Inspection on 20/09/07 for Carisbrooke

This inspection was carried out on 20th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carisbrooke 15/09/08

Carisbrooke 16/08/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Carisbrooke 35 Welholme Road Grimsby North East Lincs DN32 0DR Lead Inspector Mrs Kate Emmerson Key Unannounced Inspection 20th September 2007 09:30 Carisbrooke DS0000067528.V351401.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 Carisbrooke DS0000067528.V351401.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. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carisbrooke Address 35 Welholme Road Grimsby North East Lincs DN32 0DR 01472 354434 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) Diamond Care (2000) Limited Dean Smith Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2006 Brief Description of the Service: Carisbrooke is a residential care home situated close to the centre of Grimsby overlooking Peoples Park. The property is a large Victorian house with the accommodation set over three levels, with car parking for three cars to the side. Fees per week are £325. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted over one day in September 2007. The manager had completed a quality assessment form for the Commission prior to the inspection, which gave information on how the home was managed. Prior to the inspection the Commission had sent questionnaires to staff and people who lived in the home to enable them to give their views. Seven staff surveys were received and four surveys were received from people who lived in the home. All gave very positive comments about the home and the management. During the visit to the home we spoke to the three staff on duty including the manager. The people who lived in the home and were able to communicate verbally were spoken with to establish their views on the care they received. The interaction between staff and service users was observed throughout the inspection. A selection of records relating to the care provided, staff recruitment and training and health and safety in the home were examined. A tour of the building and garden was also completed. What the service does well: The home had a very friendly feel with an emphasis on providing a homely environment for the people who lived there. One relative spoken with stated that ‘the day to day care was fantastic’. People were assessed before they went to live in the home and information about their some of their needs was put into a plan which described how care was to be provided. People were able to make choices about their lives and care requirements and were provided with whatever support was necessary to make those choices. People were supported to manage risks as part of their independent lifestyle. One person said that they had been involved in the decision to come to live in the home and in their assessment. People enjoyed a variety of pastimes in the home and the community that were appropriate to their ability and preference, and they led fulfilling lives in respect of the activities they do and the relationships they have. Their rights were fully upheld and they experienced a high level of respect. They all enjoyed a varied and nutritious diet that they assisted to devise. Comments made were the ‘the food is good’, ‘I like Dean’s curry, and can we have curry today’, and ‘I like the food’. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 6 The people living in the home received a good level of personal support when necessary and in a manner, which met their preferences. Their physical and emotional needs were well met. They had opportunities to give their own medication if they wished and were capable. Views and complaints were listened to and acted on if possible, and they were well protected from self-harm or abuse. People living in the home knew how to respond if they were unhappy. One person living in the home said, ‘ I would speak to Dean (the manager) and another said ‘I would tell my key worker’ and named the person. Another said, ‘I am happy’. There was clearly confidence in the staff that care for them and know their problems or worries will be dealt with. One person said that ‘they listen to what you say’. The home provided a comfortable environment that was clean and hygienic. Competent and well-trained staff were provided and people living in the home were in involved in choosing the staff at interview. People living the home benefited from a service that considers their interests, their views and their wishes as part of the monitoring, reviewing and development of the home. What has improved since the last inspection? What they could do better: They must make sure that all peoples care needs are clearly written down to ensure that consistent care is provided. They must ensure that where there are risks to people’s health and safety these are written down and a management plan is developed to minimise the risks and keep people safe. They could develop individual health action plans for people to ensure that all their health needs will be met in a consistent and effective way. They must assess people’s nutritional status to ensure that people stay health and that any extra support required with eating and drinking is recognised quickly. They must make sure that the keep a records of any medication they dispose of so that all medication coming into the home is accounted for. Where people sometimes need medication to help with their behaviour the home must Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 7 develop a care plan so that everyone knows the right point at which to give the medication. The home must decide how many staff they need on duty at any one time by looking at the needs of the individuals living in the home. They must use a specific calculation called the Residential Forum guidance to make sure that they have enough staff on duty. They must make sure that they get two written references for all staff before they start to work in the home. This is to make sure that the staff are suitable. They must make sure that staff receive regular supervision. This to make sure that staff feel supported and for the manager to ensure that they are competent in their work. They should review the manager’s hours to ensure that he has sufficient time to carry out management tasks. They must ensure that the people in the home are protected from the risk of fire by ensuring that the fire risk assessment