Inspection on 18/06/08 for Camber Lodge

This inspection was carried out on 18th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Camber Lodge 14/09/07

Camber Lodge 29/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Camber Lodge 93 Lydd Road Camber Rye East Sussex TN31 7RS Lead Inspector Michele Etherton Unannounced Inspection 18th June 2008 09:40 DS0000067943.V366709.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 DS0000067943.V366709.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. DS0000067943.V366709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Camber Lodge Address 93 Lydd Road Camber Rye East Sussex TN31 7RS 01797 222360 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) camber.lodge@nellsar.com Nellsar Ltd Manager post vacant Care Home 8 Category(ies) of Learning disability (0) registration, with number of places DS0000067943.V366709.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 8. Date of last inspection 14th September 2007 Brief Description of the Service: Camber Lodge is a large, modern two storey detached property sited on the Main road of Camber, a small holiday village 4 miles from Rye. Sand dunes are within a 100 yards of the home accessible by crossing the Main road. A small general shop is within walking distance of the home along with a bus stop, which provides public transport to historic Rye several times daily. Rye has a mainline train station. The home has ample off road parking facilities within its own enclosed grounds. Camber lodge was originally a Motel and has been renovated, redecorated, and refurbished to a good standard in order to provide residential care for up to 8 adults. Bedrooms are of a good size with ground floor bedrooms sufficient in size for wheelchair users. All rooms have en-suite facilities. Communal areas such as the lounge, reception, dining, and kitchen areas are spacious. The home has its own minibus type vehicle. Camber Lodge first opened in 2005, it has been under the new ownership of Nellsar ltd since August 2006. Current fees charged ranges from £860 to £1187 per week. Inspection reports are routinely sent out to families and advocates who express an interest in the home or who specifically request a report. A copy is contained with the home’s guide [Service User Guide] kept on display in the reception area of the home. DS0000067943.V366709.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection of this service has been undertaken that has taken account of information received from the service and about the service since the last inspection, including an Annual quality assurance assessment (AQAA). The AQAA has been completed to a reasonable standard but contains areas where more supporting evidence would have been useful to illustrate the improvements made by the service in addressing outstanding shortfalls. The inspection has also included an unannounced site visit to the care home on 18/6/08 between the hours of 9:40 am and 4:00 pm. During this visit a tour of the premises was undertaken, time was spent with residents, and discussions held with three staff of the home in some depth in addition to the manager and a representative of the company. A range of records including, care plans, risk assessments, Medication administration records, staff recruitment, and training records have also been examined. All key inspection standards have been reviewed, in addition to some other standards where progress on addressing outstanding requirements has been assessed. Staff and service users were co operative and helpful during the site visit speaking positively of their experiences of the home, their input including survey feedback has been influential in the compilation of this report. What the service does well: The premises offer service users spacious, comfortable and homely accommodation in a relaxed and friendly atmosphere. Bedrooms are single occupancy and en-suite. The home is accessible. Systems are in place to ensure prospective residents are assessed and can visit and test-drive the home before moving in. Residents now benefit from having enough staff available to support them, staff continuity and stability is improving. Staff’ feel they are now valued and listened to; both they and service users have opportunities to express their views. DS0000067943.V366709.R01.S.doc Version 5.2 Page 6 There is a commitment to staff training. The home is more encouraging and enabling of service users to make choices and decisions in their daily lives and take an active role in running the home. The home is welcoming to visitors. Residents enjoy a varied diet and are consulted about what they eat. Staff commented that: “I’m happy working here” “I feel valued and I think the clients feel this too” “Things have definitely improved for the clients and staff” What has improved since the last inspection? What they could do better: Whilst the home has addressed specific requirements issued, shortfalls remain in some areas and further requirements have been made as a result. There is a need for the home to improve medication record systems to ensure service users are safeguarded by good practice. Although the home has provided some training to staff about the impact of adult safeguarding issues, they would benefit from further training that incorporates local protocols and makes staff aware of their own roles and responsibilities in working to these. DS0000067943.V366709.R01.S.doc Version 5.2 Page 7 The new manager has made good progress in strengthening the staff recruitment procedure, but, systems developed are not being consistently applied, the content of staff files is not compliant with legislation. Induction for newly recruited staff who have already attained NVQ2 level 2 and above is not clearly evidenced to ensure competency levels are satisfactory and to identify areas of training need. Some further recommendations for improved practice in respect of the environment and recording in service user documentation have also been made along with the need to progress the development of quality assurance systems. 