Inspection on 24/04/07 for Byron Terrace (Respite Care)

This inspection was carried out on 24th April 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Byron Terrace (Respite Care) 11 - 21 Grandidge Street Rochdale Lancashire OL11 3SA Lead Inspector Jenny Andrew Unannounced Inspection 24th April 2007 08:45 Byron Terrace (Respite Care) DS0000067356.V334162.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 Byron Terrace (Respite Care) DS0000067356.V334162.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. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Byron Terrace (Respite Care) Address 11 - 21 Grandidge Street Rochdale Lancashire OL11 3SA 01706 702180 01706 702181 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) Heywood, Middleton and Rochdale PCT Miss Gillian Patricia Golden Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 4 service users, both male and female to include: up to 4 service users in the Category of LD (Learning Disabilities) Date of last inspection This is the first inspection since the service was first registered on 8th November 2006. Brief Description of the Service: Byron Terrace, which is run by the Heywood, Middleton & Rochdale Primary Care Trust (PCT), offers short-term accommodation for up to four service users under the age of 65 years, with a learning disability. The service’s aim is to provide respite to parents/carers of people who are cared for in their own home, to enable them to maintain their role as carers. The home is adapted to meet the needs of physically disabled individuals. Four single bedrooms are provided, one of which is on the ground floor level. There is a lift to the first floor. Lengths of stay vary, dependent upon need and this is determined jointly with the Local Authority. The home is situated less than a mile from the Rochdale town centre and is close to local shops, pub and public transport. The weekly fees are dependent upon the assessed needs of the individual with benefits being taken into account. Additional charges are made for activities/ outings and toiletries. The manager makes information about the service available in the form of a Respite Service Handbook, a copy of which is kept in each bedroom. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The staff at the home did not know this visit was going to take place. The visit lasted seven and a half hours. The inspector looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of the two newest members of staff were also checked. The manager of the service was off sick and so the Learning Disability Practitioner, who was on duty, assisted with the inspection. In order to obtain as much information as possible about how well the home looked after the service users, the Learning Disability Practitioner, three support workers, the administrator and four service users were spoken to. The service users found it difficult to express what they thought about the home but observations made showed they liked the company of the staff on duty. Before the inspection, comment cards were sent out to relatives/carers and an excellent response was received, with 17 being returned. Information from these has also been used in the report. What the service does well: Before anyone came to stay at the house, someone would go to visit the person in their own home to find out about how they needed to be supported. The person’s carer would also be spoken to so that everything about the service user could be written down. The manager could then make a decision about whether the service would be able to meet their need. The care plans were good because they set out everything about each person, stating what they needed help with, what they could do for themselves and their likes and dislikes. The staff were then able to meet the person’s needs and support them to follow their chosen routines whilst staying at Byron Terrace. All the staff had worked at the house for a number of years and had got to know the people using the service really well. This had meant the service users had built up trusting friendships with the staff who knew how they wanted to be supported. The staff were good at making sure the service users’ health care needs were met during their visits by escorting them on health appointments or to hospital. They were also good at keeping in touch with their carers/relatives and letting them know of any problems or concerns they had. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 6 The house was well equipped so that people who found it difficult to walk or do things for themselves, could be properly cared for. What has improved since the last inspection? What they could do better: Where any risks and dangers to the people using the service were noticed by the staff, they had not done a risk assessment showing what the risk was and the steps they were taking to reduce the risk so that the person would be safe. The food was cooked at the hospital, then frozen, packed and sent to the home. This meant that the staff were limited in what they could offer people for their meals and it was not always the food the person would have chosen, if the staff could have bought and cooked the meals at the house. As the people using the service would not all be able to understand how to make a complaint, the complaints procedure needed to be sent out to their relatives/carers so they would know how to complain on their behalf. Most of the staff needed to have training in what to do if they thought a service user was being treated unkindly so they would know the right steps to take to prevent the abuse continuing. Before new staff started work, the manager said checks were done to make sure they were suitable to work with the people using the service. The files did not contain any proof these checks had been made and unsuitable people may have been appointed. The staff files did not have any copy training certificates in place to show that staff had done all the right training to make sure service users were safely and properly cared for. There was no system in place so the manager could see if the service offered needed to be improved in any way for the benefit of the people using it. This is called quality assurance. The bath and mobile hoists had not been checked for a long time to make sure they were safe to be used by the service users. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 7 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. Byron Terrace (Respite Care) DS0000067356.V334162.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 Byron Terrace (Respite Care) DS0000067356.V334162.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users were assessed in full, prior to admission, ensuring staff were able to meet their identified needs. EVIDENCE: The files for the four service users currently on respite were looked at. Each one contained a detailed assessment of need, which had been done by a care manager. The care manager assessment document had recently been reviewed and updated and was in a different format. An assessment for one service user had been completed in March 2007. It contained a lot of important information about the service user, including hobbies/interests, likes/dislikes, spiritual needs, health and personal care, routines and finances. The manager said they used a lot of this information when writing the care plan and this was confirmed from checking the care plan files. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 10 Before new service users started to use the scheme, it was usual for them to be introduced on a gradual basis. The staff placed great importance on making sure their initial introductions were done as positively as possible, so the person would have a good first experience of the service. The manager described the process they were currently going through with a new person who had never been away from home before. The manager had first met the service user and carer in their own home and then staff had supported her on an outing to Hollingworth Lake. Then arrangements had been made for the service user to look around the home and meet some of the staff whilst there were no other service users in. This enabled the staff to spend time with her on a one to one basis in order to begin to get to know her. The day following the inspection, arrangements had been made for her to again visit the house for a few hours. From this, teatime and possibly overnight visits would be arranged and then, dependent upon whether the person wanted to, arrangements would then be made for a longer respite stay. During this process, the family carers’ interests and needs were taken into account as well as the needs of the potential service user. The support workers spoken to said that, as well as the mandatory training, they received training to meet specific needs of service users referred to the service. Examples given were training in diabetes, epilepsy, physical intervention, Asian awareness and dementia. The staff files did not however, contain copy training certificates or any information about when the training had taken place. This is addressed in the staffing section below. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users were encouraged to be as independent as possible within individual capabilities and enabled to lead fulfilling lives but the lack of risk assessments could compromise their safety. EVIDENCE: The service catered for people with varying needs and abilities. Three care plans were looked at for the people currently using the service and a fourth one was seen which was being done for the person being introduced to the scheme. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 12 The three care plans were detailed and contained really good information about the whole person. All had been updated between September and November 2006 and several more recent updates had been made. The more recent recordings had not however, been dated and signed and the manager addressed this shortfall in one plan, during the visit. The manager had recently been on person centred planning training. As a result of this, she was in the process of changing the care plan format so that it was more person focused. One care plan recorded that a service user would eat both Asian and English food. However, the care plan did not make it clear that he was a practising Muslim who should only be offered Halal meat. On discussion with staff, it was clear that his dietary needs were being met in this area. When compiling the plan the manager said, wherever possible, service users and/or carers had been fully involved in the process, but this was not made clear in the care plan and no consent forms had been signed with regard to being given medication and outside activities. In addition to the care plan, there was a preferred routine for each of the service users as well as a daily programme of daytime pursuits, e.g., college, day centres, etc. As many of the service users had been coming to stay at Byron Terrace for many years, the information held had been developed and expanded upon as necessary over this time. Daily diaries were also kept for each person living there. These were seen and the entries were detailed and gave a good idea of how the person had spent their day. Before service users came in, the staff made contact with the family to check whether the support needs had changed since the last visit. One of the files seen showed that medication for one person had changed since she had last used the service and the records had been updated. Limitations on choices were only made in the best interests of the individual. A listening device was used in the corridor on the first floor level so that if anyone was restless and moved around during the night, they could be heard by the waking night staff and appropriate action be taken before they had an accident. The service users’ rights to make decisions about their lives and everyday routines were respected by the staff, as far as possible, but some restrictions were placed by relatives/carers. An example was given whereby family had requested that two service users go to bed at the time they did at home, so their routines would not be unsettled when they returned home. This had been recorded on their care plans and staff were respecting these wishes. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 13 There was a very low turnover of staff at the house. Indeed the two most recently recruited staff had worked there for two years. The previous support workers had left due to sickness and retirement. This meant that the staff knew each of the service users’ needs well and were able to use different ways of communicating with them. Good relationships had been formed between staff and service users and this was evident upon the visit. It was difficult to determine what the service users thought about the staff team, as they had some communication difficulties. However, from the way they responded to the staff and the comments they were able to make, it was clear they felt well supported. It was usual for parents/carers to deposit money for safekeeping with the staff as part of the admission procedure. Any money spent on behalf of the service user was accounted for by the staff and receipts retained for audit purposes. Any money left over was kept, with the relatives’ permission, for the next visit. From checking care plan files, it was noted that where risk areas had been identified, assessments were not always in place, showing what action needed to be taken to reduce the risk area. The manager said she was doing risk assessments whilst updating the care plans. One service user requiring assistance with moving/handling had no assessment in place. The manager said her needs had only recently changed due to a hospital admission. Another support plan showed that a service user could be at risk of locking himself in the toilet but a risk assessment had not been written showing what action staff should take to reduce the risk. Risk assessments must be in place where service users require assistance with moving/handling, have challenging behaviour or for any other identified risk areas. Byron Terrace (Respite Care) DS0000067356.V334162.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): 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. The opportunities available for service users to pursue leisure and social activities, reflecting their diversity and social, intellectual and physical capacities were limited which could result in service users becoming bored and restless. EVIDENCE: The daytime occupations of the service users were determined as part of the initial assessment process. The staff spoken to said it was usual for service users to continue to attend their day care centres whilst on respite, unless there was a reason why they should not. On the day of the inspection, one of the service users was staying at the house because of not feeling well and the service had been staffed to accommodate her needs. An example was given where, in the past, a service user had attended college whilst on respite and the necessary support for him to do so had been arranged. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 15 The hobbies/interests of service users were also identified as part of the initial process and were recorded on the support plans seen. This enabled the staff to plan what kind of outings/activities the service users may like to do whilst in their care. Feedback from the manager and staff did, however, indicate that outings and activities were dependent upon carers/relatives sending money in for social activities. Staff said that, often, their money ran out before the end of their stays and meant that activities were restricted to drives out to places of interest. From checking the daily diaries, it was noted that the previous weekend, support workers had taken the service users to Manchester Airport. Other places they had been to over the past 12 months were trips to Hollingworth Lake, Trough of Bowland (picnic) and Port Sunlight village. As funds limited what could be offered, the staff should try and resource other activities that could be done on a tight budget. Several service users were said to enjoy going to the pub for a drink, shopping and the cinema. One support worker said he would support one service user to go to watch football. The staff said the manager made sure that the rotas accommodated the needs of the people using the service at any one time. They felt that since the number of beds for respite had been reduced to four, that the staffing levels enabled them to do more activities with the people on respite. The previous weekend some of the service users had enjoyed baking. Evening activities generally consisted of watching television. One person’s diary recording showed that she had enjoyed a painting session but very few entries had been made in respect of varied and appropriate activities other than watching television. The staff need to look at offering more varied activities during the evening, geared to the assessed needs of the individuals so that the service users’ intellectual and social needs will be better met. Whilst the main aim of the service was to provide respite for parents and carers, the staff were good at keeping in touch with them. Feedback from all the returned carer comment cards was extremely positive about how they were consulted about any important decisions about the care of their relative whilst on respite stays. Sixteen of the 17 comment cards also confirmed that they were kept informed of important matters affecting their relatives whilst staying at Byron. One person felt they were not. Relatives/carers were able to visit if they so wished and this had in fact recently happened when it was the birthday of one of the present service users. The service user had clearly been very pleased to see them and showed the inspector the cards and presents he had been given. