07/07/06

Boxgrove 17/10/05

Boxgrove 03/05/05

Boxgrove 26/01/05

Boxgrove 11/11/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 Boxgrove Little Heath Road Tilehurst Reading Berkshire RG31 5TY Lead Inspector Stephen Webb Unannounced Inspection 6th June 2007 10:00 DS0000011190.V340671.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 DS0000011190.V340671.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. DS0000011190.V340671.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Boxgrove Address Little Heath Road Tilehurst Reading Berkshire RG31 5TY 0118 943 1019 0118 945 4669 judiclark@choiceltd.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Choice Limited ****Post Vacant**** Care Home 10 Category(ies) of Learning disability (0) registration, with number of places DS0000011190.V340671.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 10. Date of last inspection 12th February 2007 Brief Description of the Service: Boxgrove is a purpose built care home for 10 adult men with severe learning difficulties. The home is situated on the outskirts of Tilehurst in Reading and is surrounded by open countryside. The home has an extensive garden which service users are encouraged to use and provides opportunities for horticultural activities. A separate day care building is situated on the site and provides a range of day care activities for service users. The staffing ratio is high to meet the complex needs of the service users. Staff have access to a range of training and the provider has facilitated access to NVQ training for staff. The current scale of charges as at February 2007 is between £1695.00 and £1995.29 per week. There are additional charges for toiletries, chiropody, meals out and holidays. DS0000011190.V340671.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.00am until 7.00pm on 6th of June 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with staff members on duty, and briefly with the manager. None of the residents present during the inspection were able to communicate verbally with the inspector, to a significant degree. Some time was therefore spent observing the interactions between residents and staff at various points during the inspection and over lunch with the residents. Written feedback was obtained from the relatives of three of the residents, who raised a range of concerns, which centred around aspects of the past practice in the unit. The current manager is proposing to provide a quality assurance questionnaire to relatives and other parties to try to explore any remaining areas of concern. The inspector also toured the premises, and ate lunch with the residents. What the service does well: It was not possible to examine the current preadmission assessment procedure in action, but according to the current written procedure, the needs and wishes of prospective residents would be appropriately assessed prior to admission. Residents are supported to take appropriate risks within a risk assessment framework, which will be better integrated into the new care plan format once these are in place for each resident. Some of the residents have regular family contact and visits, and arrangements are being made for two residents to attend a self-advocacy group. Residents are offered a varied diet and some culturally appropriate meals have been identified and provided for one individual as well as being available to the others as an option. The individual preferences of residents regarding how they are supported, are detailed within the new care plan format which is being gradually introduced for all residents. DS0000011190.V340671.R01.S.doc Version 5.2 Page 6 The home has an appropriate system in place to manage the medication on behalf of residents, and to protect residents from abuse. Staff now receive a detailed induction and a good core training package, though there remain some gaps which are being addressed by the manager. Residents are protected by the rigorous recruitment and vetting procedure and appropriate records of this are retained. The health, safety and welfare of residents are promoted by the home. What has improved since the last inspection? Since the previous inspection the provider has provided a detailed improvement plan to address the range of requirements previously made, and has addressed the majority of these effectively. There remains some issue regarding unpleasant odour in some areas, despite a range of strategies having been tried, which is the subject of a further requirement here. The new care plan format being rolled out by the new manager identifies the needs, likes and dislikes of residents in detail and includes identified goals, which will be reviewed periodically to assess progress. Improvements are being made to the level of consultation and involvement of residents in their day-to-day lives, though these improvements will need to be sustained, in order to address previous concerns expressed by some of the relatives. The level of activities and community access for residents has improved, but there remains room for further development in these areas, and the service has some plans already in place to address this. The rights of residents are more respected, and they are being encouraged to take greater responsibility for daily tasks and routines. Residents are also being encouraged to have more involvement in choosing the menu and in others aspects of food and meal provision. There are also improvements in how the healthcare needs of residents are met by the home, via the new formats being introduced, though these have yet to be put in place for all of the residents, to maximise the level of staff understanding of these issues for each individual. The views of residents and others now appear to be heard, where they are able to express them. Some improvements have been made to the environment including more regular cleaning in some problem areas. A detailed fire risk assessment has been completed. DS0000011190.V340671.R01.S.doc Version 5.2 Page 7 Residents are supported by a core of longer-term staff, some of whom have returned, having left previously, and staff retention has improved under the new manager. Levels of NVQ attainment are also improving. In general, the home appears to be being run more effectively in the interests of the residents than was evident under the previous manager. The new manager has identified appropriate priorities for change and begun to effect these, and there have been improvements in staff morale and motivation. The views of residents and others are being sought more systematically, though there remains room for improvement in the QA system. The new process of seeking the view of residents, relatives and others should help to improve the image and perceptions of the unit, and enable more effective communication between the service and its customers. Under the new manager the unit is likely to be more able to meet the cultural or spiritual needs of residents more effectively through improvements in consultation, and advocacy input, as well as through the improved morale of the staff group in general. What they could do better: The manager should continue to develop the level of resident’s access to activities and community events in order to maximise their community presence. The provision of external validated medication training for all staff should be considered by the provider. The proposed development of more accessible versions of the complaints procedure and the planned self-advocacy input will be of further benefit to the residents. Appropriate training on protecting vulnerable adults, needs to be provided to staff who have not received this recently and updated to all staff on a regular basis. Any other identified gaps in staff core training, need to be addressed. Additional work remains necessary to maximise the potential of this unit with regard to its physical condition in some areas, and the provision of appropriate en suite facilities for one resident. Some of these matters are in hand, but some require additional input to provide an appropriate environment. The residual urinary odour issues remain of some concern, despite the strategies tried to date, which have reportedly achieved a reduction in the problem. Appropriate steps also need to be taken to address a proliferation of ants in one en suite facility. DS0000011190.V340671.R01.S.doc Version 5.2 Page 8 The exterior environment is attractive but also would benefit from further development, in particular the planned provision of additional shade. The provider should consider the production of a summary report of the findings of the quality assurance survey, detailing any action plan arising, and make it available to participants to encourage an open dialogue. The manager should discuss and agree the unit’s night-time fire evacuation plan with the fire authority. Copies of accident records should be filed on the relevant resident’s case record, in addition to being filed collectively for monitoring purposes. 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. DS0000011190.V340671.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000011190.V340671.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and wishes of prospective residents would be appropriately assessed prior to admission according to the current procedure. EVIDENCE: Examination of the files of two residents indicated that a full preadmission assessment was present on one file, together with a later summary for the most recently admitted resident (2005). The other resident had been admitted in 2002 and the assessment had since been archived, but the current care plan was comprehensive with regard to their needs and wishes. The current pre-admission assessment process, (as described within the AQAA, pre-inspection questionnaire), was thorough and appropriate. Within the AQAA, (pre-inspection questionnaire), the manager also described An appropriate process. DS0000011190.V340671.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): Standards 6, 7 and 9: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs, likes and dislikes of residents are identified in detail within the new care plan format being rolled out by the new manager. The format also includes identified goals, which will be reviewed periodically to assess progress. It is evident that the level of consultation and involvement of residents in their day-to-day lives are improving, though these improvements will need to be sustained, in order to address previous concerns. Residents are supported to take appropriate risks within a risk assessment framework, which will be better integrated into the new care plan format once these are in place for each resident. EVIDENCE: A detailed new care planning format is in the process of introduction by the new acting manager, which has a positive focus on residents’ abilities as well as recording their individual likes and dislikes. DS0000011190.V340671.R01.S.doc Version 5.2 Page 12 The new format is being rolled out thoroughly and so far only a few have been completed, but the manager was keen to ensure that staff fully understood the reasoning behind them and had time to read them in detail to maximise awareness and consistency of approach. The new format is detailed and positive and its various components now give a picture of the various aspects of the individual, including their interests, skills, communication, support needs and any preferences for how these are met, activities, family contact and healthcare needs. Components include “What I enjoy”, “what is important to me” and “what I really don’t like”, which are evidence of improved consultation with residents where possible, and they also record observed preferences where known. The new care plan is supported by other documents including individual risk assessments and behaviour management plans where necessary, which are cross-referenced to, within the file. The plan format also sets measurable goals, which are to be followed up via action point monitoring and at reviews. Evidence of provision for individual’s cultural and spiritual needs is included within the new care plan format. The manager indicated that the provider has written policies and procedures to promote equality and diversity. As well as the individual risk assessments, there is also a risk management plan summary for the