Inspection on 26/10/06 for Cardinalls Road

This inspection was carried out on 26th October 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cardinalls Road 20/10/08

Cardinalls Road 31/10/05

Cardinalls Road 09/06/05

Cardinalls Road 03/02/05

Cardinalls Road 27/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cardinalls Road 43 Cardinalls Road Stowmarket Suffolk IP14 5AA Lead Inspector Deborah Kerr Unannounced Inspection 26th October 2006 10:00 Cardinalls Road DS0000024541.V297714.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 Cardinalls Road DS0000024541.V297714.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. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cardinalls Road Address 43 Cardinalls Road Stowmarket Suffolk IP14 5AA 01449 677527 01449 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.mencap.org.uk Royal Mencap Society Miss Christine Anne Smylie Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: Cardinals Road is a 3-bedded home for people with learning difficulties and is centrally placed in relation to facilities and transport in the town of Stowmarket. All three service users are female and form an established group who have lived together in this environment for a significant period. The primary role of staff in this service is to prompt, encourage and support the service users to maximise their skills, abilities, and interests and provide service users with opportunities to pursue active lives within the community. The home has a detailed statement of purpose and service users guide, which are available in different formats on request. These documents provide information about the service and give details to prospective service users how to obtain a summary of the most recent Commission for Social Care Inspection (CSCI) report. The property is owned and structurally maintained by Mid Suffolk Council and Mencap provides the direct care. Each service user is provided with a licence to occupy setting out their basic rights and responsibilities with the Council and Mencap. The current rent charged is £62.35 per week. Social Services contribution is £241.65 making a gross weekly fee of £304.00 per week for each individual service user. Not included in these fees are service users own personal items such as toiletries, clothes, hairdressers, chiropodist, theatre trips, concerts, holidays and meals outside of the home. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was spread over two days starting with an unannounced visit on a weekday afternoon and early evening lasting four and half hours. The inspector was unable to access staff files as the manager was on sick leave and arranged to return to the home on the 2nd November to meet with the manager and inspect staff files. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from the residents ‘Have your say about’ comment cards. The home’s Statement of Purpose and Service Users Guide were reviewed and a number of records including those relating to service users, staff, training, health and safety records and policies and procedures. Time was spent with all three service users, the manager and two staff. What the service does well: What has improved since the last inspection? All staff working at Cardinals Road have undertaken Protection of Vulnerable Adults and other appropriate training prior to undertaking lone working. The hall, stairway and landing have been decorated including the installation of a cupboard to conceal the electrical fuse boxes. Service users and staff were involved in the decoration, including artwork displayed on the stairwell. The bathroom has been retiled and decorated and the lounge/dinning room has had a new carpet. Following a visit from the fire and rescue service the home have had smoke seals fitted to the edges and at the top of the laundry door and have had the emergency lighting tested in line with the British Standard. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 6 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. Cardinalls Road DS0000024541.V297714.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 Cardinalls Road DS0000024541.V297714.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, Quality in this outcome area is good, however information needs to be amended in the statement of purpose to provide current information about the service. Where service users lack the capacity to agree and sign the terms and conditions between themselves and the home, support from family or an independent advocate must be obtained to act in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since 1993. Therefore it was not possible to fully assess standards 1-4. The manager described the process of admission, for the most recent service user, which consisted of a series of meetings and visits to the home. Mencap have an admissions policy and procedure in place. The Statement of Purpose and Service User Guide were revised and updated in January 2006; these are available in different formats upon request. However these documents need to be amended to reflect the homes admissions criteria and the current fees charged by Mencap and Mid Suffolk Council for the service users to live in the home. Evidence was seen that service users needs are being met, all staff have received training to ensure they can communicate with service users who use Makaton and sign as their method of communication. The home is in the Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 9 process of implementing new care plans based on the person centred approach, which will focus on people making choices that can change their lives for the better. Service users files had a letter regarding their Individual Placement Contract (IPC) and the amount they had to contribute to their fees. Mencap have produced a basic guide to the tenancy and licence agreement between the service user and the home, which has been produced in picture symbol and written format. The licence agreement was not signed or dated by the service users or the home. The manger expressed their concerns that only one of the three service users has the capacity to fully understand the content of these agreements. In line with the Mental Capacity Act 2005, service users that are unable to understand and agree to the terms and conditions set out