Inspection on 17/07/06 for Canterbury Adult Support Unit

This inspection was carried out on 17th July 2006.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Canterbury Adult Support Unit 16/05/07

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 Unannounced Inspection 17th July 2006 10:00 Canterbury Adult Support Unit DS0000037735.V303231.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.V303231.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.V303231.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 01622 671411 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 Mr Tim Birchley Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005 Brief Description of the Service: The home is a three-story, 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 were £490.37 (max) per week, subject to financial assessment. 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 timbirchley@kent.gov.uk Canterbury Adult Support Unit DS0000037735.V303231.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 site visit, which was intended to review findings on the last year’s inspections (November and July 2005) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on those occasions. The inspection process took just under eight and a quarter hours, and involved meeting with three residents (though one was not communicative) and a visiting relative; the registered manager; a senior support worker, three support workers. Interactions between staff and the residents were observed during the day. The inspection also involved a review of the premises and a range of records. One resident’s files were selected for care tracking. What the service does well: The location is generally suitable for its stated purpose, convenient for visitors and offers ready access to community and seaside resources. Property maintenance checks were in good order, and the home is tidy, clean and odour free. There are homely touches throughout. This home is judged a good quality service overall, with significantly more strengths than weaknesses. It provides good evidence of strong and consistent management, delivering good outcomes for people, and uses its resources well. The registered manager shows an awareness of the homes strengths and areas for development, and has the ability to take forward constinuous improvement. There is 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. There is a clear statement of purpose and 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 and abilities. home is viewed positively by its stakeholders. There are good links with the community and an open culture. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 6 The registered person demonstrates a commitment to equality and diversity, and this is demonstrated in practice. A good level of compliance was found with almost all aspects of the National Minimum Standards inspected. Record keeping is systematic and the personcentred care plans are judged very holistic. This is a staff team, which feels well invested in, and supported on a day-today basis. The rapport between the manager, staff team and residents is appropriately familiar, relaxed and respectful. 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. Canterbury Adult Support Unit DS0000037735.V303231.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.V303231.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 1. A judgement could not be made about the information available to prospective residents as they were not available for inspection at the time of this visit. 2. There is a systematic preadmission assessment process, which identifies needs, preferences and interests 3, 4. This home has a careful admission process, designed to enable the prospective service users to sample the facilities, company and environment provided by the home, before their admission is confirmed. 5. Each service user’s placement is subject to a documented contract. This document is available in a suitable format for the residents Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Public Information The Statement of Purpose and Service User Guide and contract have each been undergoing revision since the last inspection, and were not available for inspection. However, an examination of the last edition showed that each Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 9 document usefully details a range of elements of the services and facilities provided by this home. When assessed against the elements of the National Minimum Standard, however, each document was judged in need of further attention to obtain full compliance. This effectively means that funding authorities, relatives and other representatives do not have all the information they could have to make informed placements and this must be addressed. The detail has been reported back to the home separately. Once these documents are revised and available as public information, they should be submitted to the Commission for assessment against the elements of the National Minimum Standards. The inspector understands that although Kent County Council has the resources to provide both documents in other languages or formats, the residents have been supported to produce their own video version of the Service User Guide. Staff are available, moreover, to explain their provisions. A copy of the latest inspection report is readily available in compliance with the standard – it is kept in the hallway. Preadmission Assessment 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. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 10 The format of early referral assessments did not include the service user’s own contributions but the service users are now routinely involved in the referral process. There was anecdotal information about the preparation for one prospective admission – involving 3-4 visits by the service user and a close relative. The plan is to follow this up with an overnight stay so that s/he can leave for work the next morning The care plan is written to meet the service offered, and risk assessments are used to establish what restrictions need to be in place. See also standard 9. . Capacity to Meet Needs The home is 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. Although the ground floor bedroom has an en-suite WC and walk in shower, plus lever grab rails, which would make this facility relatively accessible, the rest of the property is not generally adapted for individuals with significant mobility impairment. The inspector was advised that planning permission for a ramp access at the front had been refused. All the current service users tend to require staff prompts or supervision with aspects of their daily living rather than direct interventions. 