individual. The manager indicated that risk assessments would be used creatively, to enable the residents to experience activities outside their comfort zone. The completion of the remaining care plans to this format would be a positive step in improving the continuity and consistency of approach of the staff team, who are being given more responsibility and opportunity to be involved in these processes under the new manager. The new plans are also evidence of a change in attitude to residents, towards their greater consultation and involvement and the recognition of their rights, which appears to have been lacking under the previous manager. Residents were observed being encouraged by the staff to make some choices, during the inspection. Feedback, in this area, from three residents’ relatives was not very positive and the service will need to demonstrate sustained improvements in most areas, in order to meet their expectations. In particular, dissatisfaction was expressed about the level of access to places of worship, and to the community in general. Some concerns were raised DS0000011190.V340671.R01.S.doc Version 5.2 Page 13 about the level of choice available to residents, though it was acknowledged to be hard to determine for some individuals. Some dietary concerns were also raised, (which in at least one case appeared now to have been resolved), as well as failures in communication, and high levels of staff turnover and inconsistency of approach by the staff were also of concern. During the inspection there was evidence of improvements in many of these areas and the potential was there, for further development. The new manager should ensure regular contact with residents’ families, where possible, in order to communicate the changes being introduced. The manager indicated a range of areas where consultation with residents was being improved, including regular residents meetings, where action points are recorded and implemented, monthly keyworker meetings with residents and the quality assurance questionnaires. Changes in response to residents’ feedback had been made, according to the manager, around redecoration, residents’ holidays, menu planning and activities. The manager also identified other planned improvements within the AQAA (pre-inspection questionnaire), such as having a picture board version of the rota, showing who was on duty each day, increased meal choice and the provision of a range of sitting/eating areas to enable more choice. None of the current residents is able to manage their own finances and the home manages these on their behalf within an appropriate recording system. However, under the previous manager, the provider undertook an audit of residents’ finances, which resulted in reimbursements of some monies where funding should have been included in the fees rather than coming from residents’ personal allowances. During this inspection a small number of additional records of expenditure were identified, (having occurred prior to the tenure of the current manager, but after the above-mentioned audit), which required further examination. The provider undertook a prompt review of these remaining issues and discussions with CSCI are ongoing. No items of concern were noted in the period since the appointment of the current manager. DS0000011190.V340671.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 15, 16 and 17: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been improvements in the level of activities and community access for residents but there remains room for further development in these areas, and the service has some plans already in place. Some residents have regular family contact and visits, and arrangements are being made for two residents to attend a self-advocacy group. The rights of residents are generally respected and they are being encouraged to take greater responsibility for daily tasks and routines. Residents are also being encouraged to have more involvement in choosing the menu and in others aspects of food and meal provision. They are offered a varied diet and some culturally appropriate meals have been identified and provided for one of the residents. DS0000011190.V340671.R01.S.doc Version 5.2 Page 15 EVIDENCE: The new care plan format being introduced includes records of leisure activities, use of the community and family contact as well as identifying any specific areas of interest. The action plan system within these new care plans could also be a useful tool for identifying and encouraging further developments in residents’ activities and community access. Each resident has an activity plan in place as part of the care plan. Day care is provided on-site within a separate building, which offers a range of activities within several separate areas, as well as a sensory room. However, at present a single day care worker runs this service, so day care tends often to be provided in turn to the residents rather than simultaneously, which also fails to make the best use of the potential of the available building. There are proposals to employ an additional day care organiser, which would be of significant benefit to the residents in terms of broadening the opportunities for both on and off-site activities. During the inspection two residents were escorted to go swimming, and one later accompanied a staff member on a shopping trip. One resident is a volunteer at a local church hall café, one day per week and another attends a supported voluntary work placement alongside the in-house maintenance man. The activities records indicated a variety of in house and community activities including swimming, cinema, skating, pub visits, walks, shopping trips, playing football, bus and train rides, social clubs, theatre and music sessions. A wheelchair-using resident goes to wheelchair ice-skating sessions. At present there were only three authorised drivers for the two unit vehicles, which presents some limitations on the level of community access. If this is not already included as a desirable characteristic within the person specification, this should be considered to try to increase driver numbers in the team. As noted elsewhere, the use of taxis is