in the licence agreement, should have family or independent advocacy support to establish the best interests of the service user. Cardinalls Road DS0000024541.V297714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is good. Service users can expect to have detailed plans identifying the level of support they need and be fully consulted on all aspects of their lives using appropriate means of communication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comprehensive care plans in place, which covers the health, social and welfare needs of the service users. Two service users care plans were seen; these were divided into individual support plans identifying the level and support they required to meet their individual needs. Care plans are being reviewed using the person centred planning approach, which will create a comprehensive portrait of each service user, including what they want to do with their life and bringing together all of the people who are important to the person including family, friends, neighbours, support workers and other professionals involved in their lives. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 11 Two service users have behaviours that can be challenging or distressing to themselves or to others. Their care plans reflected that individualised procedures had been established with input and support from the Intensive Support Team and the Community Nurse. The plans detailed a positive approach to managing their behaviour, which included indicators that would trigger a change in the service users behaviour and the actions staff should take to avoid or reduce their agitation or incidents of self-harm. Staff spoken with confirmed the actions they should take in these circumstances as described in the service users care plans. Daily records and incident/accident records were very detailed and these were being used to help the community support teams to monitor changing patterns and the frequency of inappropriate behaviours of the service users. The care plan for one service user with limited communication was in a format, which they could understand. The plan consisted of a series of picture symbols produced by the Suffolk Total Communication Scheme as well as written information. Long and short-term goals were identified, for example the longterm goal was to increase communication skills to widen the service users means of communication and use of symbols. In the short term staff were building up a folder of their interests introducing new symbols. One of the residents continues to be involved in an advocacy group, Suffolk People First based in Stowmarket. They also used to attend regular meetings in Ipswich as part of the Mencap Service Users forum where they discussed issues relating to the running of Mencap homes, however they had chosen not to attend recent meetings. Service users are supported to manage their finances. Mencap is corporate appointee for all three service users. Their disability living allowance is paid by Giro. Monies not needed for immediate use are paid directly into a building society account. The manager is the only signatory for the account and is the only person that can withdraw money from the account on the service users behalf. Each service user has a lockable container to hold a small amount of money which staff monitor. Two members of staff countersign any withdrawals made by the service user and a record of all purchases are kept and receipts. One of the service users had a copy of an audiotape called ‘easy guide to direct payments’. The manager has been trying to obtain direct payment funding on the service users behalf to fund one to one support for an at home day once a week. Risk assessments specific to the individual were seen on their care plans. These related to a variety of activities and events in the domestic environment and community based activities. These had detailed interventions and actions staff should take to minimise the risks and hazards but still enable the service user to take part in their chosen activity. There were also assessments detailing the risk of financial, physical and sexual abuse. Cardinalls Road DS0000024541.V297714.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 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, Quality in this outcome area is excellent. People living in the home are supported to make decisions and choices about their daily lives and have a lifestyle that matches their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are supported to live ordinary and meaningful lives; evidence was seen that each service user has a programme of daytime activities either at home or within the community. During the week the service users attend a variety of day care services, linked to the Stowmarket Resource Centre (SRC). This provides service users with the opportunity to meet and socialise with other people. For example, two service users access the Catholic Centre on a Thursday where they are supported to go shopping and out for lunch. Another service user attends the Red Gables Centre who has the choice of using the facility to relax or to go out for the day. On a Monday one service users has access to the Mid Suffolk leisure centre, where they take part in activities of choice. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 13 Each service user is supported on a one to one basis to have a home day once a week; this is to carry out personal and domestic tasks within the home and the community. They are actively encouraged by staff to take part in the day to day running of the home, by helping to keep their rooms tidy, hoovering, washing up, putting away their own laundry and shopping for groceries. To enable a service user with a visual impairment to keep up to date with current affairs they receive audiotapes, called News Talk, which contains local news. They also receive tapes from the Valuing People Support Team, providing updates on their newsletter, which is issued on a four monthly basis. The service user told the inspector they used to have ‘talking books’ but did not like them so have stopped using this service. The service user also showed the inspector a copy of an audiotape which they have recorded their comments about the home and day care service in preparation for their