Inspection on 14/07/06 for Self Unlimited Rowde

This inspection was carried out on 14th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Self Unlimited Rowde 19/03/08

Self Unlimited Rowde 06/03/06

Self Unlimited Rowde 15/09/05

Self Unlimited Rowde 14/03/05

Self Unlimited Rowde 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 CARE Rowde Furlong Close Rowde Devizes Wiltshire SN10 2TQ Lead Inspector Tim Goadby Key Unannounced Inspection 14th & 21st July 2006 10:20 CARE Rowde DS0000028267.V302647.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 CARE Rowde DS0000028267.V302647.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. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service CARE Rowde Address Furlong Close Rowde Devizes Wiltshire SN10 2TQ 01380 725455 01380 729030 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.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Vacant Care Home 36 Category(ies) of Learning disability (36) registration, with number of places CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The number of service users receiving residential care and accommodated in the bungalows known as Alder, Fern, Hawthorn and Myrtle must not exceed 9 in each bungalow. The Commission for Social Care Inspection agrees that statutory records may be kept in the central administration office located on site. The Commission for Social Care Inspection agrees that medication kept on behalf of service users may be kept in the central administration office located on the site. Any statutory records kept and the arrangements, handling and recording, storage and safe keeping of medications kept on behalf of residents must be open to inspection at all times. 6th March 2006 Date of last inspection Brief Description of the Service: CARE Rowde opened in March 1994. It is run by the registered charity, Cottage and Rural Enterprises Ltd (CARE). The site is purpose built and owned by the company. The complex, including day facilities, is known as CARE Wiltshire. The care home establishment is registered in the name of CARE Rowde. According to its own Statement of Purpose, CARE Rowde ‘meets the needs of those with a mild or moderate learning disability [and] those with more complex needs and some behaviour which can challenge’. Although managed as a single establishment, the accommodation for service users is provided in four separate, self-contained bungalows, known as Alder, Fern, Hawthorn and Myrtle. The facilities in each house include a lounge, a kitchen/dining room, and a utility room. There are also flats where people can live more independently. Each bungalow has nine registered places. Therefore the service is registered to care for up to 36 people, but in practice it is unlikely to ever fill all these spaces at the same time. The bungalows form part of a complex that also includes workshops, a computer suite, a communal hall/dining area and a central office block. There are grounds around the site for recreational and horticultural use. Many of the service users use the on-site facilities during the day, and people also attend from the local community. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 5 There is one staff team that supports service users in the bungalows and another that provides support and supervision with the day activities. Administrative support for the residential and day services is provided by staff who work in a central office block. The manager of the registered care home provision is a member of the on-site management team. Fees charged for care and accommodation vary depending on each service user’s assessed needs. At the time of this inspection weekly rates varied between £425 and £770. Some service users also have additionally funded hours for one-to-one support, via their individual contracting arrangements. There is a range of information available about the service. Prospective service users have the opportunity to visit the site and tour the amenities available. CSCI inspection reports are kept in the communal areas of each bungalow. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place in July 2006. The evidence gathered included a pre-inspection visit in April 2006; pre-inspection information supplied by the service; three survey forms completed by service users, with support; six sets of comments from relatives of service users; and two survey forms completed by staff of the home. An unannounced visit was carried out initially, with a return visit by appointment the following week, to conclude the inspection and give initial feedback. This fieldwork section of the inspection included the following: observation of care practices; sampling of records, with case tracking; discussions with service users, staff and management; sampling activities; sampling a meal; and a tour of the premises. What the service does well: Service users benefit from the support of well trained staff. CARE Wiltshire has its own on-site training co-ordinator who oversees this area. All employees undertake a range of courses relevant to their job roles. This includes achieving nationally recognised qualifications in care. The safety and welfare of service users, staff and all other visitors to the site is upheld by robust arrangements for health and safety. This area is also overseen by an on-site co-ordinator. Measures include staff training, regular checks, service and maintenance of equipment and regular meetings on the topic. The same staff member also oversees quality assurance for the project. CARE has an organisational system. Following its introduction, CARE Wiltshire was the first site to complete the full implementation of the audit. The range of measures used includes obtaining feedback from service users and staff. Service users can be confident that their views contribute to an overall philosophy of continuous service development. Service users are protected by robust systems for the recruitment and selection of staff. Records shows that all required checks are completed before new staff take up post. Service users contribute to the selection process. Once new employees begin working there are suitable arrangements to give them a thorough introduction to the service before they begin their involvement in hands-on care. There is a strong focus on the provision of activities and outings. Service users have regular contact with the local community, and the opportunity to pursue a wide range of leisure interests. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 7 Management systems ensure the effective delivery of a service that meets its users’ needs. Each registered bungalow has its own manager and assistant manager. All areas of support are overseen by senior managerial and administrative staff. The registered care home component of the CARE Wiltshire site is managed by a designated person, and the site overall has a locality manager. There are also effective systems for communicating up to more senior levels of the organisation. Service user involvement is promoted in all areas of service delivery. Each individual can contribute to the planning of their own care, and also has the opportunity to be involved in groups making decisions about other aspects. Further developments are planned by the service to promote even greater user involvement and consultation. What has improved since the last inspection? What they could do better: Care plans and associated documentation for all service users need to be maintained and updated to cover all relevant aspects of an individual’s needs. Examples seen at this inspection failed to do so, placing service users at risk that they may not receive effective and consistent support. Practice in the management of medication could be improved in a number of ways, to ensure that service users receive appropriate support in this area. It must be clear that medication is being given at the correct prescribed time. Use of techniques such as giving drugs with food should be supported by relevant information to show that this is appropriate. Medication administration record charts should be maintained properly, with good practice principles upheld regarding any additions or alterations that have to be made. The use of non-prescription medication – known as ‘homely remedies’ – should be supported by information about which products may be used, and evidence of GP approval for this. Further steps should be taken to publicise the service’s complaints procedure, so that all service users and their supporters are clear about the arrangements. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 8 Systems for carrying out minor repairs promptly need review, to meet the wishes of service users in this area. The service intends to increase the staff cover available at the key periods of mornings, evenings and weekends, when service users are most likely to be at home. This should help to enhance the effective support of service users. The manager for the registered accommodation needs to complete the process of registration with the CSCI. This will ensure that service users once more have a designated person who is accountable for their welfare. 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. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 9 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 CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users have their needs assessed and make a positive choice about moving into the service. EVIDENCE: Many of the service users living at CARE Rowde have done so since the site first opened, and a number of them have been in the care of the organisation for much longer than this. There are also some more recent admissions. Most service users who move into one of the four registered bungalows already know the project well, as they will have attended the site for day care, and may also have had shortterm residential stays. Prospective service users are fully assessed, which includes spending a period living in one of the bungalows. This gives the service the opportunity to gather some detailed information, and also allows the individual to see whether or not they like the idea of living at Rowde. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 11 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 was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Some service users had no up to date care plans or risk assessments, placing them at risk that their needs would not be met appropriately. Service users can make choices and decisions in their daily lives, and about the conduct of the service. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: Four sets of service user records were sampled during this inspection, relating to one resident for each of the four bungalows which form the registered accommodation. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 12 In each case, there is a need to ensure that key care plan and risk assessment information is updated and available. The service is currently in the process of moving to a new person centred planning format. This has left some gaps in information. Also, where different records are in use, some in the bungalows and some in the central office block, it is not always clear where information may be found. The service needs to make progress to ensure that there is a consistent format for service user records, and that there is coherent presentation of all relevant current information. One service user moved between bungalows in May 2006. The individual’s records had not been updated to reflect this. They were also not included in the overall ‘Welcome’ folder of key information about each service user in that house. There was no detail in the care plan about the key risk areas for the individual, which were a main factor in the decision behind their move. Some documented evidence was available about the input the service user was having from relevant professionals, but this had not been transferred into care plan guidance. Another service user moved to Rowde in December 2005 from another CARE service. Risk assessments on file for this individual still related to their previous placement. The person receives some additional support hours for specific reasons. This information was not clearly reflected in the current care record. The most detailed written evidence was a draft report from September 2005, prior to the service user’s move. In another case, a service user admitted in December 2005 had only limited records in place in the bungalow they are living in. This was reported to be due to the individual going straight on to the development of a person centred plan. But when this was seen in the central office, it had only been completed in part. Most of the necessary information to support the care of this service user was therefore not yet documented. The site has a bursar who oversees the management of service users’ money. Various systems are in place, depending on how each individual is supported. Many service users have their own bank accounts. There are suitable arrangements for enabling them to have access to their own money. Records are kept for all transactions. Service users are supported with the management of their own money as necessary. For instance, they may receive help and advice about budgeting to save for things they want to do. There are various methods for consulting with service users about their own care and wider issues. These include meetings and discussions on site, and also participation by some service users in wider forums, such as conferences. There are service user representatives in various development groups. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 13 The service is aiming to develop service user involvement still further. Social work students will attend the site to carry out research projects, and CARE can identify the themes for these to ensure that it will be something that the project will benefit from. A range of risk assessments are in place for each service user. As noted above, some are in need of updating. However, the approach taken by the service clearly promotes access to independence and opportunities, in line with assessed abilities. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 14 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): 12, 13, 15, 16 & 17 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: Service users mix with people from the community who attend the on-site day facilities. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 15 One relative was concerned about the day service programme, feeling that there has not been a satisfactory alternative since the woodworking shop closed. However, there are a range of activities still on offer. These include information technology, arts and crafts, and gardening. The site sells its own produce in local farmers’ markets, and also offers a composting service for the village. Service users also access other opportunities outside, including education and employment. Current occupations include a service user who has a job in a local school, and some who work in a café at a nearby garden centre. College courses which service users attend include working towards independence in daily living skills. The village of Rowde is within walking distance of the CARE site. There is a bus stop for Devizes, which service users use for many facilities. The scheme also has its own vehicles, as public transport is not always available. A range of leisure activities are accessed by service users, in line with their own preferences. They are supported as necessary. Some are able to be more independent than others. All local community amenities are used, including shops, pubs and restaurants, and sports facilities. Outings also take place to destinations further afield, and all service users have the opportunity for an annual holiday. Service users can have keys to the front door of their bungalow and to their own rooms if they wish. Some rotas have been drawn up to help with a fair distribution of domestic jobs. Most service users have family contact. This is upheld in various ways. For instance, each bungalow has a private pay phone facility, in an enclosed area. Service users are also able to develop friendships and personal relationships. The range of contacts which CARE Wiltshire has with the surrounding community gives service users access to a wide social network. During the week most service users have their main midday meal in the central dining hall that supports the day service facility. Other meals are eaten at home, and each bungalow has normal domestic kitchens. Service users are able to participate in the preparation of meals and snacks. The service has recently consulted with a nutritionist about changes to its menus. There is a particular focus on ensuring service users have the opportunity to have the recommended daily portions of fresh fruit and vegetables. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 16 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 was good overall. However, quality in the management of medication was only adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported to address their personal and health care needs effectively. Service users are placed at risk by deficits in the service’s practices for the administration and recording of medicines. EVIDENCE: One relative felt that standards of personal care for service users were not always satisfactory. But practice was seen to be of a good standard at this inspection. All service users appeared well cared for. Relevant personal care issues are addressed within care plans. Service users’ records show details of contact with GPs and other health care professionals. All service users except one are registered with the same local GP, who conducts an annual health check with each person. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 17 Information is obtained about specific conditions which service users have. This helps staff to understand individual needs, and support them effectively. Medication is received and stored centrally. Supplies are then issued to each bungalow as necessary. Some medication is retained centrally, as lunchtime doses are given from this supply. Medication administration records are provided by the pharmacy. All doses given are recorded. A record is also made of medication taken away for home visits or holidays. Medicines available without prescription, known as ‘homely remedies’, may be given on occasions. The service has policies to govern how this is done. However, there could be better information to support this area of practice. For instance, there is no documented list of what products may be used; nor is there formal confirmation from the GP that they are happy with the arrangements. All support workers receive training in the handling of medicines from managers and an external agency. Service users can take responsibility for their own medicines after thorough risk assessments have been completed, but this is little used at present. From the records sampled at this inspection, some specific concerns were identified relating to the management of service users’ medication. In one bungalow, a service user was having some of their medication administered with jam, to help them swallow it. There was insufficient evidence in the person’s care plan to make clear the reasons for this practice, and to demonstrate that it was appropriate for the individual. It also needs to be shown that this practice will not impede the action of the drugs concerned. Another service user had a discrepancy in the time shown for administration of a particular dose of medication. The label supplied by the dispensing pharmacy indicated that this was to be given between 4 and 6 pm. But the home’s own medication administration record chart had been drawn up for this to be given at 10 pm, which is when it was being done. This effectively means that prescription instructions are not being followed. A number of examples were seen where care home staff have added to or amended the pre-printed medication administration record charts supplied by the pharmacy. When this is done, it is good practice to ensure that such handwritten entries are signed, preferably by two people. This should be done separately for each alteration or addition. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 18 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 was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are safeguarded by the service’s policies and procedures for complaints and protection. EVIDENCE: The service has a complaints procedure. Records are kept of any issues raised, and of the actions taken in response. Complainants also get a feedback form, so that they can say if they are satisfied with how the service has dealt with their issue. Complaints information includes contact details for the CSCI. Informal concerns are logged, as well as any more serious complaints received. Various complaint issues have been addressed by the service since the previous inspection. These have been referred to other agencies when appropriate to do so. Suitable actions have been taken in respect of the findings of investigations, including the dismissal of staff for misconduct. According to comments received by the CSCI, not all relatives were aware of the complaints procedure. All service users and their families are issued with a copy, but this information may not be retained over time. It would be useful for the service to remind all relevant persons about its complaint arrangements when the opportunity arises. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 19 CARE Wiltshire has suitable procedures for adult protection, and also works within the local multi-agency arrangements. Various issues have been referred to this process when necessary. This has helped to identify agreed strategies for managing known risks for some individuals. All staff receive training about abuse and protection. They also receive instruction in principles and techniques for management of challenging behaviour from service users. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a comfortable, clean and safe environment, suitable to their needs. EVIDENCE: Four bungalows within the overall CARE Wiltshire site form the registered care home accommodation. Each one is built to a similar template. Some are slightly larger, to allow greater accessibility for service users with physical impairments. These properties also include suitable equipment, such as adapted baths. Each bungalow has two flats with their own bathroom and kitchen. These were originally intended as staff accommodation, but can now be used for any service users working towards living more independently. All service users have single bedrooms. Bathrooms are for general use. It is hoped to be able to provide more en-suite facilities for service users at some future stage. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 21 Staff areas in each bungalow are an office with sleep-in bed, along with an ensuite shower. Service user comments included an observation that repairs in the bungalows can sometimes be slow. There are systems for recording and reporting any defects, and the site employs its own maintenance man who can attend to many of the repairs. The manager was confident that all urgent issues are addressed promptly, but accepted that more minor issues, such as replacing light bulbs, may be delayed. These can affect the daily lives of service users. All homes appear well maintained. Recent work has included repairs to flat roofs, and there is an ongoing programme for renewal of kitchen units. A relative raised a concern about standards of cleanliness in the bungalows. However, all areas seen during this unannounced inspection visit were clean to an appropriate standard. Where necessary, additional hygiene and infection control measures have been put in place. These include protective clothing for staff and suitable arrangements for handling laundry. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported by suitable numbers of appropriately trained staff. Service users are protected by effective recruitment practices. EVIDENCE: Staff are on duty in each of the bungalows whenever service users are at home. There is always a designated shift leader. The service is in the process of reviewing arrangements for staff cover. The aim is to provide additional staff in the bungalows at key times, such as mornings, evenings and weekends, when more service users are at home. The increase will ensure two staff on duty in each bungalow at these times, along with two ‘floaters’ who can give cover where it is most needed. Some service users have specific hours of one-to-one support as part of their individual care contracts. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 23 Overnight cover for each bungalow is provided by a staff member sleeping on site, who can respond to service users’ needs if required. There is also an oncall system within the management team. Comments from staff and the relatives of service users expressed some concern about staff turnover, and the need to use agency staff to maintain cover. This is acknowledged as an issue by the service. There are ongoing efforts to address the problem. Turnover has reduced recently, but there were still some vacant posts at the time of this inspection. There are block booking arrangements with an agency supplying staff, to ensure as much continuity as possible. The site also has a number of relief staff who assist with maintaining cover. There is an extensive range of training available to all staff. This is overseen by a training co-ordinator. New staff have a six week induction programme. The first two weeks of this is spent being introduced to key policies and guidelines, and shadowing other staff members on shifts to observe care tasks. New starters also receive a handbook of various relevant information, including the national codes of conduct for social care staff. Induction is carried out in accordance with the national framework for staff working in learning disability services. CARE participates in a scheme within Wiltshire where different organisations act as markers for each other’s staff. This leads into staff undertaking National Vocational Qualifications (NVQs) in care. A number of candidates were due to complete this award around the time of this inspection. Senior staff have the opportunity to go on to take the qualification at a management level. There is an overall training plan for the service. This includes defining what training is needed for each post. There is a range of mandatory courses that all staff undertake, with more training required for more senior roles. Individual training records are maintained for all staff. There is also an overall database, which helps to keep the service plan updated. CARE has its own training staff who can deliver many of the courses which are needed. Other sources of training are accessed as necessary. There is a training room on site at Rowde. Staff recruitment is carried out in line with all the required criteria. Records for three recently appointed staff were checked during this inspection. All showed that the full range of required checks had been completed before people commenced employment. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 24 CARE has a central human resources department, which generates all necessary policies. The process of recruitment and selection for Rowde is managed locally. Service users are involved wherever possible. This has included some of them participating on interview panels, after receiving suitable training. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 25 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, 39 & 42 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Quality assurance measures underpin service developments, and include actions based on the views of service users. Service users’ health and safety are protected by the systems in place. EVIDENCE: The manager for the registered care home component of CARE Wiltshire is Mrs Christine Smith. She is currently in the process of applying to the CSCI for registration as manager. Mrs Smith has previously held this role at Rowde, but left it for a time to oversee another project. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 26 Each of the four registered bungalows has a home manager and assistant. Home managers undertake the Registered Managers Award, whilst assistants do NVQ Level 3. CARE Wiltshire has a number of other senior management and administrative staff, who oversee various areas of service delivery. These include staff training, health and safety, quality assurance, financial issues and day services. There are regular management meetings covering all aspects of service delivery. There is a locality manager for the project, and clear chains for organisational reporting up to the senior levels of the company. CARE has an organisational quality assurance system. At Rowde, one staff member is responsible for overseeing the implementation of this. The process involves auditing all areas of service delivery, with checks at various frequencies. This includes obtaining feedback from service users and staff. Any actions identified from the quality assurance process are planned in order of priority. Records specify what action is to be taken and who is responsible for this. There are regular meetings to oversee progress. The site is also to set up a management committee of service users to support its operation. This body will be able to feed its recommendations up to senior executives of CARE, and make contributions to the service’s business plan. The same staff member is also responsible for overseeing health and safety arrangements. CARE has a wide range of standard policies and manuals covering all aspects of this topic. The organisation has also entered into a consultancy agreement with another company specialising in health and safety, which will advise on various aspects of practice. There are regular recorded checks on all elements of health and safety. The co-ordinator oversees this process, ensuring that each area carries these out. This includes the required checks and instructions relating to fire safety. For the registered bungalows, current records are kept in the house, and then returned for central storage when complete. Health and safety is also regularly discussed in meetings, and an overall monthly report is produced. All staff receive training in a range of health and safety topics. Any relevant information is circulated to them. Service users also receive training in issues such as the use of hazardous materials. Risk assessments are carried out on a wide range of areas. This includes general topics, and issues relating to individual service users, such as whether or not they are safe to be left at home on their own. Staff who carry out risk assessments are trained in how to do so. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 27 External contractors are engaged to carry out various checks and services so that all equipment is maintained safely. For instance, shortly before this inspection all fire fighting equipment had been checked, and all electrical appliances across the site. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 28 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X N/A X 3 X X 4 X CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the action/s 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 YA6 Regulation 12-1 14-2 15-2 17-1a Sch3-1 13-2 17-1a Sch3-3m Requirement All service users must have upto-date care plans and risk assessments reflecting all areas of current needs and support. This part of Regulations also applies to the above requirement. For all medicines administered to service users, there must be clear evidence to demonstrate that these are being given at the prescribed time. Timescale for action 30/09/06 1 YA6 30/09/06 2 YA20 21/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations Written additions or alterations to the printed medication administration record should be signed, dated and checked by two members of staff. CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 30 2 YA20 Information about the use of ‘homely remedies’ should be expanded, with a list of products used, and evidence of GP approval. There should be clearer information to support the use of specific techniques for the administration of medication, such as giving medicines with food. Steps should be taken to remind all relevant persons of the service’s complaints procedure. There should be a review of the system for attending to minor repairs, to ensure these are dealt with more promptly. The service should implement its proposed increases in staff cover without delay. 3 YA20 4 5 YA22 YA24 6 YA33 CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 CARE Rowde DS0000028267.V302647.R01.S.doc Version 5.2 Page 32 - 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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