expensive and taxi tokens are in limited supply, so all other options need to be effectively utilized. The manager identified some plans for improvements in the area of activities, day care and community access, within the AQAA pre-inspection document. None of the residents has an external advocate at present, though applications have been made for two of the residents to attend an external self-advocacy group, and funding is being sought for this. Where specific issues arise, such as the bedroom swap discussed during the inspection, the input of external advocates could be considered as part of this process to ensure all of the possible aspects are explored from the point of view of the residents. DS0000011190.V340671.R01.S.doc Version 5.2 Page 16 It was noted that attendance at an appropriate place of worship, was included in the plan for one resident in order to address their spiritual needs. Though no other such needs were identified, the inspector felt that the service would seek to address these, should they arise. Regular family links were only in place for three or four of the current residents, with limited or no contact for the others. Keyworkers maintain some telephone contact where possible and family are invited to reviews. Residents have a choice of two main meals each day and on Fridays, individual residents have their own choice in rotation. Choice is supported using photographs, and now that the unit has a digital camera the range of meal photos is to be increased, which will hopefully support increased involvement in the wider menu planning. One resident is provided with culturally appropriate meals once or twice a week, with this option also being offered to others as one of the choices that day. Others also choose meals they like with staff support. A number of suitable recipes had been printed off the internet and laminated, for reference by the cook, who was an enthusiastic advocate of the residents’ need to have choices in this area. The cook and the majority of the care staff have received food hygiene training, and five staff were booked to attend the training in July. DS0000011190.V340671.R01.S.doc Version 5.2 Page 17 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): Standards 18, 19 and 20: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The individual preferences of residents regarding how they are supported, are detailed within the new care plan format which is being gradually introduced for all residents. There are also improvements in the available evidence of how the healthcare needs of residents are met by the home, via the new formats being introduced, though these have yet to be put in place for all of the residents, to maximise the level of staff understanding of these issues for each individual. The home has an appropriate system in place to manage the medication on behalf of residents, though the provision of external validated medication training for all staff should be considered. EVIDENCE: As already noted, the new care plan format being introduced gradually, incorporates good levels of detail on the individual support needs and preferences of residents, where it is in place, and the manager indicated that the new format would also be introduced for the remaining residents. DS0000011190.V340671.R01.S.doc Version 5.2 Page 18 There were improvements in the details of individual communication methods, and in recording the current level of skills of the individual as a baseline upon which to develop; as well as the inclusion of information about the individual’s preferences about how support is provided to them, where these can be identified, though by necessity, some of the content is the observations and impressions of the staff, from their knowledge of the individual. The CTPLD speech and language therapist has also provided training to the staff on the range of communication methods used by the residents, (uncertificated as yet). Improvements in the recorded details regarding the physical and psychological healthcare needs of the residents were also noted within the files where the care plans have been upgraded, and again the remaining files will also be improved once they too, have been upgraded. A health action plan was also in place together with records of any healthcare appointments attended. For one resident written agreements had now been sought for the use of a monitoring device at night in case of seizures, though a response from the care manager was still outstanding. The manager was exploring the benefits of other, more specialist types of seizure monitoring device, via the advice of the psychologist. Some staff have undertaken accredited medication training previously, which they then cascaded to other staff, but the manager is seeking external validation of the competence of the management team, to enable them to assess the competence of staff with regard to medication administration. However, it remains best practice for all staff to receive external validated training on medication, from someone, such as a pharmacist, as this ensures that the trainer remains up to date at all times on the wider aspects of training around medication, in addition to basic administration competence. Staff have also received training on emergency epilepsy medication and the manager reported she is exploring the appropriateness of the newer oral alternatives to the current medication. None of the residents is able to self-medicate, but the home has an appropriate system in place to manage this on their behalf, which provides an appropriate medication audit trail, via the MAR sheets and stock control records for non-blister packed medication. The home uses parallel MAR sheets for recording the administration and witnessing of all medication. DS0000011190.V340671.R01.S.doc Version 5.2 Page 19 A staff initials sheet is now in place to identify the initials of the staff who administer medication and written medication assessments of staff are undertaken. The medication file includes individual photos and medication profiles. Letters were seen on file, regarding the authorisation of homely remedies by the GP. This is good practice. The pharmacist visited in