Inspection on 18/09/07 for Cambridge

This inspection was carried out on 18th September 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cambridge 21/08/06

Cambridge 13/02/06

Cambridge 22/11/05

Cambridge 08/02/05

Cambridge 21/07/04

Cambridge 29/03/04

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 MIXED CATEGORY MAJORITY ADULTS 18-65 Cambridge 47 Downing Road Bootle Liverpool Merseyside L20 9LU Lead Inspector Mr John Mullen Key Unannounced Inspection 18th September 2007 09:00 Cambridge DS0000005259.V351160.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 Cambridge DS0000005259.V351160.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 Older People and 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. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cambridge Address 47 Downing Road Bootle Liverpool Merseyside L20 9LU 0151 9338695 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) www.peterhouseschool.org Autism Initiatives Simon Michael Thomas Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to Include up to 4 (LD) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 21st August 2006 Date of last inspection Brief Description of the Service: Cambridge Road is a home for the personal care and support for a maximum of four adults with learning disabilities. The home is owned by Autism Initiatives, a voluntary organisation experienced in this field and the registered manager is Simon Thomas. The home’s fees are based on individual assessment and at the time of the inspection ranged from £1067 to £1400 per week. There is an additional charge for toiletries, activities, hairdressing, and other sundry items. The home is situated in a residential area of Bootle within easy access of shopping and general community facilities. The premises consists of three units, two for single occupation and one for two residents. In addition, the home has two sleep-in rooms to accommodate staff. The home provides twenty-four hour staffing cover from a dedicated staff team led by a registered manager and deputy manager. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of Cambridge Road which included a site visit. All key standards were assessed in addition to a selection of other standards. This inspection encompassed information received since the last key inspection. In addition it included information provided by the agency through its pre-inspection questionnaire and supporting documents. Interviews took place with the registered manager and two support workers. Comment cards were sent out to a random selection of family members and in addition two family members were interviewed by telephone. All four residents were spoken to and observed during the site visit. The premises were inspected and a large amount of documentation examined. What the service does well: Cambridge Road is a good home which provides specialist support for residents. Its staff team is well trained and experienced in their work. There has been no change of residents in the recent past which means that staff are well aware of their needs and preferences. Relationships between staff and residents are of a good quality. One resident stated, “this is the best place I’ve ever been in”. The home bases it work on residents’ preferences and individual needs which means there is a lack of unnecessary rules and restrictions. They have full policies on which to base their work and they promote good relationships with residents’ families and friends. They attempt to integrate residents with the local community by use of local facilities and there is no institutional approach to their work. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Statement of Purpose was not available at the time of the inspection which detracts from the quality of information available. Although the care plans have been improved some are out of date and need to be reviewed. Equally, within the context of a generally safe medication process recording of medicines is not always exact and needs improvement. The home has attempted to record food taken by residents but further effort is required in this regard to ensure that a proper diet is maintained. The home has an element of a quality assurance system but this needs to be expanded and brought together to provide a framework for the home’s self-monitoring. Equally, all complaints must be recorded appropriately so that any trend can be identified. Most importantly, although there is a good standard of care being provided in the home it is being undermined by the lack of documentation in certain areas. In particular, the training and supervision of staff is not being fully documented so that these processes can be planned and recorded to provide direction for staff in the future. Cambridge DS0000005259.V351160.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. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a range of information both on and for residents so that it can plan its work appropriately. EVIDENCE: During the site visit, the registered manager could not locate the full Statement of Purpose which means that full information on the service is not readily available. The home has individual Service User Guides which contain full information for each resident including the individual fees to be paid and Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 10 the identity of their key workers. Since the last inspection the home has arranged for the registration certificate to be prominently displayed, as is the name and address of the Commission throughout the home, to fully inform residents and visitors. An examination of residents’ files found full background material on each at the point of referral to inform the home. This home has not had a new admission for five years and, therefore, the initial material is quite old but adequate. The home takes referrals from a wide geographical spread and, therefore, the format of assessment varies but all were very detailed and informative. The pre-inspection material stated that the home has up-dated its information to ensure it remains relevant. In addition, as part of its reorganisation of residents’ case files, the home has compiled full assessment material on each resident at the start of each file to give staff a full picture. Interviews with staff found them well aware of the needs of residents, particularly when they acted as key worker. Residents spoken to felt their needs were being met by the home as did relatives contacted. One relative interviewed stated that her daughter had “picked up quite well in the home” as an indicator of the improvement noted. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An individualised approach to care is promoted by the home resulting in service users being encouraged to have a varied experience whilst resident. EVIDENCE: An examination of case files found a new format for residents’ plans which consists of support plans, positive intervention support plans and health Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 12 assessment purpose and health action plans to provide an overall direction for the work. Interviews with both the registered manager and support workers found them in favour of the new format which they felt was both more concise and more useful in directing their work. The registered manager confirmed that some support plans were out of date and this was noted in some of the files considered, which detracted from their usefulness. In addition, the support plans seen did not identify future goals which would be helpful in planning future work. Staff spoken to were aware of the plans for residents as were those residents able to express their views on this, confirming that individualised planning is in place. Interviews with staff including the registered manager showed that the philosophy of the home, also stated in the pre-inspection material, is to promote individual choices and decision making. Observations during the inspection and interviews with residents showed that residents were making choices in terms of activities, food and education based on individual preferences and so promoting individuality. An interview with the registered manager confirmed that the home has applied for advocates for two of the residents so that they can have an independent voice. Both residents and families said that the former are encouraged in their individuality in the home so that routines are not fixed. An examination of case files confirmed that the home has now rationalised its risk assessments so that there were fewer in the files and, therefore more useable. The risk assessments were up to date, comprehensive and therefore, relevant. Interviews with the registered manager, agreed by other staff, showed that residents were encouraged to participate in activities within an safe framework and good examples were given of this including the most dependent resident travelling some distance to her family and, therefore, leading a more varied life. The pre-inspection material stated that the philosophy of the home is to promote independence and residents spoken to had no complaint to make about any unnecessary rules within the home but on the contrary were very complimentary about their care. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 14 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures of the home ensure that residents have an individualised approach to their care resulting in a varied lifestyle. EVIDENCE: An interview with staff, confirmed by the files, showed that residents are being encouraged to take part in varied activities, depending on capacity, to expand their lifestyle. One resident is about to start an Open University course in web design and is being encouraged in his computer interest generally. An interview with this resident found him very appreciative of the staff support he is receiving in this area. Another resident is about to have a final interview for a voluntary post at a local hospital. This resident is anxious about this matter but staff are well aware of this and are appropriately supporting him through this process so that he can achieve this goal. Two other residents are less able but are being provided with appropriate activities which was observed during the site visit and confirmed that they are encouraged to develop their social skills. The site visit confirmed that residents are encouraged to use local facilities and this was taking place at the time of the inspection confirming that the daily routine is varied. In addition, residents use the local dentist, general practitioners and libraries as part of their integration into the community. Discussions with staff confirmed that generally the home has a good relationship with the local community and is well sited to access local facilities. Unfortunately, recently, the home has been targeted by some local youths who have been irritating one resident in particular with adverse effects. The registered manager is taking appropriate steps to deal with the situation so that upset can be minimised. Contact with families confirmed that they are encouraged in their links with the home so that their relatives are not isolated. One family who live a considerable distance away have recently visited for the week and one sister of a resident stayed with him over a weekend to maintain family links. Families contacted had no concerns about the home but were complimentary in their opinion and comments receives included “no problems” and “no complaints”. The registered manager also stated that another resident had recently visited her family some distance away and all have regular contact with family and friends. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 15 Observations during the site visit confirmed a positive and appropriate interaction with residents within the home resulting in a relaxed atmosphere. Residents have keys for their own rooms and use the home as they so wish so that they can feel relaxed in the home. Residents spoken to were happy with the level of independence they have and this was confirmed by families, one of whom was particularly complimentary about the improvement in her daughter since she has been in the home. Interviews with staff showed they were well aware of the need to promote residents’ independence and this was confirmed by the individual support plans which are in place which confirmed a standard of care based on good practice. A tour of the premises confirmed that each individual resident has their own shopping and menus based on individual preference. One resident said she “choose what I want” although she has to be supported in the shopping so that a balanced diet is provided. Some residents are very independent and do all their shopping and cooking without help so that their skills in this area are developed. The home attempts to record the food taken by residents but this is not entirely successful with the more independent residents despite the home’s best efforts. Residents spoken to were happy with the arrangements for meals and interviews with staff confirmed a flexible, individualised approach to meals and mealtimes. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good level of personal and health care support so that residents’ needs are identified and promoted. EVIDENCE: The pre-inspection material stated that the home provides very little personal care for the residents but generally provides support and encouragement so that residents can develop in these areas. The home does have a key worker Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 17 role for staff and interviews with staff found them both well aware of the requirements of the role and the particular needs of those residents they are responsible for. Observations during the site visit plus interviews with residents confirmed that the latter are encouraged to choose their own clothes and other personal effects so that there is no institutionalised appearance. On the contrary, residents looked well dressed and well cared for reflecting a high standard of care. Contact with families confirmed no problems with the personal care provided for their relatives. An interview with the registered manager showed an understanding of the health care needs of residents and the need for the home to promote these. One resident is about to undergo a minor operation and interviews with staff confirmed that they are aware of the stress this is causing and are actively reassuring the resident. Another resident is diabetic and is being attended by the district nurse twice a day for injections. However, the resident is being supported to take over this process herself which is a positive promotion of independence. Other health care needs are being met as required with residents being registered with local dentists and general practitioners as part of a normal daily life. Documentation seen, including a health action plan, showed that health care needs are actively promoted within the home. A tour of the premises identified that medicines are being stored appropriately within the home to safeguard residents. The registered manager confirmed that only one resident is currently partly self-medicating to develop experience. Self-medication was at a higher level but the resident concerned expressed doubts and asked the home to take over the process so that safe practices are maintained. Interviews with staff confirmed that all have had training in medication and all felt confident about the process. Medication records seen were completed although there were some minor deficiencies that need addressing to fully promote good practice. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies and procedures to protect residents. EVIDENCE: Since the last inspection the home has ensured that the complaints’ procedure, including the name and address of the Commission, is within the Service User Guide to provide full information. In addition, the name and address of the Commission is widely publicised throughout the home and one resident interviewed was very aware of this which confirmed the effectiveness of this process. The registered manager said there had been no complaint since the last inspection and an examination of the complaints’ book confirmed this. However, in interview and in documents seen from the quality assurance audit, it was confirmed that a complaint had been made by a resident although not about the home. In discussion, the registered manager admitted that it should have been recorded in the complaints’ book as a matter of good Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 19 practice. All residents spoken to as well as family members had no complaint to make about the home which confirmed the good opinion they had of the service. The home has a full procedure for the prevention of abuse which has been seen on previous inspections to confirm correct practice. The pre-inspection material stated that the home publicises the existence of an Adult Protection Officer to further protect residents. The home has not had any such allegation to test the procedures effectiveness. An examination of training records showed that most, but not all staff have had recent training in this matter to reinforce practice. No concerns surrounding this issue were raised by either families or residents during this inspection. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises of the home are suitable for the comfortable and effective care of residents. EVIDENCE: Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 21 A tour of the premises confirmed there had been no structural changes since the last inspection and its suitability for its purpose. The pre-inspection material showed that a plan to refurbish the home is in place to maintain standards. The home is divided into three units two of which are selfcontained flats for two residents and one a two-bedded unit in the main building. Since the last inspection the home has ensured that at least one comfortable chair is in each bedroom so that it can be better used by residents. The bedrooms are pleasant and comfortable so that they remain pleasant living areas. The home is reasonably decorated and furnished and although interviews with staff showed that some minor repairs are still outstanding the overall impression is of a pleasant living environment. Interviews with residents, confirmed by contact with families, showed a high level of satisfaction with the premises which blend easily into the community. Residents have full access to the home although they tend to stay in their specific areas and the home is well sited for access to local facilities. A tour of the premises found them clean and hygienic and, therefore, fit for purpose. It has appropriate laundry facilities and hand washing facilities to maintain hygiene standards. The home does not have any domestic support but in an interview with the registered manager he did not find this an issue and the site visit confirmed this. Residents are encouraged to manage cleaning to the extent that their abilities allow and therefore contribute to the running of the home. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home recruits, trains and supports staff to a reasonable level although the lack of documentation detracts from this. EVIDENCE: An examination of staff files found appropriate recruitment procedures in place for the protection of residents. These included full application forms, checks Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 23 on identity, police checks and references as part of a comprehensive process. The pre-inspection material confirmed that this process has been adapted to take account of equality and diversity issues. Staff interviewed had been recruited some time previously but felt it was fair and complete. The registered manager stated he had no problems with the staff group and that the recruitment processes were appropriate to ensure a good level of staff quality. The registered manager had acquired some training records for the purpose of the inspection and these confirmed that regular training has been given to staff. However, the home does not have a staff training and development plan in place although the new personal professional development portfolio does allow for this once this is properly introduced. This new format also allows for a full induction training for staff when it is introduced so that staff are properly prepared. The registered manager confirmed that there is a shortage of recording in this area meaning that the home cannot fully demonstrate its commitment to training. Vocational training is being provided to a good standard and support workers interviewed felt they were being trained to a good level although there were some gaps in some of the required subjects meaning that an overall picture was lacking. Interviews with staff all confirmed they felt well supported within the home so that they were confident in their work. However, they did give varying responses to the frequency of formal supervision which indicates a lack of consistency in the process. In addition, an interview with the registered manager confirmed that there is a lack of documentation both about the frequency of supervision and the outcome of each session which means that the process of formal supervision is not clear. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and positive environment for the care of residents. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 25 EVIDENCE: There has been no change to the registered manager since the last inspection which confirms continuity in the home. He has been in post for a number of years and is experienced to undertake the role. The pre-inspection material stated he is currently undertaking the Registered Managers Award which he expects to complete by the end of the year and then a vocational training in care which will complete his qualification requirements. An examination of his training record confirms that he has undertaken regular training in relevant subjects to maintain his knowledge base. Interviews with support staff within the home revealed that they are well supported by the registered manager and they had confidence in his management of the home. Interviews with residents and contacts with families revealed no concern with the management of Cambridge Road which they felt was well run. An interview with the registered manager confirmed he felt there were deficits in the documentation of a quality assurance system. The home does have a quality assurance file but this lacks an amount of documentation so that a full process is not in place. The home does have some external monitoring including a quality assurance audit, last undertaken in June 2007 and a management monitoring visit on 20th August 2007 so that some elements of a quality system are in place. The pre-inspection material stated there is a residents’ forum in place although no current resident of this home attends to represent Cambridge Road. In interview, the registered manager said that the main quality assurance process is through staff talking individually to residents to gauge their opinions. This however, needs to be expanded into a quality assurance system so that there is a method of continuing improvement in place. Relatives contacted did not say they had any input into a quality assurance system although this did not detract from their opinion of the home. A tour of the premises found the home to be a safe environment for the care of residents. An interview with a support worker with responsibility for health and safety matters showed that monthly checks are made on health and safety matters and weekly checks are made of water temperatures as part of promoting safe practice. An examination of training records showed that health and safety and moving and handling training, amongst others, are provided to staff to promote safety. In addition, the new induction programme includes a module on the introduction to health and safety to introduce staff early to these concepts. An examination of the fire book found that regular checks are being made and that a current fire risk assessment is in place for the protection of staff and residents. Autisms Initiatives has a full range of health and safety policies to underpin practice and promote safe working. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 26 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 X 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 2 43 X 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cambridge Score 3 3 2 X DS0000005259.V351160.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA35 Regulation 18 Requirement The registered manager to ensure that staff receive five days training a year, that this is fully documented in the training records and that these records are kept in the home so that a full training plan is in place. (Previous timescale of 1st January 2007 not met). The registered manager to ensure that an up to date Statement of Purpose is present in the home so that fuller information is available. The registered manager to ensure that residents’ plans are up to date and reviewed regularly to confirm their relevance. The registered manager to ensure that medicines are fully recorded in the home to safeguard residents. Timescale for action 01/01/08 2. YA1 4 01/01/08 3. YA6 15(2) 01/12/07 4. YA20 13(2) 01/11/07 Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 28 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 YA17 Good Practice Recommendations The registered manager to further attempt to record all food consumed in the home so that residents’ diets can be monitored. The registered manager to ensure that supervision sessions are fully planned and documented to assist staff in their development. The registered manager to expand and document a quality assurance process to be used as a basis for continuing improvement. The registered manager to ensure that all complaints are appropriately recorded. 2. YA36 3. YA39 4. YA22 Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Cambridge DS0000005259.V351160.R01.S.doc Version 5.2 Page 30 - 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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