Inspection on 23/05/07 for Cherrytrees

This inspection was carried out on 23rd May 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherrytrees 30/01/09

Cherrytrees 08/06/06

Cherrytrees 12/12/05

Cherrytrees 31/05/05

Cherrytrees 25/10/04

Cherrytrees 18/05/04

Cherrytrees 05/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cherrytrees Cherrytrees Kitelands Road Biggleswade Bedfordshire SG18 8NX Lead Inspector Mr Ian Dunthorne Unannounced Inspection 23rd May 2007 14:45 Cherrytrees DS0000033114.V335212.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 Cherrytrees DS0000033114.V335212.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. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherrytrees Address Cherrytrees Kitelands Road Biggleswade Bedfordshire SG18 8NX 01767 313370 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) Bedfordshire County Council ** Post Vacant *** Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Maximum number of service users: 2 Gender: Male & Female Age Range: 18 -65 Category: Learning disability (LD) Period of stay: Respite only - up to a maximum of 6 weeks Until the reprovision of this service takes place, the premises must be safe, and meet service users` individual and collective needs 8th June 2006 Date of last inspection Brief Description of the Service: Cherrytrees is a respite care service located on the outskirts of Biggleswade, which shares a site with a domiciliary care service. The accommodation and grounds are owned and maintained by Aldwyck Housing Association, with Bedfordshire County Council providing the staffing and care support. The long-term plan for this service is reprovision. This is because the building does not meet the National Minimum Standards (NMS) for Younger Adults (18-65). It is hoped that the service will remain in the local area, but at the time of this inspection, there were still no definite timescales for this to take place. The accommodation comprises of a small flat, which is intended to provide respite care for up to 2 adults with learning disabilities at any one time. Stays are limited to a maximum of six weeks. There are two bedrooms, a shared kitchen, a bathroom and a living/dining area. The accommodation would not meet the needs of individuals with a physical disability. Community facilities and shops are a short distance from the home, which is also in easy access of local transport routes. The service has developed some user-friendly information for current and prospective people using the service, including: a Service User Guide, a Service User Contract and a pictorial shopping list. There was also evidence of pictures being used to aid communication with at least one customer. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 5 Information regarding the home’s range of fees and the manager’s figure provided in the pre-inspection questionnaire in January 2007 stated that the weekly fee ranged from £64.65 to £639.00. Any additional fees not included were not specified within the information provided. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours during the afternoon and early evening and it was unannounced. Prior to the inspection time was taken to review the information gathered since the last inspection and plan this inspection visit. The inspection included a tour of the communal areas and bedrooms, inspection of certain records, discussion with staff and the manager, discussion with customers and observation of the routines of the respite service. No relatives were available during the inspection to speak with. The method of inspection was to track the lives of several customers. This was done by speaking to them about the service they receive, observing their life in the home, talking to staff and reviewing their records. The service had no permanent manager at the time of this inspection, however an experienced manager from another similar Bedfordshire County Council service had been supporting the service since January this year on part time basis. Consequently several areas were in the process of being improved and there was clear evidence that this service was going through a transitional period, demonstrated by positive outcomes in several areas of the service already. What the service does well: What has improved since the last inspection? Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 7 There was a training and development plan available for each staff member, which included their induction and mandatory and specialist training courses. The service had developed systems for asking for the views of customers and others about what they think of the service and any suggested ideas for improvement. Then producing a plan, showing how they will act upon those views and carry the plan out Receiving regular supervision supported staff. All electrical equipment had been tested to ensure the health and safety of the customers. Care Plans had been developed using a person centred planning approach in a suitable format for the customers, that included measurable goals and there was clear evidence of the involvement and consultation with the customer. What they could do better: Some of the things that the home could do better include: • Making sure that customers are clear about anything they will have to pay for and that the customer signs the contract to show their agreement with it. Ensuring that assessments provided to help manager any risks to customers in their daily lives at the service, are available, reviewed and updated at regular intervals. Providing training for staff, which would help them understand, support and meet some of the specialist medication needs of the customers. Making sure that the registered responsible individual visits the service each month and produces a report about the visit, which is then made available in the home for CSCI to view when they visit. Ensuring the appropriate information about staff is available at the service. Supporting customers to take part in events, activities and facilities in the local area. Making sure that customers or their families are involved in preparing information about them, to help the service meet their needs. Then checking the information regularly and making any changes needed to it. Ensuring all staff attend training in preventing abuse, to help them know how to identify and protect customers from potential abuse or harm. • • • • • • • Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 8 • Providing training for staff, which would help them understand and meet some of the specialist needs of the customers. 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. Cherrytrees DS0000033114.V335212.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 Cherrytrees DS0000033114.V335212.