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 16 Daily preferred routines were recorded on each person’s care plan and staff tried to follow similar routines as the person enjoyed in their home environment, i.e., preferred rising/retiring, breakfasts, attendance at day centres, etc. All bedrooms were equipped with safety locks and lockable space was provided in each of the bedrooms. This work had been done as part of the registration process, but service users were not being offered keys to their bedroom doors or their lockable space. Where these are offered and refused, recordings should be made on each person’s support plan. If service users were assessed as not being able to hold their own key, then this should also be recorded, together with the reason why. Meals are not cooked on site at the home but are delivered to the home having been cooked at the local hospital. The way the evening meal was chosen and cooked was institutional and not in keeping with normal life principles. Serious consideration should be given to providing the service with their own food budget. The staff were restricted in what they could offer the people using their service as they could only plan menus around what could be ordered via Rochdale Infirmary. They said that the orders delivered very rarely matched what had been requested. The food ordering sheets were seen. The food on offer was what was being cooked for hospital patients and whilst it included a wide variety of food, e.g., meat, fish, pasta, pies and casseroles and included Halal and soft diets, the meals were not always what the service users would have chosen had they been able to say what they would really like. The home’s menu offered three choices at each evening meal, one of which was a salad. The same menu was used every week and for people staying over a two week period, it would have been repetitive. A minimum of two menus should be written and implemented. The food arrived in frozen prepacked containers and except for pureed or Halal meals, was for eight people. As only four service users were accommodated, this meant that choice was restricted as if each person wanted something different, the portion sizes could not accommodate this. The only non-packaged food was cooked meats, fruit and salad. The staff were able to buy small amounts of food from petty cash but the amount to be spent on food was restricted. Items such as bread, eggs, sausages, bacon and a Sunday joint with fresh vegetables were purchased locally. On the evening of the inspection, two service users had chosen to have sausages, which the staff cooked for them. The other two people had individual Halal meals that only took approximately eight minutes to warm up. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 17 In some instances, the meals each person had been given was recorded in their daily diary but this was not always so. When the menu is not followed because staff want to offer a wider range of foods, they must record what each person has had in their diary or other record. This will enable anyone inspecting the records to be able to measure whether the meals are varied and nutritious. The cooking of the frozen meals was done in a large industrial type container unit and was done on a cyclical programme, which took approximately an hour and a half. This meant that mealtimes were inflexible due to the time it took to cook a meal, unless the service users wanted a snack type meal. This way of cooking food meant there were no nice cooking smells to tempt some of the service users to eat. The house did however, have a cooker and this was used to cook “brunch type” breakfasts on a Sunday and any other snack type meals or occasional Sunday roasts. It was clear the staff were making the best of the limitations imposed on them from the PCT. Service users’ special dietary needs were observed as recorded on the care plans, e.g., diabetic, soft diets, vegetarian, etc. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There was evidence of close working links with parents/carers to ensure the health care needs of service users were fully met and their preferred routines being followed. EVIDENCE: During the visit, it was noted that staff spoke respectfully to the service users but at the same time, were able to have a laugh and joke with them. It was clear that the service users and staff had good relationships with each other. Care plans identified where service users had specific needs in respect of a particular gender of staff for assisting with personal care tasks or for cultural reasons. Of the 11 staff working on the team, there were two male staff, one support staff and one manager who also worked on the rota. This meant that service users’ preferences could usually be observed. Care plans for each service user were explicit in exactly what service users preferred routines and support needs were. Such detail was vital given that some service users could not easily communicate their needs and preferences. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 19 During respite stays, community health care services were accessed as required and the care plans inspected all had details of each person’s GP and any other relevant health/social care professional. One service user had been supported on a podiatry appointment during their stay and another person had needed to go to see their GP. A service user had recently been admitted to hospital from Byron Terrace. The manager’s communication book showed that her parents had been kept fully advised of her becoming ill and her subsequent hospital admission. Where health appointments had been made whilst service users were on respite, staff supported service users to attend. It was noted there were no “Consent to Treatment” forms on any of the care plan files for the people presently staying at the home. When service users had seizures, staff would follow the written procedures in place, which included informing the person’s family. Specialist staff training was facilitated when service users with specific medical conditions were referred, i.e., diabetes, epilepsy, dementia but when this training was undertaken could not be determined due to absence of certificates or training profiles. From 17 returned carer questionnaires, feedback indicated full satisfaction with the way the service communicated with them in connection with any important matters affecting their relatives. During the stay, relatives were welcomed to visit if they chose, or to ring up and speak to the staff at any time. One relative commented they would have liked more written communication to show what happened whilst their daughter had been on respite. The home had now addressed this by handwriting a note at the end of each person’s stay, outlining what the person had done and whether there had been any problems. The house had been adapted to meet the needs of individuals who were physically disabled with a large walk-in shower, toilets fitted with grab rails and rise/fall bath. A lift was also provided to the first floor accommodation. The service had its own medication policy/procedure in place. This did not however, identify how medication would be collected or sent back at the end of stays and other processes were also missing. The policy needed to be reviewed and expanded upon. The manager said the way medication was picked up and returned varied and that sometimes staff picked it up or carers dropped it off or it was sent via day care. All medication was booked in upon arrival. In order that all staff would know exactly what times each person had to take their medication, at the start of each person’s stay, this information was recorded and displayed in the office. Staff said there were very few people who were able to self medicate, although in the past they had had one or two who had requested to do so. If people wish to self medicate, a risk assessment must be undertaken. Lockable space was provided so that medication could be kept locked in the person’s bedroom. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 20 Satisfactory arrangements were in place for the storage of all medication, including controlled drugs. There was no-one on such drugs at the time of the visit. However, the controlled drug book was checked and, on several occasions, two staff had not signed to say the drugs had been given. This shortfall should be addressed. Staff were clear about what they were able to assist service users with and what to do in emergency situations. Before staff were able to give out medication, they received training from one of the Learning Disability Practitioners who had nursing qualifications. An assessment form was used and these were in place for each member of the staff team. The assessments were done on a six monthly basis and six that had been done in September 2006 were ready for re-assessments. It was noted that the assessment did not include the administration of controlled drugs, except for rectal diazepam. Training must include all controlled drugs. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 21 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 was a clear complaints procedure in place but the lack of protection training for staff could result in procedures not being followed and service users being placed at risk. EVIDENCE: As well as the corporate complaints procedure, a more user-friendly version had been formulated and this was included in the respite service handbook, a copy of which was kept in each bedroom. The majority of service users on respite stays also attended day care centres and had the opportunity to talk to their respective key-workers if they had any concerns to address. Feedback from 11 of the 17 returned relative/carer comment cards indicated they did not know how to make a complaint. Given that many of the service users would not be able to understand the complaints procedure, a copy complaints procedure must be circulated to all relatives/carers. There had been no complaints sent directly to the Commission for Social Care Inspection since the service was registered in November 2006. The manager had introduced a complaints book in which had been recorded six minor complaints. All had been appropriately actioned and this good practice is acknowledged. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 22 The manager said there had been no protection investigations undertaken over the past 12 months. The Protection of Vulnerable Adult joint policy/procedure was kept in the office. The manager found it difficult to locate and acknowledged that the staff would not know where to find it. Other than the two most recently appointed staff, who had undertaken their Learning Disability Award Framework training (LDAF), staff training records did not identify any protection training undertaken by the staff team. This training must be provided in order that staff will know what to do if abuse is suspected so that the service user will be kept safe. Staff said they received physical intervention training so they would know what to do if a service user exhibited challenging behaviour. The training could also be geared to individuals but again, there was no evidence of when courses had been done or which staff had received the training. Policies/procedures related to service users’ monies/valuables, etc., were in place. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The house was clean, safe and adequately maintained, affording service users a comfortable place to stay whilst on respite. EVIDENCE: The house was accessible, safe and reasonably well maintained. It was equipped to meet the needs of physically disabled service users. The service was located just out of Rochdale town centre in a quiet cul-de-sac. One of the domiciliary care flats was located next to Byron Terrace. Before the service was registered, this house and the flat next door were staffed as one unit and could be accessed internally, although each unit had its own front door. It was a condition of registration that each of the services had to be staffed separately and treated as two separate units. This had been adhered to, in that, the units were separately staffed but access could still be gained to the flats from within Byron Terrace. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 24 The manager said some of the respite stay service users liked to visit the flat tenants and vice versa, the tenants liked to come through into the respite unit to chat to the manager and staff. As the tenants will be moving out over the next few months and the future of Byron Terrace has still not been decided, it was felt the existing arrangements could be left as this was in the best interests of the tenants and respite stay service users. Close circuit television cameras had been fitted on both ground and first floor corridors but they were only viewing the garden and car park areas for security purposes. The accommodation comprised of a communal lounge, a dining room, kitchen, two bathrooms with toilets, one walk-in shower room and four single bedrooms. A wide access toilet was situated on the ground floor that people in wheelchairs could easily use. There was also an office and a staff sleep-in room. The first floor bathroom was equipped with Jacuzzi facilities that many of the service users enjoyed. It was noted that the first floor walk-in shower did not have a shower curtain fitted. In order that service users’ privacy/ dignity needs are upheld, a curtain must be provided. The bedrooms which were too small to be used by service users, were being utilised for storage purposes and some of the items being stored were combustible and constituted a fire hazard. These items must be removed and stored elsewhere. The ground floor bedroom was in need of re-decoration and the manager said an estimate had been received and she would chase this up. It was noted that in the kitchen, the waste disposal unit was not working and had been covered over and taped up so that it would not be accidentally used. This was dirty and unhygienic and either the unit must be repaired/replaced or a more suitable cover fitted. The premises met the requirements of the local fire service. assessment was in place. A fire risk The house was seen to be clean throughout. Laundry facilities were satisfactory and hand-washing facilities were in place in all bathrooms and toilets. A supply of disposable gloves and aprons were available for staff to use as and when necessary. Byron Terrace (Respite Care) DS0000067356.V334162.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): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The staff team were providing consistently good support and meeting the needs of the service users. Systems in place did not fully support the robustness of the recruitment, training and supervision arrangements which potentially could put service users at risk from staff who have not been properly checked, or trained or supervised sufficiently. EVIDENCE: The home was being staffed to meet the identified needs of the service users and this was done on assessed individual need, e.g., who needed one to one support and how many people needed assistance with moving/handling. The rotas also took into account what individual clients were doing during the day and at weekends. Of 17 returned relative/carer comment cards, 14 people felt there were always sufficient staff on duty and three felt there were not. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 26 The staff team were all white British, which did not reflect the diverse cultures of those having respite care. Two of the support staff on duty had however, undertaken cultural awareness training but due to lack of training records, it could not be determined how many of the staff team had completed this training. The staff had worked together for a long time, with the two most recently recruited support workers having been in post for about two years. This consistency had been good for the service users as they were being supported by the same staff each time they came on respite stays. This had enabled the service users to develop trusting relationships with the staff team. If additional cover was needed for staff absence due to sickness or annual leave, two bank staff were used whom the service users had got to know well. Feedback from returned comment cards was very positive about the staff team. Such comments included: “Staff are very helpful and friendly. It’s nice that you see the same staff regularly”, “The staff at Byron are very caring and understanding of service users, it’s like home from home”, “We have always been very satisfied with the care our daughter gets at Byron Terrace”, “Staff have always been kind, understanding and helpful in all the years we’ve used the service”, “First class care with very helpful staff” and “The staff are people who care and try to make it like a home”. The registered manager and the two Learning Disability Practitioners, who worked some shifts at the house, all