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. DS0000067943.V366709.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 DS0000067943.V366709.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is continuing to develop accessible information about the service for current and prospective service users. People who come to live at the home can be confident that their needs will be assessed prior to their admission to ensure these can be met. EVIDENCE: Information available to prospective service users about the service in the form of Statement of Purpose and a user guide has now been updated. A terms and conditions document has also been developed for users in a format that uses pictures and texts. Currently only one service user is able to read information provided. Other service users are unused to information being provided in a more accessible pictorial format and need training to familiarise themselves with what symbols and pictures represent, if this format is to be effective; consideration should also be given to other formats that may include audio and visual aids. The manager is promoting greater use of picture references in everyday routines to encourage active participation by users in making choices and decision-making and this should continue to be expanded upon. The last inspection highlighted that satisfactory systems are in place for the assessment of prospective service users, in the absence of any new user admissions the assessment of this standard remains unchanged. DS0000067943.V366709.R01.S.doc Version 5.2 Page 10 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from having clear and detailed plans as to how care and support is to be provided by staff, improvements to incorporate user preferences in care delivery and how often plans are evaluated are ongoing. Changes to the management’ and culture within the home has empowered service users to express choice and decisions about their daily routines. Service users are safeguarded by the homes responsible approach to risk taking EVIDENCE: User files examined contain a comprehensive range of information including risk assessments and behaviour guidelines, care plans are being redeveloped to reflect a more person centred approach to care delivery for individuals, the manager has an understanding of person centred planning the establishment of realistic goals and is committed to introducing these; she recognises that further improvements in this area can be made to ensure personal preferences are fully reflected. An examination of records for two service users highlighted the omission of important information in respect of behaviours regarding DS0000067943.V366709.R01.S.doc Version 5.2 Page 11 falling and medication refusal, the manager has been recommended to ensure this is incorporated into the relevant user files. The manager reported that plans are underway to review care plans more often, at present there is a lack of clarity as to when plans have been reviewed by whom and what changes have taken place, it is recommended that this information is made clear and the planned improvements progressed. Discussion with staff and the manager indicated that improvements in the atmosphere and work practices in the home had encouraged and empowered users to be more actively involved in decision making and choices, it is not uncommon now for users to refuse to do something and there are opportunities for users to be involved in choices and decision making. The manager reports that she is trying to involve residents more in the daily routines of the household and some were observed undertaking household tasks e.g. hoovering, room tidying. Risks are responsibly managed, the manager is keen to ensure that service users whilst safeguarded from harm in their routines are not unduly restricted and as a consequence felt that already users are responding positively to a much less rigid daily routine. The holding of bedroom keys by individual service users has been discussed during the site visit and has been reported on elsewhere in the report. The manager has been reminded of the need to support judgements around the inability of service users to manage aspects of their daily routines with appropriate capacity assessments. DS0000067943.V366709.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users enjoy individualised activity programmes that enable them to maintain a community presence; they are supported to maintain links with family and friends where these exist. Opportunities are improving for users to make choices and decisions in their daily lives. Service users eat a varied and wholesome diet and are consulted about menu development. EVIDENCE: Service users spoken with during the site visit commented on the range of activities they currently enjoy and some aspirational goals, one person reported that they enjoyed literacy and numeracy, will be starting a photography course shortly and has an aspiration to sit an exam. Another service user advised that they are currently completing a geography course at college that they have enjoyed, they indicated an interest in history and the home has helped them to access a history course run by the college that starts shortly. DS0000067943.V366709.R01.S.doc Version 5.2 Page 13 The manager and staff reported