Inspection on 16/05/07 for Canterbury Adult Support Unit

This inspection was carried out on 16th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Canterbury Adult Support Unit 17/07/06

Canterbury Adult Support Unit 03/11/05

Canterbury Adult Support Unit 05/07/05

Canterbury Adult Support Unit 15/03/05

Canterbury Adult Support Unit 08/04/04

Similar services:

Southfields

Thorndene

Insight - Eastchurch

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Canterbury Adult Support Unit 88 Whitstable Road Canterbury Kent CT2 8ED Lead Inspector Jenny McGookin Key Unannounced Inspection 16th May 2007 10:20 Canterbury Adult Support Unit DS0000037735.V334686.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 Canterbury Adult Support Unit DS0000037735.V334686.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. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Canterbury Adult Support Unit Address 88 Whitstable Road Canterbury Kent CT2 8ED 01227 454020 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) tim.birchley@kent.gov.uk Kent County Council Ms Amanda Gerlack Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th July 2006 Brief Description of the Service: The home is a three-storey, semi detached property. It is currently owned and operated by Kent County Council as part of the Canterbury Adult Support Service. The home is registered to provide short-term respite care for up to eight persons at a time, aged from 18 years to 64 years, who have a learning disability. However the home has reduced its shared bedrooms and is now only able to accommodate five service users. The inspection in March 2005 suggested that Kent County Council consider reducing its registered number accordingly, which would offer a saving in bed fees, but this matter was found to be still outstanding. There is a ground floor bedroom with en-suite WC and walk in shower. There are some adaptations but the premises are not currently judged accessible for individuals with mobility impairment. The home also provides a day care service. The home is located about 1.5 miles from Canterbury City Centre and is on a direct bus route to the seaside towns of Herne Bay, Whitstable in one direction and with Canterbury itself in the other. There are several parking bays on a vacant site to the side of the home and some sections of Whitstable Road. There is a small back garden and patio area for the service users’ use. The current fees for the service at the time of the visit per week were not available, but would be subject to financial assessment in each case. Information on the home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is mandygerlack@kent.gov.uk Canterbury Adult Support Unit DS0000037735.V334686.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 site visit, which was intended to inform this year’s key inspection process; to review findings on the last year’s inspection (July 2007) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion. The inspection process took just under seven and a half hours, and involved meeting with three service users (including two over lunch); the registered manager; a senior support worker, and three support workers. Interactions between staff and the service users were observed during the day. The inspection also involved a review of the premises and a range of records. Three service users’ files were selected for care tracking. And three personnel files were partially audited against the National Minimum Standards, accepting most records are retained at Head office. What the service does well: The location is judged generally suitable for its stated purpose, convenient for visitors and offers ready access to community, countryside and seaside resources. There are good links with the community. Property maintenance checks were in good order, and the home is tidy, clean and odour free. There are homely touches throughout. This home has significantly more strengths than weaknesses. It continues to provide good evidence of strong and consistent management, delivering good outcomes for people, and uses its resources well. The registered person demonstrates a commitment to equality and diversity, and this is demonstrated in practice. The manager shows an awareness of the homes strengths and areas for development, and has the ability and corporate support to take forward constinuous improvement. There has been a timely response to requirements and regulations and key standards are met. The staff team is competent, well-trained and supported and there are clear policies and standards to guide working practice. This is a staff team, which feels well invested in, and supported on a day-to-day basis. The rapport between the manager, staff team and residents is appropriately familiar, relaxed and respectful. The systems for assessment, monitoring, reviewing and recording are robust to promote the welfare and safeguard people who use the service. People who use the service are involved in a variety of ways, consistenty with their wishes Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 6 and abilities. The home’s person-centred care plans are judged very holistic and it is viewed positively by its stakeholders. What has improved since the last inspection? What they could do better: 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. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 7 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 Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5 Prospective service users and their representatives have better information to decide whether this home will meet their needs. Service users have their needs assessed and there is a contract which clearly tells them about the service they will receive. EVIDENCE: The Statement of Purpose and Service User Guide and contract have each been subject to ongoing revision, and each document usefully details a range of elements of the services and facilities provided by this home. Some matters have been raised to further improve them and the detail has been reported back to the home separately. Although Kent County Council has the resources to provide both documents in other languages or formats, these have not in practice been requested. One service user did, however, assisted with the production of the latest Service User Guide by selecting its illustrations, which is judged an inclusive approach. Staff are available, moreover, to explain their provisions. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 9 A copy of the latest inspection report is readily available in compliance with the standard – it is kept in the hallway. The referral process is in the first instance led by care managers, and information obtained at that stage is then supplemented by the unit’s own assessment processes e.g. of behavioural issues. The service users are routinely involved in the referral process. The care plan is written to meet the service offered, and risk assessments are used to establish what restrictions need to be in place. The home is primarily designed to provide for short-term periods of respite care and day care. Emergency admissions are possible but they are rare and the circumstances may well override the home’s more usual carefully managed incremental approach. Care support plans, risk assessments, Quality Assurance surveys and “Exit” questionnaires are routinely used to identify and review the assessed needs. The contracting function operates on three levels. Once a referral is accepted, there are in each case Service Delivery Requests identifying the specific bookings (respite or day care), which are backed up by detailed funding and service provision arrangements between the unit and the funding source e.g. Kent County Council Care management. The Service User Guide is also expected to summarise the terms and conditions of placements. There is also a “Personal Responsibilities Agreement” between each respite user and the unit covering a range of undertakings (key safety, room maintenance, core values, smoking, medication, finances, daily routines, fire safety and complaints). This document is illustrated to make it more accessible. Canterbury Adult Support Unit DS0000037735.V334686.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 6, 7, 8, 9, 10 Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: The format of the care plans used by this home is designed to enable all aspects of the health, personal and social care needs of the service user to be met. They are usefully underpinned by risk assessments (generic and specific), in respect of individuals, their activities and environment, and followed through by the daily reporting log sheets and “Exit” questionnaires. However, service users have historically shown no sustained interest in these process, despite (foe example) the introduction of computer-generated illustrations to make the care plans more meaningful to them, and despite efforts to record their opinions on each issue raised with them. The planned Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 11 introduction of courtesy calls is the latest initiative, to help ensure feedback on each stay is as inclusive as it can be. Quality assurance surveys and “Exit” questionnaires would be the other most likely way of identifying unmet needs. The service users’ level of understanding of the spoken language is generally adequate, although the home uses some Makaton, signs, symbols and verbal prompts. All staff undertaken in-house communication training to meet their individual needs. Kent County Council has the resources to support the home to meet the needs of minority ethnic communities, but this does not in practice apply. With one exception (who is westernised in all respects), all the current service users are white UK. All the current service users tend to require prompts or supervision with aspects of their daily living, rather than direct interventions. There continues to be good evidence that service users are supported to make choices for themselves. Feedback from relatives and service users (representing respite residential care and day care) invariably confirmed that: they felt the service users were well cared for and that staff treated them well. The arrangements for keeping records, medication, valuables and money are judged generally secure. Nursing care is not provided. Canterbury Adult Support Unit DS0000037735.V334686.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 11, 12, 13, 14, 15, 16, 17 People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities generally meet individual’s expectations. EVIDENCE: This home is judged well placed in terms of access to bus routes, train routes and shops as well as pubs, restaurants, cafes and all the community resources associated with Canterbury city centre. The home also has access to its own 7-seater people carrier transport, and staff can use their own cars if they have the necessary insurance cover. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 13 The scope of this home’s risk assessments keep people safe, while their scope for independence is being promoted. There are house rules relating to health and safety matters (e.g. smoking, fire safety) and their likely impact on other service users. Service users can generally choose when to get up and go to bed, whether to go out or stay in – the home’s daily routines are organised around this, accepting some would have day centre or other commitments. Service users have a choice over having keys to their bedroom doors, subject to risk assessments, and the front door is not locked to prevent egress. This home offers a range of activities inside and outside the home: activities inside the home include: watching the television or videos, using the unit’s DVD player or PlayStation, jigsaws, painting, arts and crafts, as well as opportunities to learn and use practical life skills. See below. Leisure activities outside the home are said to include bowling alley, pubs, library, shopping, theatre, cinema and organised outings / trips i.e. socially inclusive activities, not readily associated with disability. Some service users can go out on their own and travel independently e.g. by train or bus. Some others are judged able to do so, but have not been allowed to do so by parents, or have not been provided with the pocket money to do so – this can effectively frustrate plans for group outings. There is a payphone in the hallway lounge and service users are supported to make and receive calls. There are cost implications. The home has open visiting arrangements – though visitors are asked to ring ahead to establish whether their visit is convenient. This is judged reasonable. Service users do continue to link up with friends from outside the unit as well as family