forthcoming annual review. A certificate seen in one of the service users bedrooms reflected that they had completed a course at Stowmarket Resource Centre (SRC) called Myself/Yourself, which covered topics about the importance of personal space and speaking up for themselves. They also attended a Suffolk County Council training course in August 2006, which covered areas of recruitment, for example understanding equality and diversity, policies and procedures of recruitment, how to ask questions of applicants and good practice in recruitment of staff. The service user confirmed that they have been involved in recruitment of staff and that the training was to support them in this role. Discussion with service users and entries in their care plans showed that they are supported to access a range of leisure activities. They spoke of a recent trip to see the Buddy Holly story at Ipswich Regent and a production of Beauty and the Beast at the Theatre Royal in Norwich. Other activities included a visit to Felixstowe in the summer where they went for a walk, had a pub lunch and then watched the carnival. The service users attend local evening clubs in the town, for example Gateway and Target and one service user has recently joined a bible group at a local church. Service users and staff had decorated the dining room in preparation for a Halloween party; they explained that they had invited friends, relatives and staff. In the evening service users were observed spending their time as they chose listening to music in the privacy of their own rooms or in the communal lounge watching television. One service user’s care plan reflected they had spent a week’s holiday in a caravan in Great Yarmouth during the summer. Another service user spoken with they confirmed that they had also been on holiday to Felixstowe where they had a flat on the sea front and spent their time on the beach, visiting a harbour to look at the boats and ferries, shopping and going out for meals. One service user told the inspector they meet with a friend at a local café on Fridays after attending the SRC and had recently visited a friend who lives in Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 14 another residential home. They regularly go shopping in Ipswich and Stowmarket and have lunch out or have a coffee. Photographs of a service users recent birthday celebrations showed that they had invited family and friends to a party. Another service user was seen preparing to go home to their relatives for weekend, evidence was seen in their care plan that they visit on a regular basis. Service users and staff have access to all parts of the home and grounds, but respect the privacy of individual’s own rooms. All service users are offered a key to the home; one service user has chosen not to hold their own key. The interactions between service users and staff were observed to be friendly and appropriate. Meal times were seen to be variable to suit the service users needs. They tend to have a cooked meal at lunchtime at their various groups and were observed choosing what they wanted for their tea. They had chosen a selection of sandwiches with fillings of cheese, marmite and salad and peanut butter with crisps and as election of fromage frais. Service users are encouraged to take part in the preparation of food whenever possible and to help with the food shopping for the home. A good selection of food was seen in kitchen cupboards; fridge and freezer, including a range of weight watchers foods as two service users loosely follow the weight watchers programme to monitor their weight. Cardinalls Road DS0000024541.V297714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, Quality in this outcome area is good. People living in the home can expect to have their health and emotional needs met in partnership with appropriate professional input where needed, however cannot expect to be protected by the home’s procedure for storing and administration of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has support plans in place detailing the level of support they require and their preferences of how they spend their time, for example when they get up, their preference to a bath or shower, choice of activities and the time they go to bed. The plans are flexible to meet their day care needs and how they choose to spend their weekends. Service users benefit from a small but established staff team and regular relief workers, they also have identified key workers providing consistency and continuity of care and support. The care plan of one service user reflected that incidents of inappropriate behaviour and self-harm had increased. Staff had identified regular patterns of behaviour occurring and requested advice from the general practitioner (GP). The service user has limited communication; it was therefore difficult to establish the possible cause for the change in their behaviour. The GP recommended a course of Hormone Replacement Therapy (HRT) treatment. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 16 The number of reported incidents appear to be less frequent indicating it is possible that this course of action is having an affect. However, the GP also made a referral to the Mental Health Partnership Team, specialist service for adults with learning disabilities. A community nurse has visited the service user, their day care service and the home and has supported staff to implement a behavioural management plan to further support the service user. The health needs of service users are identified in a health action plan. An ongoing record of dates for health visits was kept including visits made to or by the GP and the details of care and medication prescribed. There were also records of appointments with other professionals such as dentist, hospital consultants, chiropodist and optician. Evidence was seen that the service users were being helped to promote their health and well being by attending regular health checks and Mencap have produced audiotapes for service users who are unable to read called ‘you and your safety’ and ‘you and your health’. Service users medication is kept in the staff office in a locked cupboard. Staff administer medication to the service users and evidence was seen that the Medication Administration Records (MAR) charts