that activities are individualised and each service user now has their own activity programme, this includes access to college-based courses. The home makes use of local facilities including the pub and local holiday camp where possible to supplement activity programmes in addition to trips farther a field, although a staff survey response indicated that staffing levels sometimes impact on the level of activities offered both in house and externally, the home is recruiting for an additional staff member currently. “I would like to see more outings and in house activities, staffing levels mean we do not always have the man power to facilitate these” Staff’ commented that they thought service users were generally well accepted in the local community. Discussions with individual users who were able to express a view indicated that they are enjoying the activities they do, staff’ demonstrated a good understanding of individual users and their interests and preferences. Where there are active family contacts the home manager and staff are supportive of maintaining these. The change in management and overall culture within the home has brought about improvements in confidence within the user group in expressing their own choices and decisions, the manager reported they seem able to say “no” now which they didn’t before when she first came she felt they seemed timid and withdrawn from taking an active role. There is observational evidence that the home is promoting independence for users in some areas of their daily routines; and this needs to be expanded upon to provide a more enriching and interesting lifestyle and enable them to develop and maximise their potential. The manager and staff reported that menus are developed weekly by a nominated staff’ member in consultation with service users, there is an absence of recording of this process. Menu boards are in place and the home is currently developing picture reference cards to aid menu selections and choice for service users, one user has been involved in producing photographs, consideration should be given to involving more service users in this project and also to ensure that the menu board is kept updated, the manager agreed she would consider this. Proposed changes to the kitchen environment will enable service users to become more actively involved in cooking. DS0000067943.V366709.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users personal care and health needs are being met but improvements to medication arrangements would better safeguard them. EVIDENCE: Staff’ demonstrated a good level of overall awareness about individual users care needs and routines, the manager has made improvements to information available to staff about care routines but acknowledges this could be improved upon to reflect personal preferences. An examination of user files indicated that health contact information is being recorded, and there is evidence of regular weight recording, there is also evidence of the recognition of possible skin viability risks for some people and this is appropriately assessed. Discussion with staff and the manager indicates that they have a good relationship with the local GP surgery and seek intervention from health professionals appropriately. The manager acknowledges that documentation about health needs and support is located in a number of places within the care file and the importance of the accessibility DS0000067943.V366709.R01.S.doc Version 5.2 Page 15 of this information, they have consulted with the local community learning disability team and consequently Health action plans are now being recorded for individuals these are time consuming to complete and a sample of one that is under completion was examined. Service users medication is predominantly provided within a new nomad style system, storage has not been assessed on this visit in preference to a review of recording and administration. A review of Medication administration records highlighted some shortfalls, these being the use of pre-printed sticky labels onto the administration records, this is not viewed as good practice by the Royal Pharmaceutical Society within their guidelines owing to the possibility of error occurring through overlapping, peeling off. Care staff are using medication codes but no key is in place to either provide consistency to the codes used or to provide information about what they mean, stock recording is being recorded inconsistently on the medication record sheet in the absence of somewhere else to put it, this was discussed with a suggestion that this should be recorded in the margin in the interim, handwritten entries are not routinely being signed for and dated. Only trained staff’ administer and yet no sample signature and record of initials used is maintained by the home. Discussion with the manager indicated that in the case of one user prone to refusing medication, the GP is to be contacted if there are two refusals, this is not recorded in the individual user plan, risk assessment or behaviour plan, the home is required to address all of the shortfalls highlighted. DS0000067943.V366709.