September 2006 to assess the management of medication systems and was satisfied. DS0000011190.V340671.R01.S.doc Version 5.2 Page 20 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): Standards 22 and 23: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the views of residents and others now appear to be heard, where they are able to express them, the proposed development of more accessible versions of the complaints procedure and the planned self-advocacy input will be of further benefit to the residents. The service has systems in place to protect residents from abuse, but appropriate training in this area needs to be provided to all staff. EVIDENCE: The Commission has not referred any complaints to the service for investigation, since the last inspection. However, as already noted, inspection feedback received from three relatives indicates some underlying dissatisfactions regarding the service previously provided, (detailed earlier within care planning section), which will need to be addressed by the new manager. The manager’s plan to undertake a new quality assurance survey (see later in report), might provide an opportunity for these issues to be addressed in detail. The service has an appropriate complaints procedure in place, and the complaints log showed the last recorded complaint in October 2006, which appeared to have been addressed appropriately. DS0000011190.V340671.R01.S.doc Version 5.2 Page 21 In conversation with the new manager, a more recent issue, relating to trees overhanging the roadway, came to light, which should also be entered in the complaints log together with the details of its resolution. A more accessible version of the complaints procedure, to assist in explaining this to residents was said by the manager to be under development, though there was a version of the procedure in the service user guide, which was a combination of symbols/pictures and text. The manager described a complaints/feedback format she was working on, with advice from the speech and language therapist, with separate versions for those who are and are not able to express their needs verbally. This format might also lend itself to being used as part of the quality assurance system to seek the views of the residents on wider issues. As already noted places for two of the residents are being sought on an external self-advocacy group, which would be a positive step in supporting them to be able to express their wishes more effectively to staff. There had reportedly been no adult protection issues in the period since the new manager took up her post. The provider has a procedure in place for protecting vulnerable adults. Most staff have received or were booked to receive POVA (protection of vulnerable adults) training, though for some this appeared to have been over two years ago. The provision of adult protection training to all staff, by an accredited trainer, must be a priority and consideration should be given to regular, even annual updates thereafter. DS0000011190.V340671.R01.S.doc Version 5.2 Page 22 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): Standards 24 and 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there have been improvements in the environment, additional work is still needed to maximise the potential of this unit in some areas, with regard to its physical condition, the residual odour issues and the provision of appropriate en suite facilities in one case. Some of these matters are in hand, but some require additional input to provide an appropriate environment. The exterior environment is attractive but also would benefit from further development, in particular the planned provision of additional shade. EVIDENCE: The communal rooms were homely and most furnishings were satisfactory. Residents had been involved in choosing the colour scheme in some areas. There were several light and airy communal rooms providing alternative quiet rooms away from the group or space to eat alone if preferred, and a piano and drum kit were also available for residents to play in different areas. DS0000011190.V340671.R01.S.doc Version 5.2 Page 23 The kitchen units and worktops were tired and in need of replacement, and the kitchen was said to be due for refurbishment in July. It is important that this work is carried out as stated to maintain satisfactory conditions of hygiene. The home has a large garden, which included a patio area, lawns and some sensory planting. Ramps were provided where necessary to provide wheelchair access, and some seating was also present. The garden was very sunny and the manager said she planned to provide some trees or other structures to provide areas of shade, which would be a good idea, and work had already begun to prepare another area ready for further sensory planting. There is a separate day-care building within the grounds, which was not being used to its full potential, due to staffing limitations. The building has several separate rooms, including a sensory room, but tends to be used by one person at a time. There were tables and chairs with parasols provided outside this building, which were sometimes used by residents to eat meals. The bedrooms were individualised to varying degrees to reflect their occupant, and two of the residents held their own bedroom key. The carpet in one bedroom might benefit from replacement with an appropriate alternative owing to odour issues. Both standard and adapted bathrooms are available to address different needs, but one resident has an unsuitable en suite shower, which they cannot use whilst needing an en suite toilet, and has therefore been provided with a commode. The manager indicated that a more appropriate alternative would be to swap this resident’s bedroom, with another who has a level-entry en suite shower and toilet, but doesn’t use it. This option could be pursued via appropriate consents, or the unsuitable shower could be replaced with an additional level entry shower and toilet to provide better for his needs. A potential ant infestation problem was observed around the gaps in the flooring in one en suite, which will need to be addressed as a priority. Since the previous inspection the hours