is reviewed and that the fire alarm is tested at least weekly. They must ensure that there is a supply of hot water for people living in the home maintained close to and not exceeding 43°C at all times. This is to ensure peoples comfort and safety and control of infection. They must ensure that all staff receive annual refresher training in moving and handling to ensure safe practise. They should ensure that any purchase of equipment or care made on behalf the people in the home from their own finances have been agreed with the person or representative and the placing authority. Written evidence of the agreement should be obtained. The company should adhere to contractual obligations in the purchases of equipment and care. This is to protect the person’s finances They should actively support people to maintain privacy and dignity by providing a privacy screen in the bedroom on the top floor and ensuring that health care visits are taken in private. They should record all concerns and complaints and ensure that all health and safety policies and procedures are up to date. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 8 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 Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People had received good information about the home in order to make an informed decision about whether the service was right for them. The personalised needs assessment identified people’s diverse needs were before they moved to the home. EVIDENCE: The majority of the people had lived in the home for over a year. One new person had been admitted to the home since the last inspection. They said that they had been involved in the decision to come to live in the home and in their assessment. The council and the home had completed separate assessments of the persons needs. Both assessments detailed individuals needs in most areas of their lives. Selections of other assessments were seen. Council assessments were held in files as well as the ones completed. There was evidence in assessment Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 10 documents that the people and their family representatives had been involved in the process, information on the way people liked to live their lives was recorded by the home. The home had developed information to give to people about the service they provided. These documents were up to date, informative and easy to read. The information was only available in standard written format but the manager stated he could have these available in different formats depending on need. People who lived in the home stated that they had a choice about going into the home and had received all the information they needed about the service. Carisbrooke DS0000067528.V351401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. All the people who lived in the home had a care plan which set out their needs and preferences. There were some deficiencies, in that that specific care needs and associated risks were not always documented. This could put people at risk of needs not being met in a consistent and effective manner. People were consulted on all aspects of their lives and were supported to be as independent as possible. EVIDENCE: A selection of care plans was examined. These had been developed from the information collected at assessment. The format used was not user friendly for the people who lived in the home although some people knew what the document was. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 12 There was a wealth of information recorded which detailed needs and how these should be met. However, the care plans that described the tasks that carers must complete to meet needs mainly concentrated on personal care tasks. There were some deficiencies in this practise, which meant that there was sometimes no plan of care for specific needs such as managing challenging behaviour, constipation and eating problems. There was also a lack of planning in order to meet people’s social needs and interests. Although there were some deficiencies in care planning there was no indication that care needs had not been met. Staff showed good knowledge of individuals care needs and previous history. They had a clear understanding of individual’s preferences, likes and dislikes and daily routines. The plans that had been developed had been regularly evaluated and updated as needs changed. Staff constantly maintained individuals state of involvement with one another by including them in conversations, seeking their opinions and asking them questions about their day etc. Staff provided information on community life and offered choices, which were often taken up. One person had a voluntary job doing outdoor work and attended the local college and at least seven others attended day services where they interact with friends and acquaintances, or engage in activities. One person loved gardening and helped the manager attend to the homes garden. They were keen to point out the work that they had completed and said that they ‘enjoyed being in the garden’. Service users were observed interacting very well and making their needs easily known. Staff were observed responding to needs in a timely fashion and to service users’ satisfaction. The manager stated that all the people in the home were supported to some degree with their finances. The manager stated that he is appointee for seven people. Individual records of financial transactions were maintained and a random selection of these records was examined. The records balanced with cash held and receipts were maintained for purchases. There were examples where people had bought equipment for their room from their savings or had paid for 1-1 support. Although the manager stated that this had been done with families knowledge and agreement there was no documentary evidence to support this. Some of the purchases were in conflict with information on the person’s contract, which indicated that the company should have made these purchases. The manager was requested to review this situation and ensure that contracts were adhered to. The manager provided written confirmation Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 13 that he had reviewed this situation and repaid money where necessary to two people. The manager was further advised to ensure that purchases of equipment or 11 support are agreed in advance with relatives and the placing authority and that written evidence of the