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The respite service provided sufficient information for prospective customers, however it sometimes failed to identify the fees payable, which did not allow all customers to be aware of the fee and what they may need to pay, including that of any additional extras. EVIDENCE: The service’s statement of purpose and service user guide had been reviewed in January 2007 and they were available in a suitable format for some of the customers intended and provided information to enable prospective customers to make an informed choice about whether to stay. Both contained the necessary information required; however fee information was absent. Customers who were spoken with as part of the inspection supported that evidence. The homes last inspection report was available within the service. There was evidence that the home had assessed the needs of prospective customers and demonstrated that the method and system for doing so provided a satisfactory form of assessment and involved appropriate communication methods. The method of assessment involved the customer, the family and other individuals referred to as part of the service users care management process. They had also been provided with a summary Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 11 assessment from the referring care management service, which they had used to form part of the information that contributed to their own needs assessment. One customer who was being case tracked as part of the inspection process was new to the service and was undergoing what the service referred to as a ‘transitional process’, forming an introduction to the service. Extensive records were made during this period by staff of the customer’s progress when visiting the service for tea visits initially, which provided valuable evidence, which the manager demonstrated, supported the needs assessment process of gathering information. The records of customers examined verified that introductory visits took place and it was evident that the service considered them a very important part of the transitional process for beneficial, successful and supportive respite stays. The service began introductory visits initially at the customer’s own pace, in the form of tea visits and built upon this as a starting point for the transition. Each customer had an individual contract, however some had not been signed by the customer or their relative or representative to acknowledge their consent and agreement. There was evidence that the service had introduced contracts in a format appropriate for the needs of most of the customers. The service had failed to include fees charged within the terms and conditions and it did not include the cost of any ‘extras’ that may not be included within the fee. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans contained satisfactory information, however further development was needed to ensure both the plans and risk assessments were reviewed and updated at regular intervals. To ensure they accurately reflected customers changing needs and associated risks to enable the home to meet those needs and minimise risk to customers. EVIDENCE: A sample of the customers care plans and supporting documentation were examined and found to contain suitable and sufficient information to help meet their changing needs and personal goals were identified and reflected in their individual plan. The plan was made available in a format the customer could understand and a person centred planning (pcp) approach was used successfully. In some cases customers had been encouraged and were able to complete their own ‘Planning Your Stay’ form of care plan, which supplemented the services one and evidence of a customer being case tracked demonstrated that their relative had also been involved and supported them to complete it. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 13 The manager demonstrated that he was currently in the process of updating all customers care plans and was visiting a different customer with their relatives each week, to enable him to do so with their consultation and involvement. Consequently not all care plan reviews had been undertaken as yet and some required a review, in conjunction with this some needed to be signed by the customer or their relative to acknowledge, their involvement, consultation and agreement. However, all new customer referrals to the service since January 2007 had all the necessary care plans and supporting information and had been reviewed regularly. There was evidence from speaking with customers and records examined that customers were assisted as necessary to make decisions about their daily lives. Some information provided by the home was in a suitable format to support customers to make decisions about their lives whilst staying at the service. Staff were observed communicating in ways appropriate to each individual customer, to enable them to make an informed decision in a way the customer could understand. Some examples of this were demonstrated by the ‘Planning your Stay’ form of care plan, which enabled customers to decide what they wanted to do with the information and choice provided by the service; the method used for customers to choose their menu, provided them with suitable information and in a communication format to enable them to make an informed choice and decision. There were risk assessments in place as part of the service’s risk assessment strategy to enable customers to take risks supported by staff, however some had limited value because several of those examined had not been regularly reviewed and some contained limited information and were subsequently inadequate quality. The manager was able to demonstrate and evidence that a review of all customers risk assessments was being undertaken and several of those were examined and found to be satisfactory. However the manager was the only person trained and therefore deemed competent to undertake risk assessment completion and subsequent reviews necessary. Cherrytrees DS0000033114.V335212.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, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The meals provided at the service were home cooked, balanced and varied and suited the tastes of the customers. However, further development was required to improve customer’s access to the community, and engage them in appropriate and meaningful activities during their stay. EVIDENCE: Due to nature of the service being a respite facility, most customers continued to take part in activities engaged before coming in to the home for a respite stay. Therefore staff supported people who used the service to continue with their chosen and preferred activity during weekdays whilst staying at the service. This included activities evidenced by staff who supported people to prepare for such activities. Enabling customers to be part of the local community and to engage in activities inside and outside of the home was a requirement at the last Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 15 inspection. Consequently the manager covering this service was able to demonstrate various methods and tools being implemented to improve this area, for example some opportunities were advertised in the service on a notice board for people using the service, on which a calendar of local community activities and events were displayed. A disco was advertised which some customers were planned to go to. There was evidence that bread making had recently begun as a customer activity and there had been a project on growing strawberries and fuchsias. Staff spoken with, spoke of new activities equipment which one of them had been tasked to discuss with the customers and order following discussion and agreement of what was needed to meet the needs of some of the customers. Clearly there was evidence that this area for improvement was in the process of being addressed. However, much was still to be implemented and customers spoken with confirmed this and commented, “they never ask me if I want to help with anything”; “I’m bored, we could go to the seaside or on a day trip” and “I’d like to help with the washing up”. There was evidence that the home supported customers to maintain family links and friendships inside and outside the home, in accordance with their wishes, which included personal relationships. This evidence was supported by the service user plans, which identified relationships. Staff were observed using the customers preferred name as recorded in their care plan and speaking with the customers, involving them and not just to each other. Customers were observed sitting where they liked and moving around without restriction. However, staff were observed undertaking most household tasks and there appeared to be limited customer involvement, as detailed in a previous paragraph of this section of the report. Customers were observed during a mealtime enjoying well prepared and presented, home cooked and appetising food in suitably sized portions. Customers were observed enjoying their meal and the mealtime itself and one said, “the food is lovely here”. There were no set mealtimes as such, as the customers preferred the flexibility. The menu’s choices were in a suitable format for customers to make an informed choice and decide what they would like to eat. There were several effective visual tools used by the service to enable customers to have choice in most aspects of their meals. Cherrytrees DS0000033114.V335212.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 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service’s system for the administration of medication did not enable all staff within the service to administer customers’ medication, as they had not all received training. Further development was required to ensure all staff received appropriate and accredited training, to enable them to identify any potential problems in use and any associated medication principles and records to safeguard the wellbeing of the customers, to prevent placing them at potential risk. EVIDENCE: Customers spoken with said they enjoyed living at the home and that they felt supported by the staff. Records viewed suggested customers received personal support in the way they preferred and most were encouraged to maximise their independence. This was supported by observations and discussions held with customers. During the inspection an incident was observed which demonstrated that not all staff members provided an approach or personal support in a way which ensured the customers dignity was maintained or their welfare was considered first. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 17 Due to the nature of this respite service their families or main carers supported the majority of customers health needs. However, evidence was demonstrated that the service had some skills, training and information to meet some of those personal health care needs of people who used the service if and when required. The home had begun to address the previous repeated requirement made at their last inspections to ensure all staff receive appropriate medication training, one staff member spoken with had received this training and there was evidence that three had been nominated and were waiting to attend theirs. Some care staff had received awareness training in medication administration and practises, however this did not constitute full and accredited training. As previously reported staff from the adjacent domiciliary care service, were required to support with the administration of medication within the respite unit. This was because the medication policy required two staff to administer medication, and there were not always two staff on duty within the respite unit. This arrangement was still in place at the time of this inspection. The procedures implemented suggested that customer’s safety was being maintained in most areas. Medication consent forms had not been completed for all customers, to obtain their agreement to administer their medication and provide evidence of consultation. Cherrytrees DS0000033114.V335212.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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service had satisfactory complaints and adult protection procedures in place, which ensured that complaints were listened to and customers were safeguarded from abuse. However some staff had not received POVA (‘Protection of Vulnerable Adults’) training, which could place customers at possible risk of harm or abuse. EVIDENCE: The home had a satisfactory complaints procedure that ensured customers felt their views were listened to and acted upon. The complaints procedure was produced in a format appropriate for customers to understand and access. There had been no complaints since the last inspection. Customers who were spoken with, were aware of the service’s complaints procedure and felt comfortable and confident to use it and that they would be listened to. Those customers who were spoken with during the inspection verified this evidence. A customer comments board was used as one tool by the service, to identify any concerns before it became a potential problem. The home had a Protection of Vulnerable Adults (POVA) policy in place, which included whistle blowing and staff spoken with demonstrated they were aware of the procedure. Not all staff had attended POVA training, which the manager was able to provide evidence, which indicated that more POVA training had been requested, planned, and staff nominated for in the near future. Since the last inspection there had been one notifiable incident at the service reported to Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 19 CSCI but did not require reporting in accordance with the POVA policy and guidance. Evidence examined, supported a process that had been followed to safeguard and protect customers. The homes policies and practices regarding customers’ money and financial affairs were generally satisfactory and protected customers from abuse. A revised finance and petty cash policy had recently been introduced for the management of customers’ money and finance, to improve and ensure robust practices were followed. Staff had read and signed the revised policies to indicate they had understood it. Financial records of those customers case tracked as part of this inspection were examined and found to be satisfactory. Cherrytrees DS0000033114.V335212.