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A change of culture within the house is encouraging service users to express their views and systems are in place to record their concerns, improvements have been made in safeguarding practices and this would be enhanced by staff training in this area to make clear their roles and responsibilities within local safeguarding protocols EVIDENCE: The manager has implemented a new system for recording complaints; no new complaints are logged at present. The complaints record is on display, although the manager agreed a more accessible format would be of benefit to users. The manager believes that the change in culture is having an empowering effect on users who are becoming more confident about their ability to express their views and she believes that once the present “honeymoon” period is over she and the staff may well receive user generated complaints, it was agreed that generally such complaints are likely to be of a minor nature but should be afforded the same degree of importance and value, it is important for users to gain trust in the system and to understand that if they express a concern this is listened to and acted upon, the manager was asked to ensure that staff are made aware of the need to record all expressions of concern by users and the actions taken to address them, the manager was also asked to ensure that the complaints procedure is revisited with users routinely until such time as they have the procedure in a format that is accessible to them and this is a recommendation. DS0000067943.V366709.R01.S.doc Version 5.2 Page 17 Staff’ have received some training about dealing with allegations of abuse from a staff perspective. Although clearly useful, this is not full adult safeguarding training as the home has been asked to provide. Staff spoken with demonstrated awareness of adult safeguarding issues and of the subtleties of abuse, they understood whistle blowing and that issues could be taken outside of the organisation, they would benefit from a fuller understanding of their roles and responsibilities and the local protocols that they are required to work to. It is a requirement that the staff’ receive Adult safeguarding training and that this is provided a minimum of every two years, the manager reported that this is on a list of planned training. The Commission is not aware of any outstanding alerts at this time. Systems are in place for the safe management of user finances and a sample of two users monies has been examined including record sheets, and receipts; these are accurate with cash sums held. The home has a culture for developing and using behaviour management plans although some important omissions were noted for two service users around falls and medication, although staff have an awareness of how these behaviours are to be managed this is not made clear within documentation to ensure this is consistently applied and adhered to by staff. An ABC system for recording behaviours is in place but this lacks clarity and purpose, this has been discussed at the site visit and the manager is in agreement that this is overdue for review. DS0000067943.V366709.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26,27,29,30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and homely environment and are enabled to personalise their own space but not routinely provided with the option to lock their rooms. The premises benefit from a programme of maintenance that is expected to address planned improvements and repairs accessibility could be improved further to enable full independent access. EVIDENCE: A tour of the premises during the site visit highlighted that some of the planned improvements to the patio area have been completed with others still outstanding. The development and refurbishment of a downstairs laundry area is to begin shortly, hopefully returning full use of the conservatory currently used for this purpose to the service users. The home is clean, odour free and maintained to a reasonable standard there are signs of wear and tear and the manager reports that a maintenance manager from the company has visited and made a record of outstanding repairs and works needed. DS0000067943.V366709.R01.S.doc Version 5.2 Page 19 Bedrooms are all single occupancy they are individually furnished to reflect the tastes and interest of the service user, with at least one user reporting they had purchased their own furniture because of personal preference. One bedroom viewed has a star key lock, this is not considered an appropriate lock to use and this has been discussed with the manager who has agreed to have this removed; there is also a need to ensure that service users have the choice to lock their bedrooms unless their risk assessment determines otherwise, and suitable locks that afford emergency access for staff should be installed for this purpose, these are recommendations of this report. En-suite facilities are provided in all bedrooms and there is a communal bathroom that combines the visitor’s toilet, there is need for all ensuite and bathing facilities to be reviewed as they are not always suitable of sufficiently accessible to meet the changing needs of the users and this is a recommendation. Handrails have been installed in corridors and a stair lift is in place for one user whose bedroom is upstairs. A portable ramp is used for users who wish to use the rear of the property and consideration should continue to be given to ways of making access throughout the premises independently accessible to users, and this remains a recommendation. Users have adaptations and aids in place in accordance with their needs the manager is aware of the need for servicing of these and has indicated within AQAA that equipment is serviced. There are currently two office spaces one in the former reception area of this former guest house/motel that affords little privacy either to the manager or other staff, another area is an enclosed room used to house medicines and documentation, whilst it is possible to be private within this space there is a lack of comfortable space and ventilation to hold a meeting in, currently an empty bedroom is used for this purpose but clearly in the event of the home becoming full, a review of staff office accommodation will need to be undertaken. DS0000067943.V366709.