had nursing qualifications. However, of the 11 remaining staff, only one had undertaken NVQ Level 2 training. In order to meet the required ratio of trained staff, 50 should be trained to NVQ level 2 standard. Two of the staff who had started work in the last two years had undertaken the Learning Disability Award Framework (LDAF) training. Whilst copy certificates were not in place, letters were in both files confirming the training had been completed. The manager on duty was an assessor for this training. The staff spoken to said they had regular team meetings and minutes of these meetings were seen, the last having taken place in January 2007. They also said they had annual appraisals but did not have regular one to one supervision. The Learning Disability Practitioner, who was on duty during the inspection said she had personally done supervision with two of the staff team but this could not be confirmed due to them not being on duty and supervision notes being locked away. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 27 A corporate recruitment and selection policy/procedure was in place and the manager said the policy was observed. The files of the registered manager and two support staff were requested so that checks could be made that the policy was being followed. The files were not on site but held at The Ralph Williams Clinic at Smallbridge, which was the previous base of the respite service. The inspector was advised that the files were being transferred to Byron Terrace, the week following the inspection. The files were seen at the Clinic. They were, however, incomplete, in that, in two instances there was no evidence of a satisfactory Criminal Record Bureau check having been undertaken, such as dates when the checks had been returned, reference number of check, etc. The headquarters of the PCT were in Middleton, from which all references and checks were applied for. The organisation must ensure that files contain some evidence of checks having been obtained. The files did not contain any evidence that the staff had undertaken training courses or hold proof of any professional qualifications. There was no up to date staff training matrix showing dates of any recent training, nor were there any copy training certificates in the files. Staff should receive a minimum of five paid days’ training and development days (pro rata) per year. Due to absence of individual training and development profiles, it could not be evidenced how many days training per year each employee was receiving. The manager on duty at the time of the inspection was not familiar with the General Social Care Council “Code of Practice” booklet and said she was unsure whether any of the staff had received a copy. As all social care staff should be working in line with this code of practice, existing staff should each receive a copy and new staff should be given a copy as part of their induction training. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 28 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. Some management shortfalls were identified in respect of record keeping, quality assurance and training but, in the main, good outcomes were being achieved for the service users who benefited from the service. EVIDENCE: The Commission for Social Care Inspection approved the application for Ms Golden to be registered manager of this scheme in July 2006, although the scheme was not registered until November 2006. She is a registered nurse having gained a further qualification in March 1990 in respect of nursing people with learning disabilities. She had managed the respite care service since June 1998. As the registered manager was off sick at the time of the inspection, it was difficult to establish what training courses she had recently attended, as Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 29 her training profile was not up to date. The Learning Disability Practitioner, on duty during the inspection, confirmed the manager had enrolled and commenced on the Registered Manager’s Award training course. The outcomes for service users in respect of care were good, but the lack of evidence to support this in respect of accurate staff training, risk assessment, accident and employment records must now be addressed without further delay. Staff feedback about the registered manager was positive with comments received such as “very approachable”, “easy to talk to” and “supports us well”. There was no effective quality assurance and monitoring system in place. Whilst the service handbook referred to quality monitoring of support plans by identifying “what’s working” and “what’s not working”, this had not yet been implemented, although the manager on duty said this would be done when all the support plans had been re-written using the new more person centred plans. The guide also referred to circulation of questionnaires to determine satisfaction with the service but this was not being done. There was also reference to an annual standard audit to make sure the service was meeting all agreed standards but there was no report in place. Whilst it is acknowledged the service was only registered in November 2006, some quality monitoring systems should have been in place by now. This shortfall must be addressed without further delay. Three support workers were spoken to during the visit. They were able to state what health and safety training they had had but were unsure of the dates they had done the training. They said they attended courses on first aid, food hygiene, moving/handling and fire but could not remember if they had done any infection control training. As the staff personnel files did not contain any updated training profiles or copy certificates, it could not be ascertained when the training had been done or in fact whether refresher training was provided. Information from the pre-inspection questionnaire showed that the majority of maintenance checks had been undertaken. It was noted however, that mobile/bath hoists had not been serviced since June 2005. All hoists must be serviced on a 6 monthly basis. The manager on duty at the time said this would be arranged as quickly as possible. Random samples of records relating to the lift, fire alarm and water temperatures were undertaken. All were in order. The system in place for the recording of accidents was that forms would be completed and sent to the head office in Middleton. No copies were kept on individual files so it could not be determined what accidents had occurred and whether the correct action had been taken. Copy records must be held on site. Byron Terrace (Respite Care) DS0000067356.V334162.