were being signed appropriately; these were accurate and up to date. However where prescribed tablets are packaged in two or more separate blister packs within a box, staff were attaching the opened blister pack to the outside of the box using an elastic band. This was to ensure that only one blister pack of tablets were being used at a time, however this is not considered to be safe practice if the blister packs were to become loose or the foil damaged this could lead to the miss administration of medicines and therefore endangering the safety of the service users. A tube of Panoxyl Aquagel that had been prescribed in May 2006 had lost the tab on the box displaying the expiry date. Where creams have been prescribed to service users to be used as required, the dates of opening should be recorded on the box or tube to ensure that the cream is used within it’s use by date. Following the inspection the manager provided additional information that the expiry date of all medicines received into the home is recorded in the medications in and out file and creams are used in accordance with the information on the accompanying patient information leaflet. The expiry date on the tube of Panoxyl was punched into the end of the tube of cream, however was not immediately noticeable. None of the service users are currently prescribed controlled drugs. Cardinalls Road DS0000024541.V297714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, Quality in this outcome area is good. Service users can expect their complaints to be investigated and be supported by the home’s policies and procedures for dealing with allegations of abuse however outcomes of investigations should be recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of Mencap’s complaints procedure is made available to the service users and their relatives in the service User Guide. Evidence was seen that each service user had been issued with an audiotape of the complaints procedure, called ‘Helping us to get it right’. Each of the service users relatives had been sent a copy of the complaints procedure in 1996. The complaints book was seen; a service user made the last recorded complaint in January 2002. Evidence was seen that the complaint had been investigated and a satisfactory outcome was achieved. The complaints log showed that relatives had raised concerns with the manager about the healthcare of a service user. The area manager asked the relatives of the service user to put their concerns in writing as a formal complaint. The manager had invited the relatives to a meeting to discuss the issues raised in their letter, however there is no further documentation or evidence that this meeting took place or a satisfactory conclusion was reached with the relatives. The organisation’s policy and procedure are very clear and detailed of staff’s responsibility to report allegations or suspicions of abuse to the Local Authority Vulnerable Adult Protection Committee (VAPC) and informing the Commission for Social Care Inspection (CSCI). Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 18 To ensure service users are protected from abuse, neglect and self-harm, all staff have a Protection of Vulnerable Adults (POVA) first and Criminal Records Bureau (CRB) check undertaken prior to taking up a post. A requirement was made at the last inspection in October 2005 for adult protection training to recognise abuse and the process of the referring an allegation to be completed prior to undertaking lone working. The manager confirmed that all staff currently working at the home has received training. Refresher training for all staff has been requested at a local training centre, the manager is waiting confirmation of a date. Cardinalls Road DS0000024541.V297714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,30, Quality in this outcome area is good. Service users can expect to live in a home that meets their needs in a safe and homely atmosphere, however there needs to be consideration given to how the home deals with foul linen in conjunction with department of health guidelines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cardinals Road is situated in a row of houses in Stowmarket. It provides accommodation appropriate for the lifestyle and needs of the service users, which is comfortable, homely, clean and safe. There were no unpleasant odours. The home is well maintained and nicely decorated throughout, one service user was proud to show the inspector around their home. The house is in easy reach of local amenities and local public transport. Accommodation comprises of three bedrooms, a toilet, a bathroom with additional toilet, dining room, utility room, kitchen and a separate sleep in room which doubles as the staff office. The dining room has large patio doors, providing access to the gardens, which have been landscaped and are well maintained. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 20 Since the last inspection, some redecoration has taken place. The hallway and landing have been painted. Staff and service users were involved in purchasing and painting canvases to provide the artwork leading up the stairwell, which creates a light and modern effect. A flap of plywood previously covering the fuse boxes and wires at the top of the landing has been replaced with a cupboard. The home has one bathroom comprising of a bath, shower and toilet and a separate toilet, which is shared between the three service users. Water temperatures were tested and found to be within the recommended temperature of 43 degrees. A member of staff with a keen interest in decorating has retiled and painted the bathroom. The home is furnished with good quality fixtures and fittings, which are domestic in nature to meet the needs of the service users. The carpet at the top of the landing outside one of the service users rooms is lifting needing attention as this could cause a potential tripping hazard. A new carpet has been laid in the dining area and lounge. Service users rooms were seen, these are nicely decorated with the service users own furniture, curtains and bedding. All rooms seen had personal items that reflected the service users personalities and interests. Each of bedrooms is fitted with a door lock and service users are offered the choice of holding their