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. The service users’ level of understanding of the spoken language is generally adequate, although the home uses some Makaton, signs, symbols and verbal prompts. Although the manager is confident the unit can, with support from Kent County Council, meet the needs of minority ethnic communities, this does not in practice apply. With one exception (who is westernised in all respects), all the current service users are white UK. Staff are undergoing NVQ training and the inspector was advised that all have undertaken in-house communication training. The inspector was advised that 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 Nursing care is not provided. Contract / Terms and Conditions Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 11 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 the inspector would expect to be backed up by detailed funding and service provision arrangements between the unit and the funding source e.g. Kent County Council Care management. The back up details were not inspected on this occasion. The Service User Guide is also expected to summarise the terms and conditions of placements. This was not assessed on this occasion as it was undergoing amendment. 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. The inspector was advised that the section on complaints had been amended to include the option of contacting the CSCI at any stage as required. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 6. The preadmission assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs. 7. Observed interactions between staff and the resident were respectful during this inspection. The home still needs, however, to demonstrate its control over the care plan reviews – matter raised at the last two inspections. 8. The current residents have a number of opportunities to influence their daily routines and the running of the home, and their level of involvement is a matter of personal choice. 9. There are risk assessments to cover the residents as individuals, their activities and their environment (inside and outside the home), to maximise their capacity to be independent. 10. The arrangements for the storage and disclosure of confidential information are generally satisfactory. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 13 Care Planning The revised format of the care plans used by this home should enable all aspects of the health, personal and social care needs of the service user to be met, particularly when underpinned by risk assessments, and followed through by a new daily reporting log sheet format and “Exit” questionnaires. The inspector was satisfied that these were generally being reviewed frequently. Although the format of the reviews have more recently included computer generated illustrations to make them more meaningful to the service users, and despite provision to record their opinions on each issue raised, the inspector was advised that they had in practice shown no real interest in this process Quality assurance surveys and “Exit” questionnaires would be the most likely way of identifying unmet needs. The inspector received feedback from one visiting relative and three service users (in one case individually, and as a group over lunch). The service users represented the two functions of this unit – respite residential care and day care. The service users invariably confirmed that: they felt well cared for and that staff treated them well. Autonomy During the inspection there was good evidence that service users were supported to make choices for themselves and the inspector found good evidence of risk assessments in respect of individuals, their activities and environment. The inspector has previously judged more work could be done to make various documents (e.g. policies) more accessible to the service users. This judgement still stands. See standard 8 in respect of the weekly house meetings; service users can choose whether to attend or not. All service users are given a choice over managing the keys to their rooms, subject to risk assessments, and all are supported to manage their day-to-day cash. Participation in the Running of the Home There is a weekly house meeting, which is used to discuss a number of issues of relevance to the service users (e.g. menus, activities), as well as house rules and health and safety related standing agenda items. See above in respect of quality assurance feedback surveys. There was anecdotal information on the involvement of service users in the recruitment of staff. Less clear was the extent to which service users are involved in the development and review of policies, procedures and services. Risk Management The inspector found good evidence of risk assessments in respect of individuals, their activities and environment. This home operates a two-tier system of risk assessment. Generic risk assessments are carried out in the first instance over a range of issues (the environment, personal care, health Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 14 (including medication), moving and handling, communication, mobility, behaviour, finances and fire safety). In each case the assessor is required to indicate: whether the generic risk assessment sufficient; whether the issue identified was covered by the care plan; whether an individual risk assessment was required (fire safety and moving and handling appeared to be routinely followed through with further risk assessments) or whether this was not warranted. Records confirmed these elements (generic and specific) were generally subject to regular review and underpinned by documents such as Personal Responsibilities Agreement (see standard 5). Confidentiality The inspector was generally satisfied with the arrangements for keeping records, medication, valuables and money secure. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 11, 16. Staff enable residents to maintain and develop social, emotional, communication and independent living skills. The daily routines promote choice and independence. 12. Staff support residents to undertake training and to take part in fulfilling activities. 13, 14. This home offers a range of activities inside and outside the home. Links with the community are good, and support and enrich the residents’ social and educational opportunities. Activities are recorded. 15. There are open visiting arrangements, and the home is well placed for access to local community resources. Staff support residents to maintain links with families. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 16 Activities / social contacts This home offers a range of activities inside and outside the home: activities inside the home include: watching the television or videos (the home’s stock of these has been built up considerably over the last couple of years, due to generous donations from carers), using the unit’s DVD player or PlayStation (the home had acquired a second computer), jigsaws, painting, arts and crafts, as well as opportunities to learn and use practical life skills such as cookery, laundry and other domestic duties. One service user is being supported to move on into supported living in her own flat this Autumn. One other continues to participate in chess tournaments. 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. Records also show that despite its respite function, there are ongoing visits or contact with family members (one visited during this inspection) and friends. There is a payphone in the hallway lounge and the inspector was advised that 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. One relative confirmed that the arrangements were flexible. The inspector asked about the extent to which this unit supported service users with their spiritual needs. One service user accompanies a parent to church services but otherwise, in common with other service users, shows no active interest in any religious denomination. Records show that 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. Feedback from the current service users confirmed that the home provided suitable activities, but recent quality assurance identified other or more activities as requiring further attention. See schedule of recommendations fo details. Employment / Education The inspector found some evidence of training in practical life skills, work experience opportunities and attendance at day centres. One of the service users also spoke about his employment by a local catering company. At her last visit (March 2005) the inspector felt 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. The manager said that although there was 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. See also below in respect of community presence and above for recreational activities. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 17 Community Presence 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. Recreational activities outside the home are described in standard 14. Records and anecdotal information confirmed good use was being made of activities in the local community i.e. socially inclusive activities, not readily associated with the service users’ disability e.g. shopping, pub and cinema trips, meals out. Records and anecdotal information also show service users do link up with friends from outside the unit as well as family members. Independence The inspector was satisfied with the scope of this home’s risk assessments. There are house rules relating to health and safety matters (e.g. smoking, fire safety) and 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 are said to have a choice over having keys to their bedroom doors, subject to risk assessments, and the front door is not locked to prevent egress. Catering The inspector was advised that the routines are flexible but breakfast is generally from 7.30 – 9.15am; lunch from 12noon to 1pm; the evening meal is from 6pm and supper is as required by the service users. The inspector was advised that service users have a choice and that special diets (ethnic, medical) can be catered for. One service user’s diabetes is being managed with tablets and a healthy diet. Two others are on a gluten free diet. The home uses fresh ingredients wherever practicable. There are facilities for making drinks and snacks at other times, and service users confirmed that they are encouraged to help prepare meals. During the inspection, the inspector joined the service users for lunch and judged the meal well prepared (by one of the service users, with support from staff) and well presented. The setting was judged congenial, particularly since the room has been provided with new tables and chairs, and with the provision of a painting (by service users) and colourful collages of photographs of the service users. The inspector examined records of menus chosen by the service users for the week commencing 8th May 2006 and judged the range of options varied. 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)). The manager said that service users generally took packed lunches to day services. Feedback from the service users invariably confirmed that they liked the food. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 18 Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 18, 19, 20. The residents receive an appropriate level of support with their personal, emotional and healthcare needs. Personal care is offered in a way protect their privacy and dignity and promote their independence. 19, 20. The health needs of the residents are well met with evidence of access to a range of healthcare services. 21. This standard was not assessed as it would not generally apply to a respite service. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Personal care and healthcare 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. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 20 The home has a key worker system, and the induction of new staff includes personal care issues. The current service users only need to be prompted to self-care. Although two bedrooms were originally set up as double rooms, only one still has two beds in it (because two 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. There was some evidence of communication aids e.g. signs and symbols around the property, but the current service users have a generally good level of understanding of spoken English. There are some handrails around the WC and bathroom although the home is not otherwise adapted for people with significant mobility impairment. No one requires a Loop system (for use with hearing aids). All service users are registered with their own G.P etc. but can be supported to access relevant community health care services as is appropriate. Medication 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. One takes their own herbal pills and another is supported with contraceptive medication. 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 portability of refrigerated medication should be periodically risk assessed and a dedicated secured fridge is 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 look for opportunities to demonstrate staff competency in medication arrangements e.g. by accreditation sources Ageing, illness and death This standard was not assessed on this occasion, as 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. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 22. The home has a complaints procedure, and some work has been done on its format to meet the special needs of the residents. 23. Residents are generally safeguarded against abuse. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Complaints The Kent County Council complaints policy is on display in the hallway. This version has been amended to give the CSCI as an option at any stage, so as to be more fully compliant with this standard. There is also a KCC leaflet on the corporate complaints, which has been updated to take into account the new title of the Commission. However, recent quality assurance questionnaires have highlighted the need to more actively promote awareness of this process. The home has a “Comments Book” which is designed to record the date and signature of anyone making any comments about the services provided. But there were no comments recorded in it (matter first raised for attention in March 2005). This is not judged a realistic reflection of communal living. 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. The inspector received feedback from two of the three service users present, in one case individually, and as a group over lunch. They felt well cared for and said that staff treated them well. One other did not understand the inspector’s Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 22 questions about the home’s complaints procedure but two confirmed that they knew who to speak to if they were unhappy with their care, and were confident that staff would deal with this. The inspector also met with one relative who said she was aware of the home’s complaints procedure, but had never had cause to make a complaint. Protection The inspector understands 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 seven 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.V303231.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 24, 28. The standard of the property is adequate. The furniture is domestic in style, and comfortable. Residents have a choice of communal areas, and there are homely touches throughout. 27. Each bedroom has a wash basin cubicles, and there are sufficient communal bath and WC facilities to guarantee their availability and privacy. 29. The home is not wheelchair accessible and although it has ample useable floor space throughout, it is not adapted for people with physical disabilities. 30. The home is well maintained, clean and free of offensive odours. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Premises Fit for Purpose Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 24 Access to the home and to local amenities is judged satisfactory for the current service users – the home is within walking distance of Canterbury city centre (and all the community resources and transport links that implies) and is close to one bus route linking it to Herne Bay, Whitstable and Canterbury itself. There are several parking bays on the vacant plot to one side of the home, but sections of the busy road outside are subject to parking restrictions. The premises were judged generally suitable for its stated purpose; accessible for the current service users, safe and well maintained. The inspector was satisfied that the provision of furniture and fittings observed generally complied with most of the elements of the standards in this section. One walk-in shower was installed in the upstairs bathroom but plans to refurbish one other facility were cancelled for want of funding – as were plans to repaint the exterior and stairwell. Planning permission for ramped access to the front was refused. Although there is an intention to resubmit plans, there are no other proposals for further change. What this effectively means is that although the property has had some adaptations made, it is not judged suitable for anyone with a s 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. The home is judged better suited to registration for six rather than eight. This matter was first raised by the inspector in March 2005 for consideration by Kent County Council, and found to be still outstanding. 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. Bedrooms With one exception (ground floor) all the service users’ bedrooms are sited on the 1st , 2nd and 3rd floors. Two bedrooms were set up as double rooms but the practice is to use them as single occupancy unless service users particularly wanted to share. Two service users choose to do so. All the others are single occupancy. The ground floor bedroom has an en-suite WC and walk-in shower room. The inspector was satisfied that the provision of furniture and fittings observed generally complied with the elements of this standard. 