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35, People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users enjoy improved continuity of trained staff in sufficient numbers to support their daily routines; the safety of service users could be compromised if staff recruitment and induction procedures are not consistently adhered to. EVIDENCE: The home has done well in supporting staff to complete NVQ and to date has achieved the 50 of trained staff as other staff are completing the course currently this figure will rise. Since the appointment of the new manager Staff reported that there had been an improvement in staff morale, the culture and working atmosphere of the home and that these changes had encouraged staff that left previously to return. Staffing levels are satisfactory for the number and needs of the present users, one staff survey response indicated that sometimes staffing impacts on activities available to service users, this could not be evidenced as routinely effecting activity levels but should be kept under review. The manager has been committed to reducing staff turnover and the resulting need for agency cover, this has resulted in a significant reduction in the numbers of shifts DS0000067943.V366709.R01.S.doc Version 5.2 Page 21 covered by agency staff to just three in a 3 month period. This improved continuity of staffing and a more positive working environment has been of benefit to the service users whose behaviour has also shown improvement. Service users are kept informed of which staff are on duty by the introduction of a whiteboard showing the days rota and staff photos are affixed to the shifts they are covering. Staff commented that: “I’m happy working here” “I feel valued and I think the clients feel this too” “Things have definitely improved for the clients and staff”. An examination of four staff files highlighted improvements to the layout of staff files with information easily accessible, the home is also ensuring that new staff are not commencing work until receipt of a satisfactory CRB, the home has also implemented interview records and checklists unfortunately whilst the recruitment procedure has the potential to be robust the systems in place are not being consistently applied to all staff recruited in that one file had no application form and was missing one reference, gaps in employment and verification of reasons for leaving previous caring roles could not be evidenced as having been explored at interview and not all files contained interview records, a current photograph was not available on file for each staff member although clearly these are used for the pictorial rota, there is a need for the provider to ensure that staff files are compliant with regulation 19 & schedule 2 of the Care Homes Regulations as amended in July 2004 and to ensure that the recruitment of staff is robust and consistently applied, this is a requirement of this report. Whilst it is acknowledged that of the four newer staff recruited all but one have achieved NVQ2, discussion with two and examination of personnel records fails to indicate that qualified staff recruited to the home are receiving a suitable level of induction other than a basic orientation. Unqualified staff recruited confirmed they are completing skills for care workbooks and an example of these was examined at the site visit, it is essential that there is clear evidence of the managers assessment of new staff’ competencies in keeping with skills for care irrespective of the qualifications they made hold to be assured they have the necessary skills to support service users safely and appropriately. The provider is required to ensure that a system of induction is in place that takes into consideration the experience and knowledge of recruited staff and evidences judgements around what level of induction they receive in keeping with common induction standards. The manager has developed a training matrix and confirmed that a programme of training for staff to complete mandatory core training is in DS0000067943.V366709.R01.S.doc Version 5.2 Page 22 place, the manager was reminded of the importance of ensuring this is completed within a timely manner, the manager is currently considering the development of a staff trainer for some areas of mandatory training. Staff spoken with were positive about the improvements made since the new manager came they felt that the home was now somewhere where they wanted to work and wanted to see thrive, they felt settled and well supported by the new manager who they find approachable. DS0000067943.V366709.R01.S.doc Version 5.2 Page 23 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements in the management and atmosphere of the home ensure that it is run more in the interests of the service users, improvements are needed in some key areas to ensure service users are safeguarded and theirs views are taken into consideration when developing the service. EVIDENCE: Staff told us that the appointment of the new manager has made an impact on the morale and atmosphere within the home. This is a first management appointment for the manager who has completed the RMA and is awaiting assessment for this. Although limited in management of care experience the manager has made a good initial attempt in completing Annual assessment information for the Commission, this has been completed to a reasonable DS0000067943.V366709.R01.S.doc Version 5.2 Page 24 standard but would benefit from improved reflection on how the home has addressed previously identified shortfalls. The manager