own key. The kitchen is suitably laid out for the service users to be involved in the preparation of food. The kitchen was clean and tidy. Evidence was seen that the temperature of the refrigerator and freezer were taken and recorded daily. The records showed that they maintained temperatures within safe limits for the storage of food. The home has a separate utility area for dealing with laundry situated at the rear of the house with access to the garden. The laundry area was clean and adequately equipped and all cleaning materials and hazardous substances were locked in a cupboard. Clinical waste from the home is double bagged and disposed of in yellow bags and collected through agreement with the local council. The homes process for managing soiled linen was discussed with a member of staff, they explained it is rarely an issue and that they have an occasional incident with one service user. The current system of soaking soiled garments in a bucket and emptying the contents down the sink in the utility area does not comply with the Department of Health Guidance for Infection Control. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 21 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): 31,32,33,34,35,36, Quality in this outcome area is good. Service user can expect to be cared for by a staff team who are trained, supported and available in sufficient numbers to meet their needs and are protected by the home’s recruitment procedures. However, a system for the renewal of criminal records bureau checks (CRB) is recommended, which includes a protection of vulnerable adults (POVA) check. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager, five care staff and a team of ten relief staff have worked at Cardinals Road for a long time. This core group of staff provide service users with continuity and stability in their lives. Two staff spoken with were clear about their roles and demonstrated they had a good knowledge of the service users individual needs. They have the necessary skills to communicate effectively with service users with no verbal speech and were able to clearly reflect the stratergies agreed in the service users care plans for the management of inappropriate behaviour. The staff rota reflected 1 member of staff works from 7am to 10am then 3.45pm to 7pm. Another member of staff works from 3.45pm to 11pm plus the sleep in. Two staff work weekends covering hours from 7am to 11pm and the sleep in. Three days a week staff work flexibly to cover the day care needs of the service users having a home day. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 22 Three staff files were seen; these confirmed that the home have the necessary checks in place for the safe recruitment of staff. The files looked at had records of the staffs criminal records bureau check (CRB) and relevant documents, however where these staff have been employed for a long time, consideration should be given to a programme of renewal of CRB’s every three years to include a check against the Protection of Vulnerable Adults (POVA) register. Cardinal’s Road benefits from being part of a large organisation, which has developed its’ own induction programme for all new staff in line with the sector skills council for social care training. Evidence was seen in one staff’s file that they had completed Mencap learning programme and achieved 6 credits at level 2 in induction and foundation in care, which covered understanding positive communication, understanding abuse, and an introduction to working with people with learning disabilities. The senior member of staff on duty was inducting a new relief staff. As part of their induction they had been provided with an induction workbook. They had completed training and the workbook to enable them to administer medication but they wanted to clarify some aspects of the medication for service users at Cardinals Road prior to doing their first sleep in at the home on Saturday evening. Two staff spoken with provided supervision files, which contained evidence of regular supervision and dates and certificates of their personal training and development. A rolling training programme is in place, which included health and safety, fire safety, first aid, food hygiene, moving and handling, managing challenging behaviour, and Control of Substances Hazardous to Health (COSHH). A senior member of staff has completed the Suffolk total communication course and has been assigned the designated lead co-ordinator for communication. Their role is to cascade the training and induct and mentor new and existing staff to help service users who have limited communication. Other training included epilepsy and person centred planning. Further training for the Protection of Vulnerable Adults (POVA) has been booked for the 13th November and applied for at a local centre for training. The home has achieved 100 of staff holding a National Vocational Qualification (NVQ) Level 2 or equivalent. Mencap have been working through a programme of training to train managers and staff about person centred planning. Cardinal’s Road is waiting for a date for a final training day to be scheduled to discuss and implement the person centred planning with team and service users. The supervision log for each of the staff spoken with reflected that they were receiving regular monthly supervision sessions until June when the manager commenced a period of absence due to ill health. Staff spoken with felt that they were supported to do their job and in the absence of the manager discussed issues with senior staff. Staff felt that if they had any concerns they could if necessary approach the area manager. Supervision sessions were seen to cover work and service users related issues and further training needs. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42,43, Quality in this outcome area is good. Service users can expect to benefit from a well run home and can be assured that they benefit from the ethos and leadership of the manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has worked at the home since it opened in 1986. They hold a certificate of qualification in social worker (CQSW) and certificate in management studies (CMS). They have completed the National Vocational Qualification (NVQ) Assessor Award and the Registered Managers Award (RMA). The manager has been off work for five months due to ill health and recently returned to work on the 1st November, following a return to work interview. Service users and staff spoke well of the manager, they were all pleased to see her return to work. They felt that they were approachable and provided a clear sense of direction and leadership to the home. There is a good working relationship between the service users, staff and the manager. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 24 The fire and rescue service visited the home on the 21st August 2006. A copy of the report was forwarded to the Commission for Social Care Inspection (CSCI), which identified a number of items to be addressed for the home to comply with the Fire Precautions (Workplace) Regulations 1997. The fire logbook was seen which confirmed that the home had complied with the fire officer’s recommendations. Smoke seals had been fitted alongside sides and top edges of the fire door in laundry and the escape lighting had been tested and examined. A certificate was seen in the logbook confirming that Firesite had undertaken an inspection and tests of the fire alarm system in June 2006. Evidence was seen that weekly fire safety tests were being undertaken and recorded in the fire logbook, the log also reflected that monthly fire evacuation practice was taking place. Evidence was also seen that Firesite had completed the Portable Appliance Testing (PAT) for all appliances in the home in June 2006. The home’s procedure for reporting incidents and accidents provided clear guidance to staff of the process of what to do if an accident or incident occurs in the home and what should be reported. Evidence was seen that incident and accident report forms were being completed. These were also being used to monitor the behaviour of two service users who are receiving intervention from support teams to help manage their behaviour. Mencap have systems in place for the monitoring the quality of the service. Most recently the home sent out stakeholder satisfaction surveys to approximately ten relatives and friends. The home received four back, which covered areas of personal care, being listened too, having appropriate information, leisure and social opportunities, and dealing with concerns and complaints. Overall the responses to the questions in the survey were very positive and happy with the service being provided at the home. Mencap also provide staff with a ‘Have your say survey’. Staff have the opportunity to rate how they feel about Mencap as an employer, about their job, about their manager and learning and development opportunities. The responses to the survey will be feedback to staff in the monthly newsletter called ‘Connect’. Cardinals Road has a business plan for 2006/7, which sets out the home’s aims and objectives to support service users as adults with the same rights and expression and choices as other members of the community. Their aim is to provide service users with opportunities for increasing their independence, support them to make decisions and offer support to maintain long term relationships. To do this the home identifies that they need to maintain full occupancy and have sufficient staffing levels that have a range of experience of working with people with learning difficulties. They also intend to liaise with Social Services to review each of the service users needs in relation to funding to be able to continue to fund the project and to retain the increased use of relief staff for weekend cover. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 25 The business plan included Strength’s, Weaknesses, Opportunities and Threats (SWOT) analysis, based on information obtained from service users questionnaires, feedback from relative’s carers and other stakeholders associated with the home. The analysis concluded that the home continues to provide continuity of care and relationships for the service users, however where the project was originally set up to provide care for the service users based on them having access to social services day care a five day, the restrictive budget does not always allow for the higher levels of support which is desirable to provide one to one support. The manger explained that they had repeatedly tried to obtain direct payments for the service users to fund the one to one support, however they were advised they would loose funding for day care services as a result. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 2 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 3 25 X 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 3 3 Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 (Sch 1 (8) 5 (Sch 4 (8) 5 (b) Requirement The statement of purpose and summary in the service user guide must be amended to reflect the home’s admissions procedure and the current fees charged by the home. The terms and conditions laid out in the licence agreement must be reviewed in line with the home’s procedure to amend the agreement yearly in April to include the increase in rent. This is a repeat requirement from 31/10/06 The registered provider must ensure that the handling and safe keeping of medicines are handled in line with the Royal Pharmaceutical Guidelines. Outcomes following a response to a complaint must be recorded to show how the complaint was dealt with and the measures taken to improve the service. Suitable arrangements must be made for dealing with soiled garments, which comply with the Department of Health Guidance for Infection Control. Timescale for action 15/12/06 2. YA5 15/12/06 3. YA20 13 (2) 24/11/06 4. YA22 Sch 4 (11) 15/12/06 5. YA30 13.3 15/12/06 Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA24 YA34 Good Practice Recommendations The carpet at the top of the landing on the threshold of a service users bedroom is lifting and needs to be secured, as this is a potential tripping hazard. A programme of renewal of criminal records bureau checks (CRB) is recommended every three years to include a check against the protection of vulnerable adults (POVA) register. Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Cardinalls Road DS0000024541.V297714.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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