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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home does not adequately meet the National Minimum Standards (NMS) for Younger Adults (18-65), suitable steps have been made to provide a homely place to stay. EVIDENCE: Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 21 As previously reported, the respite unit was part of the existing Downing View building which had been ‘made good’ until re-provision of the service took place. The unit operated in conjunction with Aldwyck Housing Association, who were responsible for the maintenance and upkeep of the building, fabrics and furnishings. The accommodation did not adequately meet the NMS environmental requirements, and would also not meet the needs of all individuals with a physical disability. Therefore home’s long term plan remained reprovision. At the time of the inspection, there were still no definite plans for reprovision to take place. Therefore there was no change since the last inspection and as previously reported CSCI had agreed that the environment must at a minimum, meet the needs of the customers. The home’s conditions of registration were updated accordingly. Minor repairs noted at the last inspection and on the one conduct of the home report received since the last inspection had been addressed and rectified. The service appeared clean and generally free from offensive odours. However in the bathroom there was evidence supporting the potential use of a communal sponge for customer use, which was not an effective infection control measure. Cherrytrees DS0000033114.V335212.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, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staff training were now satisfactory. However further development was needed to ensure that staff received training in customers specialist needs, enabling the opportunity for those needs to be understood and met. EVIDENCE: There was evidence that some staff’s mandatory and specialist training was limited or required refreshing and in accordance with their revised training & development plans completed by the covering manager recently, several staff had been identified and nominated for training. Evidence of the planned training and staff nominated was examined and supported this. Staff spoken with confirmed that they had recently received refresher moving and handling training. The percentage of staff qualified at nvq (national vocational qualification) level 2 or 3, was 60 which met the national minimum standard. The service was able to demonstrate that staff had the skills and experience to support the needs of the service users. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 23 Staff were being recruited according to County Council policies and procedures. Staffs vetting documents were being held centrally and arrangements were not made to examine them as part of this inspection. However it had been previously agreed that proformas would be compiled and kept in each service for all existing county council staff. Staff spoken to confirmed they had received a copy of the General Social Care Council Code of Practise and The County Council’s employee handbook. However it was disappointing to see that the service had still not produced its own service specific staff handbook for the respite service. Although the covering manager had devised his own ‘Information for New & Existing Staff’ which included general guidance & information on various areas such as customer privacy, dignity, respect & choice; methods of customer communication; language’; behaviour and abuse awareness. The home was using staff from an agency to supplement the existing staff team. Profiles were received for all external agency staff prior to working at the home, demonstrating that checks were made on the external agency staffs’ suitability, one was examined and found to be suitable and comprehensive during the inspection, however another record examined for an existing staff member demonstrated that no proforma had been completed as previously agreed for all existing staff and another demonstrated that proof of qualifications had not been seen and only one reference was listed. Staff photographs were not present on all staffs’ proformas of those that were available to view. The manager explained that he was still in the process of completing them in full and evidence was available to support and verify this, despite this, this was a requirement at the last inspection. The service also benefited from the same regular agency staff that they referred to as ‘core’ agency staff. The home had recently held a recruitment campaign, which the manager explained provided a limited response and unsuitable candidates. Recently revised and reviewed comprehensive records of staff training & development were examined and identified a suitable induction process, which was supported by staff spoken to and included LDAF (a specialist induction program for staff supporting service users with a learning disability), a corporate induction and work based induction. There was evidence examined of a structured training & development plan for individual staff and for the service. Revised induction plans and methods of recording, including training and development plans had been reviewed and revised by the part time covering manager, as part of an ongoing process since January this year. Clear improvements were already demonstrated. Staff spoken to and records examined, provided evidence that staff received regular supervision and annual appraisals and that regular staff meetings were held. All staff spoken with felt that the communication systems and methods within the service that had been introduced by the covering manager had improved, from which they all spoke positively of the benefits of this. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems for customer consultation were satisfactory; with a variety of evidence that indicated that customer views were both sought and acted upon. However, the services own report that reviewed the quality of care on a regular basis had not been maintained which identified that all aspects of the quality review cycle were not being considered. EVIDENCE: The service did not have a registered manager at the time of this inspection and it is understood that Bedfordshire County Council may be submitting a proposal to CSCI for consideration of alternative permanent arrangements, for this service’s management. However as detailed in this report’s summary, a temporary part time arrangement had been made which had resulted in an experienced manager from another similar Bedfordshire County Council service Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 25 overseeing the management aspects of the service on a part time regular weekly basis. It was evident that this manager was qualified, competent and experienced to run the service. The manager undertook periodic training and development to update their knowledge, records of this were provided prior to this inspection. Although not the registered manager of this service as detailed in the summary section of this report, the temporary cover manager was observed to communicate effectively with both customers and staff and appeared approachable. Customers and staff who were spoken to supported this view. The home had an inclusive atmosphere. The manager of the home maintained an effective leadership ethos that both customers and staff were able to benefit from. Opportunities were available in several formats and methods, using different tools to enable customers, staff and relatives to affect the way the service was delivered. All staff spoken with clearly felt that the morale amongst staff within the service, had improved as a result of the manager’s leadership. The service had developed a quality assurance and monitoring system, from which it had developed action plans from the information it had collected from several sources. From this consolidated information a service development plan had been developed in March 2007, with clear objectives and timescales. There was evidence that the service had begun a cyclical system of regularly monitoring and reviewing customers’ views, amongst others. The CSCI had only received one report in accordance with regulation 26 of the Care Homes Regulations 2001, since the last inspection of this home. The manager said that there had been no improvements made in this area, this was a requirement at the last inspection. Some records it was noted had a number of entries made by staff who had signed to authenticate care records using their first name only, or variations of their initials only, as opposed to their full names for clear identification purposes. In addition several daily care records of customers examined did not always provide sufficient detailed information regarding the customers support, which was provided by the service during that day or shift and their general wellbeing. Some aspects of the service’s health & safety safe working practices required some improvements to protect customers from potential risk or harm. See ‘Environment’ section of this report. Various records were examined to support adequate compliance with safe working practices, regarding health & safety including generic risk assessments for the home and various tasks. One customer’s bedroom was observed to have a mobile electric heater in it without a suitable cover to protect customer’s from the hot surface temperature, or an appropriate risk assessment to support this risk. Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 1 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 3 2 X 2 2 X Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 (1b) & (1c) Requirement Each customer must be provided with an individual written contract or statement of terms & conditions, which must include the amount and method of payment of fees. The customer and the registered manager must sign the contract. All service user plans must be reviewed on a regular basis and changes made where necessary and service user plans must be prepared in consultation with the customer or their representative. Ensure that individual risk assessments are updated and completed in line with the requirements of NMS 9. (Previous timescale of 08/06/06 met in part). All service users must have the opportunity to access the local community, and to engage in appropriate activities both in and out of the home. (Previous timescale of 08/06/06 not met) DS0000033114.V335212.R01.S.doc Timescale for action 31/07/07 2. YA6 15 (1) 31/07/07 3. YA9 13 31/07/07 4. YA13 12 and 16 31/07/07 Cherrytrees Version 5.2 Page 28 5. YA20 13 & 18 All staff must receive training with regard to a basic knowledge of how medicines are used, how to recognise and deal with problems in use, and the principles behind the home’s policy on medicines handling and records. (Previous timescales of 31/8/04, 31/8/05 & 08/06/06 not fully met). Training on the prevention of abuse must be given to all staff to ensure customers are protected from abuse. 31/07/07 6. YA23 13 (6) 31/07/07 7. YA32 18 (1c,i) Training must be provided for 23/08/07 staff, which is appropriate for the work they are to perform. Completed proformas must be held in the home, for all staff working in the respite unit, as per the CSCI/BCC agreement dated 13.6.06. (Previous timescale of 08/06/06 met in part) Visits as specified by Regulation 26 of the Care Homes Regulations 2001, must be carried out on a monthly basis. Copies of these reports must then be available to the CSCI during the inspection. (Previous timescale of 08/06/06 not met) 31/07/07 8. YA34 19 9. YA39 24 31/07/07 Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 29 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 The service should ensure that consent obtained from people using the service to administer their medication is recorded and signed by them or their relative / representative / advocate as appropriate. Communal sponges should not be provided or used in bathrooms, to ensure effective infection control practices are not compromised. Care staff should ensure that they sign documented care records with their full name on each entry. In addition to this, daily records of support provided to customers should be recorded in sufficient detail to be meaningful with regard to the customer’s needs and preferences. 2. YA30 3. YA41 Cherrytrees DS0000033114.V335212.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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. 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