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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 1 X X 2 X Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? This is the first inspection of the service since it was registered in November 2006. 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 YA9 Regulation 13 (4) (b)(c) Requirement Timescale for action 25/05/07 2. YA20 18(1)I(i) 3. YA22 22(5) 4. YA23 13(6) Where any risk areas are identified, risk assessments must be done so that staff will know what action to take to make sure the risk is managed. This should include service users who need assistance with moving and handling. Medication training must include 30/06/07 instruction on how to give out controlled drugs in order that service users are safely given these drugs. A copy of the service’s 25/05/07 complaints procedure must be sent to service users’ relatives so they will know how to make a complaint. Arrangements must be made for 30/06/07 all staff to attend protection training so they will know what to do if they suspect a service user is being abused. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 32 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. 5. Standard YA34 Regulation 19 Requirement Timescale for action 25/05/07 6. YA35 17(2) 7. YA42 13(5) 8. YA42 17(2) Evidence that Criminal Record Bureau checks have been undertaken for all staff must be kept so that anyone inspecting the records can be sure that the service is employing people who can be trusted to work with vulnerable people. Evidence of any training 30/06/07 undertaken (including induction) must be available so that it can be ascertained whether staff have received the training they require to do their jobs safely. The mobile hoists and bath 11/05/07 hoists must be serviced on a 6 monthly basis in order to make sure they are safe for the service users to use. A copy of accident records must 11/05/07 be kept in the home in order that checks can be made to make sure the right action was taken by the staff at the time of the incident. Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA6 YA13 Good Practice Recommendations Where care plans are reviewed, they should be signed and dated so that people reading the file will know when the changes in the persons needs were recorded. Specific cultural and ethnic needs should be recorded in detail on the care plan so the staff will all know how to meet the persons needs. The manager and staff should try and find places in the community the service users can enjoy that do not have a cost implication so they can enjoy different experiences whilst on their respite stays and look at more varied activities that can be done in house during the evenings. Service users should be asked if they want to have keys to their bedrooms and lockable space and their wishes recorded on their support plan. Where service users are assessed as being unable to manage keys, then this should also be recorded. A two weekly menu should be in place so that the meals do not become repetitive for the people on 2 week stays. Serious consideration should be given to the service having its own food budget so they can purchase food to meet the specific likes/dislikes of the people using the service. Consent to treatment/medication forms should be signed and in place for all users of the service. The medication policy needed to be reviewed to include all the processes including the collection and return of medication. Two staff should sign the controlled drug book to ensure the drug has been satisfactorily given. The waste disposal unit in the kitchen should either be removed, replaced or covered as the temporary cover in place is unhygienic and could be harbouring germs. A shower curtain should be fitted in the walk in shower so that the service users privacy is upheld At least 50 of the staff team should have a minimum of NVQ level 2 training. DS0000067356.V334162.R01.S.doc Version 5.2 Page 34 4. YA16 5. 6. YA17 YA17 7. 8. 9. 10. 11. 12. YA19 YA20 YA20 YA24 YA24 YA32 Byron Terrace (Respite Care) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 13. 14. Refer to Standard YA34 YA35 Good Practice Recommendations All staff should be given a copy of The General Care Council “Code of Practice” so they will know what is expected of them. An up to date training and development profile should be in place so that the manager can see at a glance what training staff have completed and when refresher training is due. A quality assurance and monitoring system should be introduced so that the manager can measure that the service is achieving its aims and that outcomes for service users are satisfactory. 15. YA39 Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Greater Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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 Byron Terrace (Respite Care) DS0000067356.V334162.R01.S.doc Version 5.2 Page 36 - 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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