agreement is obtained. Service users spoken to were satisfied with the financial arrangements within the home. Several had managed to save some money to pay for a holiday, some going to Centre Parks, Nottingham and others to Butlins in Skegness. There was a lively discussion about what each person had done on holiday and it was evident that staff had ensured that individuals had had the opportunity to participate in activities they preferred. There were some detailed risk assessments in place to ensure that risks to individuals were minimised. There was some evidence that where unacceptable risk had been identified, such as in the use of bed sides, swift and appropriate action had been taken. However risk assessment had not been completed in cases where necessary, for example one person displayed challenging behaviour putting other people at risk. Although staff knew some of the indicators for this behaviour there was no written management plan and no evaluation of behaviour over period of time. This means that there may not be a consistent approach to managing the behaviour and limited ability to judge if the care is effective. People were supported when going out of the building where necessary and either use arranged transport when going out or take a taxi. There was a written missing persons procedure, but the people living in the home had very good routines, know when and where they should be and did not usually wander. Staff surveys indicated that there was an effective key working system in the home and that service users were supported to take an active part in the home and make decisions. Carisbrooke DS0000067528.V351401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. All service users enjoy satisfying lifestyles of their choosing, with support from staff where necessary. EVIDENCE: Service users spoken to are very satisfied with the lifestyles they lead. One has a job in the community, but also enjoys helping with tasks around the home. He stated ‘I like gardening, I help Dean, I would like to cut the grass’. Other service users attend day care services, at different establishments belonging to the social services or voluntary groups. They use arranged transport and have set days to attend. Almost everyone was seen and spoken Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 15 to on their return at the end of the day was excited about their day and wanted to discuss where they had been. Another service user spoken to did not attend day services, but was quite happy with the opportunities available to go for a visit to the park across the road from the home. All but one service user had family and friend contact. There was evidence that staff encouraged people to maintain contact with their family, one person had been supported to go and visit their mum and they said that ‘the staff had helped to get some flowers to take to her’. Other people described how they went to stay with family at the weekend. People were supported to take part in community activities appropriate to their mobility. Usually they went out in twos or threes to the pub, to go shopping, or to visit the cinema. Outings had been limited as a whole group due to the level of staff support required for one person. The manager had addressed this and extra funding had been obtained to support increased staff input, the manager stated group outings could now be planned. People could have a key to their room if they requested it and if they are risk assessed for safety and security, but only one held a key. People were observed asking for a hot or cold drink at all times of the day, which were provided. They discussed what they liked to eat on a daily basis; they had chosen fish and chips on the day of the inspection. Staff explained that people have made their likes and dislikes known to them over the years and when preparing meals know what they will or will not try. There were no set menus but records of food served were available. This showed a variety of different meals was provided and indicated that there was flexibility to meet individual’s preferences. For example a main meal was provided at lunchtime to those not at work or at day centres but one person preferred their hot meal at teatime so this was provided. Tea was a lighter meal. People spoken to did not make any adverse comments about food provision, and comments made were the ‘the food is good’, ‘I like Deans curry, and can we have curry today’, and ‘I like the food’. Carisbrooke DS0000067528.V351401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People enjoyed a good level of support with their health care and personal care, and with administration of their medicines. There were some deficiencies in care planning which may put people at risk of health care needs not being met in a consistent and effective manner. Lack of records to evidence returned medication does not ensure a robust audit trail. EVIDENCE: The manager and staff provided detailed verbal information on individual service users’ health needs and how they were met. However not all service users had ‘health action plans’ recorded within their care plans to show how health care needs were to be met, of seven care plans checked only one contained a specific ‘health action plan’. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 17 Records were maintained when a person had seen a health professional and these indicated that staff interventions to arrange these visits were appropriate and timely. Care plans included a nutritional risk assessment document and dependency profile assessment, which show improvement or deterioration in graph format as well as written format although these had not always been completed. One person had been identified as having problems with swallowing and had been seen by a speech therapist and given a special diet, the details of which were displayed in the kitchen. However the homes nutritional assessment had not been completed and there was no specific care plan for this area. The home had an up to date policy and procedure for the safe handling of medication. Staff training records showed staff were trained to administer drugs. Records seen on medication receipt and administration were well maintained. Records to show what medication had been returned to the pharmacy were available up to May 2007; more recent records could not be found. These are required to ensure a robust audit trail. One service user was prescribed a