of the domestic were said to have been focused on her cleaning role, rather than being diverted into care hours, two windows had been converted to opening ones, to increase ventilation, and various carpets had also been cleaned regularly, in an effort to address previous concerns regarding hygiene and unpleasant odours. In addition the toilet pan had been re-sited within one toilet, and one toilet had been re-floored. The toilets were also being regularly checked throughout the day, but some residual odour problems remained evident. DS0000011190.V340671.R01.S.doc Version 5.2 Page 24 Whilst there was less evident odour during this inspection, some odour of urine remained present within two of the toilets, which appeared to be the result of inadequate flooring, or design issues, rather than from a lack of cleaning. The manager reported that she was considering the installation of a urinal in one problem location, to try to improve the problem This issue necessitates further investigation to try to reduce the level of odour still further in these areas. The issue was part of the requirements of the action plan which the home was required to submit after the previous inspection, and must be addressed as a priority. DS0000011190.V340671.R01.S.doc Version 5.2 Page 25 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): Standards 32, 34 and 35: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a core of longer term staff, some of whom have returned, having left previously, and staff retention has improved under the new manager. Levels of NVQ attainment are also improving. Staff receive a detailed induction and a good core training package, though there remain some gaps which are being addressed by the manager. Residents are protected by the rigorous recruitment and vetting procedure and appropriate records are retained for the most part. EVIDENCE: The unit has a core of long-term staff and some who have returned having left under the previous management regime. Agency staff are used from time to time, mainly to cover sickness, though this issue was reported to have reduced significantly recently. Two regular in-house bank staff are also used to provide occasional additional cover. The manager also has access to the provider’s bank staff in emergency. DS0000011190.V340671.R01.S.doc Version 5.2 Page 26 At the time of inspection there was only one vacant post and the manager was Considering converting this to a day care organiser post to run the in house day care service, and provide more day care capacity. Three new staff had been recruited in the last twelve months. Regular staffing is five staff from 7.30am until 3.00pm, including a shift leader, and the same number from 2.30pm to 10pm. At nights there two waking night staff. These staffing levels appeared to be sufficient to meet the needs of residents, though the already noted lack of drivers in the team and the need for an expansion of the day care service are issues still to be addressed. Staff now receive regular supervision and appraisals and there are regular, minuted, team meetings. Staff also confirmed that a proper induction was now provided. The manager plans to produce individual staff development plans, and confirmed that she had provided for an existing staff member who had not been inducted under the previous manager, to be re-inducted. Eleven of the team have at least NVQ level 2 or equivalent and a further six are undertaking their NVQ. Examination of a sample of recent recruitment records indicated an appropriately rigorous recruitment and vetting process and copies of appropriate evidence were retained for the record, with the exception of some confirmation that the POVA check had been undertaken, (in the absence of original CRB certificates or copies of application forms), which would be good practice. The service has an appropriate core-training package, which is mostly provided via Newbury College. Examination of the most current training record indicates that a lot of places have been booked on upcoming core training, with dates written in over the ensuing months. Some gaps remain and the manager will need to ensure these too are addressed. As discussed earlier in this report, the provision of medication training from the pharmacist or another appropriate source is recommended. Staff are supposed to receive annual fire safety training updates, but these are still being caught up with, having lapsed under the home’s previous management. Some staff are booked on fire safety training at various points throughout the year but no dates have been indicated on the training record, for three of the staff. Appropriate fire safety training should be booked for these three staff and for the two staff who are shown as not having received this training since 2004/5. DS0000011190.V340671.R01.S.doc Version 5.2 Page 27 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): Standards 37, 39 and 42: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home appears to be being run more effectively in the interests of the residents than was evident under the previous manager. The new manager has identified appropriate priorities for change and begun to effect these, and there have been improvements in staff morale and motivation. The views of residents and other relevant parties are being sought more systematically, and though there remains room for improvement in the QA system the process of seeking the view of residents, relatives and others should help to improve the image and perceptions of the unit, and enable more effective communication between the service and its customers. The health, safety and welfare of residents are promoted by the home. DS0000011190.V340671.R01.S.doc Version 5.2 Page 28 EVIDENCE: Staff comments indicated they were happy with the new manager, whose style appeared to be more open and who was said to share information and delegate appropriately to other members of the team to enable their development. The manager demonstrated a good awareness of the priority issues for the unit and it was evident from records and discussions that she had already made some significant changes for the better within the service, and had