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 the inspector was advised that some of the current service users had opted to lock their doors. Each room has been provided with suitable lockable facilities. All the rooms were judged reasonably individualised. Toilet and Bathroom Facilities Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 25 The inspector judged there were sufficient bath and toilet facilities for the number of service users and that they were 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. Plans to refurbish one other facility had to be postponed, for want of funding. However, at a previous site visit (March 2005) thermostatic control of the bathwater temperatures was reported to have rendered the bathwater too cool for comfort once run and service were tending to opt to use the showers instead. The inspector was advised that Kent County Council was asked to review this arrangement, so as to optimise choice without compromising the safety of service users. The advice of the Environmental Health Officer was sought but the home was still waiting for the resultant report at the time of this inspection visit. The indications are that adjustments won’t be made. 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 continuous impermeable surfaces (matter first raised in March 2005 and found to be still outstanding). A hand-wash basin has been installed in one 2nd floor WC. A suggestion to rehang the door on the opposite side of the threshold, so as to open onto a wall rather than the WC, to improve access – was found to be not workable, for want of space once the basin was installed unfortunately. Access is as a result awkward. The arrangements for storage of sanitary waste have been review in the light of advice from the Environmental Health Officer, to obtain more appropriate health and safety standards. Communal Space Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 26 The inspector judged there was 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 (though see findings on laundry below) and well maintained. However, one member of the sleep-in staff has to use a futon in the lounge which the inspector judged could inhibit its use by service users, but the inspector was assured that 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 tables and chairs have recently been replaced and the room is scheduled to be redecorated to provide a more congenial setting for meals. The inspector was shown a communal painting and colourful collages of photographs of the residents – all of which provide positive focal and conversation points. However, other areas are very worn and in need of refreshing (e.g. stairwell) or replacing (e.g. carpets). It is accepted that these have been identified for attention in refurbishment plans. 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. Hygiene 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. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 32. The registered person has ensured that staff have the competencies to meet the residents’ needs, but needs to ensure compliance with the National Minimum Standard in respect of the percentage of staff with NVQ 2 accreditation, or above. 33. The home has an effective staff team, with sufficient numbers and complementary skills to support residents’ assessed needs. 34. The registered person operates a thorough recruitment procedure. 35. The registered person ensures there is a staff training and development programme. 36. Staff receive the support and supervision they need to carry out their job. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Staffing arrangements The inspector understands that daytime shifts run from 7am to 2.30pm and from 2-10.30pm. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 28 The inspector was advised that 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 service users may sometimes have to wait their turn for support with some activities. 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. There are separate dedicated cleaning, cooking and maintenance hours, in line with required practice. Recuitment The inspector understands that the KCC Personnel organises the advertising of vacancies and receive the application forms in the first instance. The manager takes the lead on short-listing. Interviews are held on site and involve a preset question and answer session and scoring system. There was anecdotal information about the extent to which 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 the inspector was unable to confirm compliance with expected recruitment practice except through separate meetings with staff. There is a corporate induction checklist, and a unit-specific checklist to supplement this. This is judged sound practice Staff training and Support All staff have to undergo the Learning Disability Award Framework (LDAF) – accredited training as part of their NVQ accreditation. However, only 38 of the staff have obtained NVQ2 or above, so the manager will need to submit an action plan to obtain compliance with the National Minimum Standard. 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.V303231.R01.S.doc Version 5.2 Page 29 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 37. The registered manager has a range of relevant qualifications and experience to run the home. 38. The management approach is open, positive and inclusive. 39. Effective quality assurance and quality monitoring systems are in place to measure the home’s effectiveness. 40. There are systems in place to ensure practice complies with the home’s written policies and procedures 41. Records required by regulation for the protection of residents and for the effective running of the home are properly maintained. 42. The registered manager ensures as far as is reasonably practicable the health, safety and welfare of residents and staff. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 30 EVIDENCE: Manager’s Qualifications and Experience The manager has worked for Kent County Council for several years: has previous experience in residential care work and has obtained NVQ Level 4 accreditation. The inspector judged the manager’s qualifications and experience to date, as reported, were appropriate and his application to be registered by the CSCI was successful. 