demonstrates a commitment to making improvements to the home that will benefit service users and staff. Staff’ find the manager approachable they enjoy the new atmosphere in the home and feel very positive about working at the home and the future of the service, they feel listened to and respected in their work as valued team members. The manager feels well supported by the company and its representatives. The company has appointed a quality manager and improvements to the standard of regulation 26 provider reports is already evident, the quality manager is proposing to implement a number of quality measures but this has been delayed by previous problems at the home. Opportunities have been developed for users to express their views about daily routines and other things they might be interested in e.g. activities, holidays, but there is a need for the home to find ways of capturing this information, analysing feedback from all stakeholders and evidencing how this influences service development, it is recommended that the home pursue the development of a quality assurance system to self assess and audit practices within the home and to evidence consultation with all stakeholders. The manager has reported in the AQAA information that policies and procedures have been updated and that all servicing and safety checks have been undertaken, these have not been checked on this occasion. Accident records have been viewed there is a low level of accidents recorded generally, however, observation during the site visit and discussion with the manager in respect of one service user indicates that staff view the users behaviour as precipitating “staged “ falls and these are not recorded, a review of the client file failed to record this behaviour and the manager was advised that this should be included in care plan, risk assessments and behaviour plans, as there may be a danger of genuine falls being overlooked the manager was asked to ensure such falls are recorded and that the service user is checked for injury. The home is appropriately notifying the commission at this time of any serious events or incidents that occur. DS0000067943.V366709.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 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 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 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 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 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 DS0000067943.V366709.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(4) Requirement The provider is required to ensure that systems for the safe administration and recording of medication are in place in that: Pre-printed sticky labels are not to be used on Medication administration sheets. This to be discussed with pharmacy An agreed key for codes used on medication administration sheets by staff to be incorporated onto administration sheets to ensure consistency in recording by staff. A register of sample signatures and initials of administering staff to be maintained. Stock control and receipt of prescribed medications into the home to be clearly evidenced in one location e.g. medication sheets and made known to all staff Handwritten entries on Medication sheets must be signed and dated by the person DS0000067943.V366709.R01.S.doc Version 5.2 Page 27 Timescale for action 31/08/08 entering the information 2. YA23 13(6) The provider must ensure that 31/08/08 all staff are provided with training in adult safeguarding that incorporates knowledge and awareness of local protocols and the roles and responsibilities of staff in working to these this training should be provided a minimum of every 2 years or sooner The provider must ensure that a 10/07/08 robust recruitment procedure is in place to safeguard service users in that: The content of staff files must comply with regulation 19 and sch 2 of the Care Home regulations 2001(as amended in 2004) in that: The provider must evidence that gaps in employment histories and verifications for leaving previous caring roles have been explored for each candidate. Two references must be obtained for each new staff member one of which should be from the last employer. The provider must ensure that 10/07/08 all staff are provided with induction into their role, irrespective of previous knowledge and skills and is compliant with skills for care common induction standards. 3. YA34 19sch2 4. YA35 18© RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Care plans to evidence clearly regular reviewing to DS0000067943.V366709.R01.S.doc Version 5.2 Page 28 2. YA18 3 4. YA23 YA24 expected frequencies, and more fully reflect personal preferences in care delivery That clear records are made of methods of communication used by individual users including any range of non verbal signals and what they are thought to represent to aid staff in providing support consistently That known behaviours are reflected within care plans, behaviour plans and associated risks are assessed That level wheelchair access is fully available around the rear entrance to the property That service users are provided with keys to their bedrooms except where risk assessments determine otherwise A review of washing facilities is undertaken to ensure that changing needs of service users can be supported adequately within present resources The home should develop quality assurance systems to self assess and self audit the service taking into consideration the views of service users and other stakeholders 5. 6. 7 YA26 YA27 YA39 DS0000067943.V366709.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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