plans for a range of other changes. She is undertaking her NVQ level 4 and RMA. There was evidence of improved communication and consultation within the team, and of increased delegation, and levels of staff sickness had significantly improved. The residents are now consulted regularly via residents meetings, where they have also been asked their views about the service as part of the quality assurance system. A cycle of quality assurance questionnaires has been sent out to residents’ families in April, with limited feedback as only a few have family in regular contact. Questionnaires were also sent to staff, commissioners and health care professionals with only partial success. No summary report has been provided to participants, though the returned forms are analysed and the results used to draw up a development plan for the unit. The provision of a summary report identifying any changes or action arising from the issues raised, would be likely to encourage greater participation and openness, and ensure that in future, any concerns are more likely to be raised to enable them to be addressed. The manager discussed the development plan she had initially produced back in April, from which most of the identified goals had been addressed. Given the pace of changes in the unit it is suggested that a new QA survey, in the coming months would be useful to see what changes had been noticed and maintain a regular dialogue with the relevant parties. The manager plans to undertake a further cycle in the near future. The provider undertakes regular Regulation 26 monitoring visits, during which time is spent with residents and staff. Detailed reports are produced and copied to the unit for the manager to action any issues raised. Reports for the period since the new manager’s appointment were available on file, with previous ones having been archived. The provider was required to complete a detailed improvement plan following the previous inspection. Appropriate steps have been taken by the service, and DS0000011190.V340671.R01.S.doc Version 5.2 Page 29 the new unit manager, to address the majority of the issues. In some cases the unit is waiting on responses or action from others but positive steps have been taken on all of the main points, and on the requirements and recommendations previously made. The remaining issue of some areas of the home where residual odours are still evident, is the subject of a further requirement in this report. Examination of a sample of health and safety-related service certification indicated that required servicing and safety checks were taking place with appropriate frequency and copies of appropriate records were available. The most recent fire drills had been in January and February, and the records indicated some refusals to evacuate on the part of residents, though it was not possible from available drill records to identify what interventions had been tried. It is suggested that detailed notes are kept to enable the establishment of patterns and identify successful strategies to obtain individual’s cooperation. A detailed fire risk assessment was in place, which had been reviewed in March 2007 and a fire evacuation plan was also in place, together with some individual guidance on how to respond to one particular resident to try to secure a positive reaction to the alarm. The manager was advised to discuss the night-time fire evacuation plan with the fire officer. Available accident records were examined, which are currently held collectively meeting the requirement for a collective record for monitoring purposes. One accident to a resident was followed up initially by the HSE but no further action was required. Copies of accident records should also be filed within the relevant resident’s file as part of their case history. DS0000011190.V340671.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 x DS0000011190.V340671.R01.S.doc Version 5.2 Page 31 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 YA23 Regulation 13(6) Requirement Timescale for action 06/09/07 2 YA24 16(2)(j) 3 YA30 16(2)(k) The provider must ensure that all staff receive training on the protection of vulnerable adults from an appropriately qualified trainer, with sufficient frequency in order to provide protection to vulnerable residents. The manager must make 06/07/07 arrangements for the apparent ant infestation to be addressed, by a competent pest-control contractor. The provider must take further 06/08/07 steps to address the remaining odour problems within the home. DS0000011190.V340671.R01.S.doc Version 5.2 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 Refer to Standard YA12 YA20 Good Practice Recommendations The manager should continue to develop the level of resident’s access to activities and community events in order to maximise their community presence. The provider should consider the provision of accredited training to all staff who are to administer medication, to ensure they have the necessary awareness of various aspects of medication, in order to best meet the needs of the residents. The provider should ensure the provision of sufficient shade within the garden to provide for its safe use in the summer months. The manager should consider how best to meet the needs of the identified resident with regard to en suite facilities, with due regard for his dignity. The manager should ensure that any gaps in core training are identified and addressed promptly. The provider should consider the production of a summary report of the findings of the quality assurance survey, detailing any action plan arising, and make it available to participants to encourage an open dialogue. The manager should discuss and agree the unit’s nighttime fire evacuation plan with the fire authority. Copies of accident records should be filed on the relevant resident’s case record, in addition to being filed collectively for monitoring purposes. 3 4 5 6 YA24 YA24 YA35 YA39 7 8 YA42 YA42 DS0000011190.V340671.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000011190.V340671.R01.S.doc Version 5.2 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. 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