medication on an as required basis to manage a type a behavioural problem. However there was no management plan to describe to carers when this medication should be given or how to measure its effectiveness to ensure a consistent approach. There were no service users that self-medicate and those spoken to were of the opinion that medicines were best held locked away and did not want the responsibility of looking after theirs. Understanding and competence varied amongst the service user group, but they were satisfied with the way their personal and health care needs were met. On pre inspection information provided by the home the manager indicated that not all health care visits were undertaken in private unless this was requested or it was to do with a personal matter. To ensure that privacy and dignity and confidentiality can be maintained people should be encouraged to have health care visits in private. Carisbrooke DS0000067528.V351401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People, and their relatives, have access to robust complaint and protection systems within the home and are confident their concerns will be dealt with appropriately and any fears of harm or neglect will be detected. EVIDENCE: People living in the home could not remember ever making a complaint. When asked if they knew what to do to if they were unhappy with the care at the home one said, ‘ I would speak to Dean’ (the manager) and another said ‘I would tell my key worker’ and named the person. Another said, ‘I am happy’. There was clearly confidence in the staff that care for them and know their problems or worries will be dealt with. One person said that ‘they listen to what you say’. There was a complaint policy and procedure available in the home and within the statement of purpose, and staff understood the action they must take if anyone does have a complaint to make. There had been no complaints made to the Commission and none recorded in the home in the last twelve months. One relative spoken with stated that ‘the day to day care was fantastic’ but that they had raised concerns about arrangements regarding hospital visits on more than one occasion. The manager was able to explain and provide Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 19 evidence of the action taken to prevent reoccurrence of the problems but these concerns were not recorded in the complaints record. There had been no other concerns or complaints recorded since 2004. The manager was advised that all concerns and complaints and actions taken should be recorded. He was further advised that the current format for recording complaints did not protect confidentiality and should be reviewed. There were policies and procedures in place to protect people from abuse or neglect. It was evident from staff responses and training records that staff had received training in this area. The manager had also completed this training as well as training on equality and diversity. The culture in the home encouraged people to speak their minds. Staff constantly sought individual’s opinions of the support they received, on the activities they took part in, and on any subject that happened to come into the conversation. This was done in a very inclusive and respectful way during the inspection, affording individuals dignity and a sense of value. Carisbrooke DS0000067528.V351401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People enjoyed a good level of cleanliness and hygiene within the home and the fabric of the building was well maintained. EVIDENCE: A tour of the building and garden was conducted. The manager and one of the people living in the home had been working to improve the garden over the summer and had cleared a large overgrown area. Further work was required to make full use of the garden although there were comments about how much the BBQ’s had been enjoyed this year. Bedrooms were personalised and comfortable. The home had had some redecoration and new carpets in communal areas. New dining furniture had Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 21 also been purchased which were more suitable for the people living in the home. The home was generally clean and tidy but some of the bedroom furniture was dusty. Although four of the eight rooms were doubles, most were fitted with good partitioning dividers to offer separate areas for each service user. One bedroom was not fitted with a partition or any other method of screening to promoting people’s privacy and dignity. The manager was advised to ensure some sort of privacy screen was provided and that staff prompt its use especially during personal care provision. Wheelchair access was available to the front and the house has an internal ramp to the rear. The laundry was domestic in style and equipment, being relatively new, meets the Water Supply (Water Fittings) Regulations 1999. The kitchen required minor repairs to the cupboard doors and would benefit some modernisation, but in general the kitchen was clean and functional. Staff had completed infection control training and practice in maintaining cleanliness and preventing spread of infection was good. Training records, copy certificates and observation evidenced this. Personal protective equipment was seen in use and staff followed good food hygiene procedures and policies. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home benefited from a stable staff group who have received training in their role. The dependency of individuals was not used in determining staffing levels however this was to be implemented. There were some minor deficiencies in staff recruitment, which means that checks on the suitability of staff to work in the home were not always complete. Staff supervision was not regularly completed and did not include monitoring of delegated tasks, which could have put people’s welfare and health and safety at risk. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home had a small but stable staff group with very low turnover which was beneficial for the people who lived in the home as staff had developed in-depth knowledge of people living in the home and how care was to be delivered to meet their needs. Two of the most recently recruited staff files were checked. The files contained most of the necessary checks to ensure that staff were suitable to work in the home. However in one case the file only contained one written reference rather than two and in the other file the references were not dated so it could not be established if the references had been obtained before or after employment. It is important references are obtained and checked prior to employment to ensure that staff are suitable to work in the home. There was improved recruitment practise in that people who lived in the home were now involved in the recruitment and selection of new staff. They were present during interview and their comments about the staff were taken into consideration and recorded on interview records. The home was committed to supporting staff to gain qualifications in care. The evidence in pre-inspection questionnaire, staff files and discussion with the manager and staff showed there were four of the eleven staff with the necessary qualifications at NVQ level 2. A further five were working towards achieving these qualifications. One senior member of staff had recently achieved NVQ level 3. The company was continuing to use the staffing levels set when they took over the home in 2006. The rotas evidenced that there were always two staff in the home during the day, and one waking and one on call at night. A further thirty hours per week had recently been implemented to support one of the individuals on a one to one basis. The manager stated that he works for eight hours supernumerary and the rest of his hours as the second care staff on duty. Care staff were also responsible for cleaning tasks and cooking meals during their care shifts. It was difficult to fully determine whether current staffing levels were appropriate during the day of the inspection. This was due to the fact that there were only half of people in the home for the majority of the time and fish and chips from the local chip shop were provided for lunch. Only one staff member commented that an additional member of staff was required at weekends. The calculations for staff hours must be determined using the Residential Forum Guidelines applicable to the people accommodated. This calculates the Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 24 staffing hours required in relation to individual’s dependency levels and should be checked regularly to ensure staffing levels remain appropriate. The manager stated that he did not have a copy this tool but stated that it had been ordered. He was advised how to use this to evidence how staffing levels were being determined and was requested to provide evidence of workings to the Commission. Staff training and development had improved over the last year and the staff had completed most elements of the mandatory training requirements. There were still some staff that required refresher training in moving and handling and safeguarding adults. However the manager had developed a detailed overview of the training required by individuals and a training plan to address shortfalls. The standard of six supervision sessions in a year was not on course for being achieved, as regular sessions were not planned in advance. There was evidence that staff had received one or two sessions of supervision this year. The manager stated that he supervises the senior staff and completes appraisals and senior staff complete supervision for the carers. Neither the manager nor the senior staff had received training in supervision and appraisals. There was evidence that delegated tasks had not been monitored on a regular basis by the manager. This had lead to some deficiencies in care planning and health and safety checks. Carisbrooke DS0000067528.V351401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from having a Manager that is qualified and registered and that maintains consistency within the service. They have use of a quality assurance system, but what provides them with a more effective means of inclusion is the culture within the home. There were some deficiencies in the management and monitoring of health and safety measures, which could have put people’s health, safety and welfare at risk. The manager addressed immediate areas of concern following the inspection. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager Dean Smith has been in post for a year. He is qualified with NVQ level 4 Registered Manager’s Award, and experienced at having managed and supervised staff for more than two years at another establishment within the company. He was observed to relate very well with service users on the day of the visit and they responded very well in return. The manager stated he had eight supernumerary hours per week in which to attend to management duties. The rest of his hours were spent as one of the two carers on shift. Not only does this mean that he is providing care for people living in the home, some of which required constant supervision, he is also undertaking cleaning and cooking duties. On the carers shift there is little time to attend to management of the home or maintain and further develop systems. This may be the reason for some of the deficiencies seen at this inspection. People and staff spoken to were aware of the ways in which service users are consulted about their care and the support they receive: reviews and daily consultation being the main ones. People were confident they would be listened to and that any suggestions they have would be considered and adopted if possible. Consultation within the home was very much a practical, day-to-day event that was often observed, with people enjoying making choices and expressing wishes, as they needed to. Staff responded positively to requests for support and assistance. An annual audit of the home had been completed in May 2007 and relatives and agencies involved with eh home or care of the people had been asked their views of the service via questionnaires in July 2007. The responses seen were mostly positive. A random selection of records relating to health and safety management was checked. There was detailed fire risk assessment in place although this was due for review. Staff had received fire training and there had been three fire drills this year. The fire alarm records indicated that the fire alarm had not been tested since 10 August 2007 and had not been tested consistently on a weekly basis for some months and not at all in January 2007. The manager stated that this task had been delegated to a senior member of staff but also stated that he had not monitored this as part of supervision. The manager provided written confirmation that a fire alarm test had been completed immediately following the inspection. This must be completed weekly in future to ensure that the equipment is functional. Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 27 Hot water temperatures in the home accessible to service users had not been regularly checked and on testing the water in the shower it was luke warm. The senior member of staff stated that this was because the boiler had not been put back on that afternoon. The manager must ensure that there is a supply of hot water at maintained close to and not exceeding 43°C at all times. This is to ensure peoples comfort and safety and control of infection. There were environmental issues and work required to make these safe. The Commission has received written confirmation that this work had been completed immediately after the inspection. The work that was required included a lock being placed on the garden shed, which stored chemicals hazardous to health and a radiator guard being fitted in bedroom two. The home had policies and procedures in place to support safe working practice. However the policies and procedures relating to COSHH (Control of Substances Hazardous to Health) were not up to date. The majority of staff had received training in health and safety related areas such as food hygiene and infection control. Not all staff had received refresher training in moving and handling in the last year. Records were maintained for any accident within the home. The manager had completed a detailed risk assessment for a person using bedsides, this had identified some risks and a more appropriate bed and bedside system had been purchased. Carisbrooke DS0000067528.V351401.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 3 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 2 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 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 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 2 2 X 2 X 3 X X 2 X Carisbrooke DS0000067528.V351401.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 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 YA6 Regulation 15(1) Requirement The registered person must ensure that the care plans set out how all identified needs are to bet met by the care staff to ensure that service users needs are met in a consistent and effective manner. The registered person must ensure that risks to service users health and welfare are identified and minimised as far as possible The process of risk assessment and care planning must be consistently applied. The registered person must ensure that individual health action plans are developed for all people in the home to ensure that health needs can be consistently and effectively met. The registered person must ensure that nutritional risk assessments are completed for all people in the home to ensure that people’s nutritional status can be monitored effectively. The registered person must ensure that records of disposal of medication are maintained to ensure a full audit trail of DS0000067528.V351401.R01.S.doc Timescale for action 01/12/07 2 YA9 13(4)(c) 01/12/07 3 YA19 12(1)(a) 01/12/07 4 YA19 13(4)(c) 01/12/07 5 YA20 13(2) 20/09/07 Carisbrooke Version 5.2 Page 30 6 YA20 12(1)(b) 7 YA33 18(1)(a) 8 YA34 19(4)(b) 9 YA36 18(2) 10 YA42 23(4) 11 YA42 12(1) 13(4) medication received into the home. The registered person must ensure that a management plan is developed where a person is prescribed medication on an as required basis to modify behaviour. This is to ensure consistent and effective use of medication. A copy of the plan must be provided to the Commission. The registered person must ensure that staffing levels are determined using the Residential Forum Guidance. This is to ensure that staffing levels are appropriate to the needs and dependency of the service users. Evidence that this has been implemented must be provided to the Commission. The registered person must ensure that two written references are obtained prior to employment of staff; this is to ensure that the staff are suitable to work in the home. The registered person must ensure that staff receive regular supervision at least six times per year and that staff with supervisory roles have received training in this area. This is to ensure that staff are supported and supervised in their role. The registered person must ensure that the people in the home are protected from the risk of fire by ensuring that the fire risk assessment is reviewed and that the fire alarm is tested at least weekly. The registered person must ensure that there is a supply of hot water for people living in the home maintained close to and not exceeding 43°C at all times. DS0000067528.V351401.R01.S.doc 01/11/07 01/11/07 20/09/07 01/01/08 01/12/07 20/09/07 Carisbrooke Version 5.2 Page 31 12 YA42 13(5) This is to ensure peoples comfort and safety and control of infection. The registered person must ensure that all staff receive annual refresher training in moving and handling to ensure safe practice. 01/01/08 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 YA7 Good Practice Recommendations The registered person should ensure that any purchase of equipment or care made on behalf the people in the home from their own finances have been agreed with the person or representative and the placing authority. Written evidence of the agreement should be obtained. The company should adhere to contractual obligations in the purchases of equipment and care. This is to protect the person’s finances. The registered person should ensure that privacy, dignity and confidentiality is maintained when people have health care visits. The registered person should ensure that all complaints and concerns are recorded and that any records protect confidentiality. The registered person should ensure that a privacy screen is available in the top floor double room and that staff prompt use to protect people’s privacy and dignity. The registered person should review the manager’s role and number of supernumerary hours provided to ensure that the manager can fulfil all of the management responsibilities. The registered person should ensure that COSHH policies and procedures are brought up to date to ensure safe practise. 2 3 4 5 YA20 YA22 YA24 YA37 6 YA42 Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carisbrooke DS0000067528.V351401.R01.S.doc Version 5.2 Page 33 - 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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