members. There is some evidence of training in practical life skills (such as cookery, laundry and other domestic duties). One service users was supported to cook a meal for a visiting parent. One service user has been supported to move on into supported living in her own flat and another is planned. Some service users have work experience opportunities and other attend day centres. One of the service users also spoke with some pride about his employment by a local catering company. There could, however, be more demonstrable interaction between the work done at the home and the work done at day centres, college or other outside activities, so that the learning and experiential processes could be exploited to benefit service users. This matter has been raised at previous inspections. Although there is some interaction with day services at reviews, and although some services users will talk about what they have done at day services, this is not routinely the case. The daily routines in this home are flexible and service users plan their meals. Some special diets (ethnic, medical) can be catered for. The home uses fresh Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 14 ingredients wherever practicable. There are facilities for making drinks and snacks at other times. On this site visit, two service users were joined for lunch. Both service users had assisted with its preparation and it was judged tasty and well presented. Feedback from the service users has invariably confirmed that they liked the food. The dining room setting was judged congenial, with good quality tables and chairs, and homely touches include a painting (by service users) and colourful collages of photographs of the service users. Individual log sheets are used to record the meals actually consumed, so that anyone authorised to inspect the record can assess whether each service user’s diet is sufficiently nutritious, varied, and balanced (Reg 2(2)(i)). Service users generally take packed lunches to day services. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 18, 19, 20 The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: All the service users would have access to a range of healthcare professionals in relation to their own home settings, though staff are available to offer support to attend surgeries: e.g. GP, dentist etc. An assessment of needs and preferences is carried out on referral and admission, and there were records and anecdotal information from staff confirming personalised routines in respect of service users’ self-care skills. The home has a key worker system, and the induction of new staff routinely includes personal care issues. The current service users only need to be prompted to self-care. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 16 Although two bedrooms were originally set up as double rooms, only one still has two beds in it, in case service users like to share. All the bedrooms are otherwise in practice used as single occupancy, so service users can be assured of privacy. Staff are required to knock on bedroom doors and wait to be invited in. All the service users are given the choice of managing a bedroom door key, subject to risk assessments in each case. The service users’ capacity to self-medicate is subject to individual risk assessment in the first instance, but not routinely reviewed thereon, unless the need is indicated by daily reports or other sources. Some service users take medication with them for use at day services or other outside activities. Record keeping, daily checks and storage arrangements were judged generally satisfactory, though the home should review its arrangements for controlled medication. And the portability of refrigerated medication should be periodically risk assessed - a dedicated secured fridge has been recommended. KCC has traditionally arranged for staff training in medication and an examination of training records showed a useful range of topic covered. Less clear was evidence of competency testing. KCC should continue to look for opportunities to demonstrate staff competency in medication arrangements e.g. by accreditation sources The services provided by this unit (respite and day care) are not intended to include care of the terminally ill or dying, other than sudden, unexpected events, so this standard was not inspected. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 22, 23 People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Service users are protected from abuse, and have their rights protected. EVIDENCE: The Kent County Council complaints policy is on display in the hallway. There is also a KCC leaflet on the corporate complaints, which has been updated to take into account the new title of the Commission. The manager reports that no complaints have been registered by the home since the last inspection (July 2006). This is not judged a realistic reflection of communal living. The service users are advised about advocacy services and other specialist services available to them through their day care or club outlets rather than the home, but only one has been accessing an advocacy group. There is no input from advocates, volunteers or befrienders The manager should continue to look for opportunities to demonstrate that prospective complainants not only know how to complain (i.e. that there is an accessible procedure) but can be assisted through independent advocacy. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 18 Feedback from service users and their relatives indicates that they feel well cared for and that they knew who to speak to if they were unhappy with their care, and were confident that staff would deal with this. The home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets. Meetings with staff showed a sound understanding of the principle of whistle blowing bad practice. All the service users confirmed that they felt safe there. The rapport between staff and the current resident appeared appropriately familiar and respectful. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 24, 25, 26, 27, 28, 29, 30 The physical design and layout of the home enables people who currently use the service to live safely. It is a well-maintained and comfortable environment, which encourages independence. EVIDENCE: Access to the home and to local amenities is judged satisfactory for the current service users – see description on page 5 for more details. The premises were judged generally suitable for its stated purpose; accessible for the current service users, safe and well maintained. Since the last inspection communal areas such as the stairwell have been redecorated and there are new carpets throughout. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 20 The provision of furniture and fittings observed generally complied with most of the elements of the standards in this section. The home is judged better suited to registration for six rather than eight. This matter was first raised in March 2005 for consideration by Kent County Council, and found to be still outstanding. Although one ground floor bedroom is relatively accessible, and there are some handrails (e.g. around the WC and bathroom areas) the rest of the property is not generally adapted for individuals with significant mobility impairment. There is one steep step from pavement onto the garden path, and another steep step up to front door. There is a side gate but the surfaces within the back garden and outside are very uneven. Planning permission for a ramp access at the front has been refused. There are some signs and symbols around the property, but the current service users have a generally good level of understanding of spoken English. No one requires a Loop system (for use with hearing aids). The front door is locked to prevent unauthorised access and has to be physically unlocked with a key, which is kept accessible. Service users can go out on their own (two go to town) but tend in practice to go out with staff. With one exception (ground floor) all the service users’ bedrooms are sited on the 1st , 2nd and 3rd floors. One bedroom is set up as a double room but the practice is to use it as single occupancy unless service users particularly want to share. All the others are single occupancy. The ground floor bedroom has an en-suite WC and walk-in shower room. All bedroom doors have door guards linked to the fire alarm system, so that they can be left open without compromising fire safety and will slam closed when the alarm activates. One single bedroom is also the fire exit route so its door cannot be locked as this would prevent safe egress in event of fire. All the bedroom doors have double acting locks so that staff could access them in emergencies, and some of the service users do opt to lock their doors. Each room has been provided with suitable lockable facilities. All the rooms were judged reasonably individualised. There are sufficient bath and toilet facilities for the number of service users and they are accessible to bedrooms and communal facilities. There are three WCs, two bathrooms and two shower facilities (one of which was installed in an upstairs bathroom). One ground floor bedroom has an ensuite WC and walk-in shower. All the bedrooms, moreover, have washbasins to comply with this standard. The standard of cleanliness was judged generally very satisfactory, although flooring in WC areas (including the en-suite facility) needed sealing along edges and seams or replacing altogether e.g. behind WC bowl to obtain Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 21 continuous impermeable surfaces (matter first raised in March 2005 and found to be still outstanding). There is sufficient choice of communal space to accommodate a choice of social and recreational activities. There is a spacious lounge room, an activities room (which also doubles as a laundry room), and a separate dining area and kitchen, all of which was judged generally compliant with the elements of this standard and well maintained. However, one member of the sleep-in staff has to use a futon in the lounge which could inhibit its use by service users, although the service users all have TVs in their rooms as well as any other equipment of their own e.g. CD player etc. This arrangement is not ideal and an alternative arrangement should be found. The dining room provides a congenial setting for meals. A communal painting and colourful collages of photographs of the residents all provide positive focal and conversation points. There is a walled garden at the rear of the property, which provides discrete areas for privacy and positive focal features such as a pond and bench. The home is judged generally well maintained and odour free. However, access to the laundry is only through the kitchen, which is judged unsafe practice, and KCC have been asked to address this. The manager said this has been risk assessed and that in the meantime laundry is not being carried through the kitchen while food is being handled. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 34, 35, 36 Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: There should be two support staff on duty at all times, day and night. At night both staff sleep in but are on call. See standard 28 in respect of sleeping arrangements. The staffing arrangements appeared to be generally sufficient, although feedback indicates some off site activities have been frustrated for want of available staff. There are also permanent relief support workers, who cover annual leave, sickness and training, and some additional hours can be negotiated via care management to meet special needs. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 23 There are separate dedicated cleaning, cooking and maintenance hours, in line with required practice. The KCC Personnel organises the advertising of vacancies and receive the application forms in the first instance. The manager takes the lead on shortlisting. Interviews are held on site and involve a pre-set question and answer session and scoring system. There was anecdotal information about the extent to which one service users had also been involved in this process, which is judged exemplary practice. The manager also encourages candidates to make supervised informal visits to the unit and this was confirmed by staff during this inspection visit. However, recruitment documents are kept at the Head Office and were not available for inspection, so compliance with expected recruitment practice could not be confirmed except through separate meetings with staff. The KCC will need to come to a formal arrangement with the Commission for access. There is a corporate induction checklist, and a unit-specific checklist to supplement this. This is judged sound practice All staff have to undergo the Learning Disability Award Framework (LDAF) – accredited training as part of their NVQ accreditation. And 51 of the staff are reported to have obtained NVQ2 or above. All staff are also expected to undertake core training (1st Aid, Moving and Handling, Risk Assessment, Food Hygiene etc) and staff confirmed a generally sound level of investment in core training, refresher training and special interest training. Personal Action Plans and supervision are used to identify training and development needs. Kent County Council produces an annual staff training and development programme. Staff confirmed supervision meetings, 4-6 weekly i.e. in excess of the National Minimum Standards. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 37, 38, 39, 40, 42, 42, 43 The manager is suitably qualified and competent and her management and administration of the home is based on openness and respect. There are effective quality assurance systems EVIDENCE: The manager has worked for Kent County Council for several years: has previous experience in residential care work and has obtained her Registered Managers Award, which she intends following up with NVQ Level 4 accreditation. The inspector judged the manager’s qualifications and experience to date, as described, were appropriate, subject to the Commission’s formal registration processes in due course. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 25 Diversity and Inclusion. With one exception (who is Westernised), all the service users are white UK – as are the staff. There are currently no ethnicity issues. Although the home uses some Makaton, signs and symbols, all the service users have a good understanding of spoken English and can make themselves understood. Staff appeared to be able to communicate effectively with them as well as support them to make choices and decisions. The home operates a key worker system. This is a mixed gender team, which continues to report working harmoniously and flexibly to meet the needs of service users. Kent County Council offers clear lines of accountability. The processes for managing this home appear open and transparent, and the delegation of budgets and authority is appropriate. The manager controls a lot of the unit’s budgets, but does have to justify some aspects of the expenditure to KCC. One staff handover session was observed, where petty cash floats were balanced by one member of staff, witnessed by another, as evidence of probity. The standard of record keeping is judged satisfactory, and the filing systems sampled were in good order, up to date. The arrangements for maintaining the health, safety and welfare of service users and staff are also judged robust. Staff group meetings routinely include the discussion of any new policies to help ensure consistent compliance in practice. And absent staff are required to sign checklists to confirm having kept apprised of these. Staff meetings routinely included service users’ issues and interests, and there is a weekly house meeting fro service users, which is used to discuss a number of issues of relevance to them (e.g. menus, activities), as well as house rules and health and safety related standing agenda items. This is judged a well rounded arrangement. The KCC Annual Operating Plan sets an overarching outcome for all its services and usefully identifies the legislative context, a number of contributory strands; and a range of targets, priorities, lead roles and key performance indicators as part of what is called “The Kent Agreement”. And this is underpinned by the home’s own unit specific action plan, which was made available for inspection. The home maintains a range of records required by regulation for the protection of service users and for the effective and efficient running of the business, and all those seen were judged well maintained, up to date and accurate. There is good evidence of continuous monitoring e.g. of health and safety standards and through staff supervision and appraisals. Feedback on services is obtained routinely through “exit” surveys, the planned courtesy calls and the care planning processes. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 26 Pre-inspection information indicates that all the policies prescribed by the CSCI are in place, where they are relevant to this service. The home’s policies are readily accessible to staff and new policies are routinely discussed at staff meetings. Although, theoretically, policies are also available to service users they are not currently adapted in a user-friendly format for the service users. This should be pursued, to encourage their ownership. However, key policies and key issues such as health and safety are discussed in house meetings with service users to ensure their ownership. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 4 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 4 3 3 3 3 3 Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 28 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 YA30 Regulation Requirement Timescale for action 30/06/07 12,13,1623 The registered provider to produce an action plan regarding the safe accessing of the laundry area, not using the kitchen. This to be submitted to the CSCI. Original timeframe 31/01/06 Revised timeframe 30/09/06 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 YA20 Good Practice Recommendations KCC should look for opportunities to demonstrate staff competency in medication arrangements e.g. by accreditation sources The portability of refrigerated medication should be periodically risk assessed and a dedicated secured fridge is recommended. The use of a futon in the lounge by sleep-in staff should be reviewed as it could inhibit the room’s use by service DS0000037735.V334686.R01.S.doc Version 5.2 Page 29 2 YA20 3 YA28 Canterbury Adult Support Unit 4 YA40 users. Alternative arrangements should be considered. The home should continue to look for opportunities to adapt key policies in a user-friendly format for the service users. Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local 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. Extracts may not be used or reproduced without the express permission of CSCI Canterbury Adult Support Unit DS0000037735.V334686.R01.S.doc Version 5.2 Page 31 - 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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