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 were observed to have an appropriately relaxed rapport with service users during the inspection; and 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 reports working harmoniously and flexibly to meet the needs of service users. Operational Arrangements Kent County Council offers clear lines of accountability. The inspector judged the processes for managing this home open and transparent, and judged the delegation of budgets and authority appropriate. The manager controls a lot of the unit’s budgets, but does have to justify some aspects of the expenditure to KCC. The inspector observed one staff handover session, where petty cash floats were balanced by one member of staff, witnessed by another, as evidence of probity. The inspector was generally very satisfied with the standard of record keeping, and judged the filing systems sampled in good order, up to date. The inspector was also generally satisfied with the arrangements for maintaining the health, safety and welfare of service users and staff. 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 – though there were some gaps in the records seen. Information supplied as part of the pre-inspection documentation and confirmed by staff showed that the manager delegates responsibilities for a range of key roles to staff, while maintaining an appropriate level of overview and leadership. 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 Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 31 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. Business Planning The inspector was shown the KCC Annual Operating Plan for 2006/07 which sets an overarching outcome for all its services - specifically to help people to live safely and independently in their local communities. This document 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”. A number of projects and consultation events have already been planned. Clearly it is not difficult to see in general terms how respite services can positively contribute to these but there was no unit specific action plan available for inspection. This is required The inspector examined a range of records required by regulation for the protection of service users and for the effective and efficient running of the business, and found them well maintained, up to date and accurate. Quality Assurance The inspector found good evidence of continuous monitoring e.g. of health and safety standards and through staff supervision and appraisals. The inspector met with one relative and examined feedback obtained routinely through “exit” surveys this year – all of which confirmed a sound level of satisfaction with the care given overall, and pressing for more units like this one The inspector was also shown a newsletter for June 2006 which reports back on the emerging themes from its Quality Assurance Surveys; specifically a request for more outings (though addressing this is constrained by KCC staffing / funding levels); and a general lack of awareness of the Complaints Procedure, which was being addressed. This is judged a good start. However, there needs to be a unit-specific business plan, linked to these quality assurance initiatives and corporate business planning and auditing arrangements, to obtain full compliance with this standard. The views of service users and other stakeholders will be crucial to the success of this. Policies and Procedures Pre-inspection information indicates that all the policies prescribed by the CSCI are in place, where they are relevant to this service. The inspector was satisfied that 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.V303231.R01.S.doc Version 5.2 Page 32 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 2 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 4 35 2 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 X 3 4 2 3 3 3 3 Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 33 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 YA1 Regulation 4,5 Requirement Once the Statement of Purpose and Service User Guide are revised and available as public information, they need to be submitted to the Commission for assessment against the elements of the National Minimum Standards. The worn carpets in areas of the home (hallway) need replacing. Original timeframe 01/03/06 An action plan is required in respect of planned building and refurbishment work. 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 50 of care staff must have the appropriate NVQ level 2 qualification. Original timeframe – 01/10/06 Action Plan to be submitted All staff must complete mandatory training. Individual staff training DS0000037735.V303231.R01.S.doc Timescale for action 30/09/06 2 YA24 16,23 30/09/06 3 4 YA24 YA30 23 12,13,1623 30/09/06 30/09/06 5 YA32 18 01/10/06 6 YA35 12,13,18 30/09/06 Canterbury Adult Support Unit Version 5.2 Page 34 7 YA39 24 programmes must be developed and implemented. Original timeframe - 01/06/06 Action plan to be submitted There needs to be a unit01/10/06 specific business plan, linked to quality assurance initiatives and corporate business planning and auditing arrangements, to obtain full compliance with this standard. The views of service users and other stakeholders will be crucial to the success of this. 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 YA14 Good Practice Recommendations Consideration should be given to feedback from service users on ideas for further activities: • ten pin bowling (2) • Sky TV • swimming (20 • lay cards • go to the pub, have lunch out • more access to a computer • go to the park 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 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. The registered manager should ensure that the ground floor en-suite shower room is fit for use. 2 3 4 YA20 YA20 YA22 5 YA27 Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 35 6 7 8 9 YA27 YA28 YA29 YA40 The thermostatic control of the bathwater temperatures should be reviewed, as it was reported to have rendered the bathwater too cool for comfort once run 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 users. Alternative arrangements should be considered. The registered manager should ensure that the works recommended in the report produced in relation to the access audit is carried out in full. The home should look for opportunities to adapt key policies in a user-friendly format for the service users. Canterbury Adult Support Unit DS0000037735.V303231.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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.V303231.R01.S.doc Version 5.2 Page 37 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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