Inspection on 12/03/08 for Church Lane

This inspection was carried out on 12th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Church Lane 24/09/07

Church Lane 19/05/06

Church Lane 28/11/05

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Church Lane 21 Church Lane Bearsted Maidstone Kent ME14 4EF Lead Inspector Lois Tozer Unannounced Inspection 12 March 2008 08:50 th Church Lane DS0000065345.V359244.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 Church Lane DS0000065345.V359244.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. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church Lane Address 21 Church Lane Bearsted Maidstone Kent ME14 4EF 01622 730867 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) CareTech Community Services (No.2) Ltd vacant post Care Home 20 Category(ies) of Learning disability (0) registration, with number of places Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 20. Date of last inspection 24th September 2007 Brief Description of the Service: Church Lane residential setting, proving care and accommodation for up to twenty younger adults who have learning difficulties who may also have physical difficulties. The house is divided into 2 separate homes, one of which has a self contained 2 bedroom flat. This has separate access for people living there, but emergency access through the communal corridors leading out of the house. Each home has all its own self-contained facilities. Care Tech Community Services Ltd owns the home. Currently, two unregistered managers take responsibility for each separate home within the building and manage them on a day-to-day basis. It currently falls under one CSCI registration, and for the foreseeable future, remain this way unless the organisation chooses to register it differently. The home is located close to the centre of Bearsted Green near Maidstone. Local shops, pubs and a church are within walking distance. There is a main line station approximately ¾ mile away and bus services are nearby. The home has several vehicles for communal use. Twenty-four hour care is provided. Weekly fees range from £851.50 to £1894.29. Previous inspection reports can be obtained from the home, as can improvement plans detailing the action the home will take to improve the service. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 5 Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This means that the home has improved since the last site visit. Many of the requirements made in September 2007 are long-term improvements. This means that although they are not repeated as outstanding in the requirements page, there is still work to be done before the standard is met. A copy of the improvement plan and the progress being made should be obtained from the home. This key site visit took place on 12th March 2008 between 08:50 am and 4:15 pm. The managers, people who live at the home and staff assisted with the process. Two inspectors carried out the site visit and were made welcome. We were given two voluntary AQAA (Annual Quality Assurance Assessment) on the morning of the inspection. These had been completed by each manager and showed what action had been taken since our last visit. This showed that the managers were committed to the improvement of the home. The home is registered for a maximum of 20 people. Currently 8 people live on the ground floor (known as Church Lane). A further 3 people live on the first floor and 2 in a self-contained flat on the second floor (the upper floors are known as Inglewood). The managers and, for some time, a resident, showed us around the homes. The managers pointed out where changes are planned, where maintenance was needed and where improvements had taken place. The inspection process consisted of information collected before, during and in the few days after the visit to the home. Some of the information seen was assessment and care plans, medication records, duty rota, health support plans, training information and staff records, including recruitment and fire risk assessments. We also carried out a SOFI (Short Observational Framework for Inspection) observation to find out what life was like, for residents, in the home. This type of observation is used where people have communication difficulties. This meant that we sat in the lounge and the dining room for 1 hour 20 minutes observing and recording what was going on. What the service does well: People who may wish to live at the home do have their needs assessed, and information from where they lived before is obtained. Some people are really very involved in planning their support. A ‘person centred’ approach helps Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 7 people put their thoughts into pictures. This then helps them see the progress they are making towards their goals. In one part of the home, risk assessments have really helped people learn and develop new skills. They are using their picture planning process to be involved in looking at risk and how to make it less. There are service user plans in place. People are given opportunities to get out and about in the community, some have jobs and others hope to do well at college. Some parts of the home have clear daily routines and people living in these areas know what is expected of them, and they feel involved. Some parts of the home include people in chores and ordinary life activities, such as filling and emptying the dishwasher. The homes are large and spacious and are well furnished. Recruitment procedures make sure that all police and other checks take place. The home has reported any events that affect service user well being. The home keeps in touch with families and lets them know how their relative is doing. One family member commented how grateful they were that their son or daughter had received staff support when in hospital. A simple complaints procedure with pictures and easy words is in place. People have really nice bedrooms. They have been decorated to suit individual taste. Some people have specialist equipment that has been serviced to make sure its in good working order. What has improved since the last inspection? Since our last visit, a detailed improvement plan has been written up. It says what needs to be improved, and who will be responsible for making it happen. It recognises that there is a lot of work to be done. Most of the requirements that were made at the last inspection need long term work. Because there is a new, experienced manager in the part of the home that needs most improvement, we feel confident that this plan will show real development over the next 12 months. So, while many of the issues still need lots of work, there is a real potential for improvement. The way that people have assessments before they move to the home has been reviewed. If people have extra support needs, staff will be trained to meet these before the person moves in. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 8 Residents get more quality contact time with staff. There are more permanent staff and many of the agency staff know the residents quite well. Staff were kind and were getting people involved in activities throughout the day. We saw staff get people actively involved in domestic tasks, which they appeared to enjoy. At mealtimes, direct support from staff helped people eat in an unrushed and dignified way. There has been one medication error since the last inspection. This is a lot less, and shows a real improvement. We observed staff giving out medication during a meal break. They concentrated on what they were doing and helped residents to take their medication in their personally preferred way. Staff training has improved, they have been updated on protection from abuse and medication training. There is a clear programme of training in place, and gaps in staff knowledge are being filled. Two residents have made their own ‘complaints procedure’ video. The dining room has been redecorated. It is more spacious and is painted in calm colours. The whole house is more organised and cleaner. There was a more homely feel throughout. The manager has a separate building improvement plan. This recognises that although some immediate changes have improved the environment for people, it still does not give the freedom and accessibility it should. What they could do better: Permanent staff numbers have improved, but there is still a high number of agency staff used. The managers try to have the same staff as often as possible, but this is sometimes not possible. The service users plans are very bulky. Staff have to use these as a working document so they can meet individuals assessed needs. They cannot do this easily, as the files are not user friendly. A person has specially funded for staff to support them to do activities. We found that there was little evidence that this took place regularly. They need to plan ahead and make sure that the records show accurately how the time has been spent. In one part of the home, risk assessments are not very meaningful, and do not help a person develop skills. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 9 All staff, permanent and agency, must have the right support to know how to help and encourage the people who live at the home. We saw that a resident was being supported to eat in a way they did not like. Some people had to wait for support to eat their meal. We saw that it was on the table for 10 minutes before they got it. Shift leaders need to organise mealtimes better so this does not happen. Some personal support procedures have not been thoroughly assessed. It is unclear if the person has given their consent for such procedures or if there is a less intrusive way of supporting the person. People who have the greatest support needs cannot use the complaints procedure as it is. The manager is clear that staff need to observe and support people to have such a say. Staff therefore need training in advocacy and complaints. Neither the ground floor or upper floors have easy access to their gardens. The separate access enjoyed by the two residents in ‘the flat’ has been suspended. This is because they are using a fire staircase. This needs to be assessed urgently and access reinstated where possible. 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. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 10 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 Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 11 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 People who use the service experience adequate quality outcomes in this area. Although yet to be tested out, improvements for obtaining accurate service user assessments are in place. The improvement plan has made clear that extra support needs will be met through staff training prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and consultant explained that the statement of purpose (SOP) needed full revision so it would accurately describe the service offered. It needs to be made clear that two very different groups of people are supported in the one building. The service users guide (SUG) has been revised and improved, so some people living in one part of the home can, with support understand it. This includes pictures and very plain English. For others, more development around making documentation easy to use needs to take place, and is planned. The managers recognise this, and have made this clear in their AQAA’s. Contracts have been identified as needing improvement, so that they are in a suitable format for both service users with or without advocate support to sign up to. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 12 No new people have moved to the home since the last inspection. Both managers said, within their AQAA’s, that a full assessment of needs would take place. The improvement plan made it clear that all relevant information would be obtained before admission. It also stated that ‘Any extra training required [by staff]… to be arranged prior to admission dates being agreed’. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 13 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 People who use the service experience adequate quality outcomes in this area. People have a mixed experience. Some are supported well to achieve their personal goals, while others are not given support in a way they prefer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been considerable managerial input from the organisation since the last inspection. The improvement plan makes it clear that the shortcomings in the current planning system are recognised. There is a big piece of consultation work with residents taking place at the moment. They are helping the organisation sort out the type and style of paperwork that will benefit residents and staff. We understand that doing this properly will take some time, and in one area of the home we found this was progressing very well. The other part of the home has recently had permanent leadership, so developments around consulting people about their lives has only just begun. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 14 We looked at two service user plans. We found that there is still lots of information, and this makes the files heavy, bulky and hard to use. Some information was repeated and in some examples, contradicted itself, making the right support unclear. For example, one support plan said to offer a person a particular drink if unable to settle at night. Another plan did not mention this, and staff, when asked, were unclear what to do. This means that staff do not get a clear picture of the person’s support needs. Daily records showed that staff do not follow some of the guidelines in one of the plans consistently. An example was that night checks should take place 3 times a night. Records showed this was taking place hourly, which may be disturbing for the person. We saw that a care plans that said a particular person did not get involved in domestic activities. We were pleased to see this was not the case and staff were actively encouraging the person to be involved. We saw that one person had a planning review three weeks ago, but the plan had not been changed with the agreed support. The home still uses a lot of agency staff, so clear, up to date paperwork is essential. Personal goals have not been identified and recorded for all service users. Those that have been recorded don’t say how staff can support them. We observed staff supporting a person with good intentions, but with a lack of awareness about her or his actual support needs. We fed back to the manager that the person had been clearly making a decision, and the staff member had ignored this. We later saw another staff member support the same person skilfully, with very positive outcomes. It is to avoid unnecessary stressful situations that clear documented support that is followed by all staff is in place. We looked at some risk assessments in individual plans. A wide range of risks had been assessed although there was no record of when the risk last occurred. We saw that in one plan 16 risk assessments covered low risk areas, and that in 2 years, there had been no change. In one part of the house risk is supported as a way of having a more independent lifestyle. It is the aim of the manager to have the same focus across the service user group, but there is still lots of work to take place. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People who use the service experience adequate quality outcomes in this area. Some people are living active lifestyles that are helping them develop better skills for a more independent life. Other people have less opportunity for development, as the systems to support them need further improvement. There have been quality of life improvements for all people since the last visit. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We carried out a SOFI observation to find out what life was like for residents in the home. This meant that we sat in the lounge and the dining room for 1 hour 20 minutes observing and recording what was going on. We were looking for and recording 5 residents state of being, for example, positive, passive, negative, withdrawn or asleep. We looked to see how engaged they were, for example, with staff, other residents, in a task, with an object or not at all. We Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 16 were also looking to observe the quality of staff interaction, was it good, neutral or poor. We used agreed criteria within these broad descriptions. We fed back our observations to the manager. We found that there was a definite improvement in the quality of contact between residents and staff. For example, we saw one staff take the opportunity, when the lounge was quieter, to sing a rhythmic song as part of a story she was telling. We saw three people enjoy this, and were smiling and mimicking noises in the song. We saw that people were getting involved in daily activities around the home. There was more focus on getting people in small groups and on 1:1 sessions for short bursts. One person went to the kitchen to help make the lunch. Another was given support to wheel through tea on a trolley to the lounge. It was good to see most of the staff tell people what was going to happen next and to get their attention and focus before they helped them eat or drink. We felt the quality of interactions between people was, on the whole, very much improved. Some practice and support we observed needs improvement though. For example, staff did not find out what people would like to drink before making tea for all. Support plans were not clear about helping a person to eat, so one person was put under a lot of pressure to eat and drink. This resulted in them pushing staff away, which was ignored. Although plans told us that Makaton, a type of sign language, and other communication methods should be used, we did not observe this happening. We understand that there is work at the moment to revive old assessments and support plans and staff training is being arranged. In the other part of the home we found that staff were aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. The mealtime was more calm and focused, and staff, when settled, were fully concentrating on supporting the people to have their meal. There was good eye contact and conversation between staff and resident. The dining room, although improved, still causes problems, as it is not big enough to accommodate the size and numbers of wheelchairs people have to use. A person who needed their food chopped had it done on the table, rather than in advance in the kitchen. This caused an avoidable level of anxiety, as the person wanted to eat it as staff were chopping it. Another person’s food was on the table for 10 minutes while the staff member had to complete bringing drinks out. This meant that the food was cold by the time they had support to eat it. A little more forward planning is needed to make all mealtimes a consistently enjoyable experience. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 17 We saw an activity planner in one persons plan covering seven days. Activities were varied and included community-based events, but when we checked on daily notes, some of these plans did not happen. They were not replaced by an enjoyable alternative, or switched around. An example was one day marked for ‘Skills development and Gateway’ daily activity was recorded as ‘Helped with dressing’. There was no explanation why this was, even though a person is funded for considerable number of 1:1 support hours. We gave full feedback to the manager at the time of the visit, and when we compared the SOFI findings from our last visit, saw a clear improvement. We were pleased to see that all five people we tracked had a nearly equal amount of time with staff. The people had, in the 80-minute period, between 15 and 26 episodes where they were engaged with staff. This means that the very quiet or more withdrawn people are being remembered and being given time. The number of positive interactions had nearly trebled. Poor interactions were statistically higher, but we were able to see that this was a particular issue. Although, in one part of the home, documented support is still poor, there is clear evidence that the manager is having support to put this right. The other part of the home has benefited from more stability, and records around lifestyles and choice making were good. The overall style of support has improved considerably. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate quality outcomes in this area. People are supported to have her or his personal, health and medical needs met through documented support plans, but some information is not accurate. Some procedures that take place need to be agreed with the person to make sure it upholds their dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that personal care needs are recorded in each individual plans. This means that people are supported in a way they prefer. Personal care needs are recorded in some detail which is important as some people need lots of support with their personal care. We saw that there were records about nutrition and continence, which is good practice but some of the information is duplicated. This could be misleading, especially when the information recorded has the potential to lead to invasive procedures. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 19 One of the plans sampled made no reference to the fact that the person has a significant health need. Without guidelines to tell staff how they should support the person, there is a potentially serious shortfall. Some work has started to enable each person to have a health action plan, which is going to remove the duplications, as information will be recorded in only one place. At the moment, some health information is repeated for example health care appointment records. We saw evidence that some quite intrusive support may be carried out without the person’s assessed consent. There has not been any ‘Best Interests’ assessment using the Mental Capacity Act. There are plans to reduce this level of support, which is good, but further work must take place to clearly document the appropriate support for this person. One relative had recently written to the home to thank staff for keeping in touch when his or her son or daughter had been admitted to hospital. They commented that they were relieved to be kept in the picture and know that their relative was with people they knew. We looked at medication management in both parts of the home. Some very good progress is being made in one area, and people are taking a lot of control in administering their medication. Other people are more lightly involved. We observed the medication being administered to residents during a meal break. Staff were discreet, focused and made clear checks that the right person was getting the right medication. We discussed what the home had done to limit errors around mixing medication with food. The procedure described seemed safe and a good idea, but it had not been documented, and staff could not say if all other staff did it in the same way. We were told that health action plans will eventually record the individuals way of consenting to medication. This is documented for some, but not for others. We found that a requirement about medicine that was being crushed was outstanding. The improvement plan had clearly told us that this did not happen, but this was inaccurate. We discussed this with the manager and said it must be sorted out straight away. The manager consulted with the person’s GP and told us that this was now resolved. A care management review had asked for clear guidelines to be documented around a persons potential to refuse medication. This had not been completed, staff told us that they had not had the time to do this. The manager said that this would be sorted out. The policy around covert medication had been re-written and we saw it was straight to the point and clear, but the old policy had not been removed. This duplication could cause errors, so out of date information should be removed Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 20 and archived straight away. A refrigerator for medication is available. Staff told us that eye-drops are refrigerated after they have been opened for use, and applied straight from the fridge. We strongly recommend that they check with the pharmacist to make sure that the storage instructions they are following are supposed to remain in place once opened. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience adequate quality outcomes in this area. People living at the home have mixed support around being able to complain and to have their interests protected. Further development needs to be in place to help staff be advocates for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw the new complaints procedure. It has been written in plain English and has simple, descriptive pictures to help understanding. Some people find this user friendly, and are pleased with it. We found that two people had made complaints, and the manager had supported them to get these resolved. They had been taken seriously and knew that they would be helped to have the issue sorted out. A really interesting and inventive piece of work two residents have done is to record the complaints procedure on video. The manager is hoping they might be able to help other people learn how to speak up more. In other parts of the home, where support needs are greater, making complaints systems accessible needs more work. While we carried out our SOFI observations, we saw some staff respect and respond to people’s wishes. But we also saw staff be so insistent to carry out their support task with a Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 22 person they were missing what being pushed away was telling them. The communication between the two came across the resident being nagged and forced. We have already said that care plans were unclear, and discussing this with the manager, there was no agreed support plan for this person around this particular task. We discussed communication systems and profiles, and were told that the extensive assessments that had already taken place were being revived. This had not yet been completed, but support had started from a speech and language therapist visit in January 2008. When these are fully functional, and part of everyday life, people who have severe communication difficulties will be able to have a better say. There has been an adult protection alert raised about care practices in the home. The feedback received in February 2008 indicated that review has shown that the support stated in the plan was often not what was supplied. The manager advised that this alert had not yet been formally closed, but was hoping to correspond and have it closed in the next few days. It is through the staff team that the complaints process will work in the ground floor part of the house. Permanently employed staff have received adult protection training, but agency staff may not have had the same quality of support. Although this is briefly covered during induction, it is important that all staff are observed and supported to give the right sort of support. The manager and senior staff must look out for well meant, but ignorant care practices that could border on abusive practice. Staff have to act as advocates for residents, so further training in this area, especially those who support the people with complex needs, would be very beneficial. We were told that a strong system of supporting individuals to look after their money remained in place. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People who use the service experience adequate quality outcomes in this area. One part of the home is cosy and homely; the other part has improved a lot and has become more comfortable and enjoyable to be in. An extensive improvement plan is in place to develop the home around the needs of the people living in it. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We had a look around both parts of the house, and found that they were clean and fresh. Some people showed us their rooms. People are encouraged to personalise their rooms to make it feel like home. There are enough rooms and space for communal use so people can have privacy if they want it. In one area though, staff were using the quiet room for training, and this should not happen as it then becomes out of bounds for residents. There were activities Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 24 taking place in quiet areas, such as lobbies. We found that the feeling of the home had improved, and that there were quiet and noisy areas. We found that there is a restriction in place so that people cannot leave the first floor accommodation without staff letting them out. The front door has a key code to exit and the manager said that the other exit to the garden couldn’t be used regularly. We were told the organisations health and safety representative said these were for occasional use only. This means people cannot access the garden when they want to and have to rely on staff. The fire door leading to the garden from the first floor cannot be used as an everyday exit. There is no assessment to support this decision and no evidence that service users have agreed to the restriction. The area manager said they would make sure the fire officer was consulted and that something would be done. We were told that the front door did not automatically open as it should during the last fire practice drill. The manager said she has requested that this be sorted out, but was still waiting. There is a major environmental improvement plan in place. We were told it had been sent for signing off, so capital could be released to allow improvements to start. Amongst many other things, it is hoped that access for the residents of the ground floor to their garden will improve, and that the managers’ office on the ground floor will be re-located within the heart of the home. Access to and around the dining room has improved. A cupboard has been knocked out, giving more room. We observed that, once in position, the room was sufficiently big enough for the 5 service users who were eating. But when it came to manoeuvring people who use wheelchairs, turning became quite a challenge. The manager has recognised that if this part of the home were full with 10 residents, this would become very difficult to manage. At the moment, people are supported in sittings and in the lounge too. The cleanliness and hygiene of the home had dramatically improved. We saw the laundry for the ground floor was in clean condition. It was clear where dirty and clean items should go. All detergents were boxed away. It is planned that this will have a new floor, cupboards, sink and be tiled in the near future. Around the home, in people’s bedrooms and en-suites we saw that small improvements were needed. For example, a wooden toilet seat had a big crack that could be dangerous and give off splinters as well as become a source of infection. Toiletries and items were kept on the en-suite floor, as Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 25 there were no cupboards or shelves. The manager said that this could be easily improved and would ask the handyman to sort it out. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 26 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 People who use the service experience adequate quality outcomes in this area. People are supported more consistently and with a greater deal of respect and consideration. Some staff need support to understand care principles and give support more sensitively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the checks that take place for recruitment and saw that the head office had confirmed that all the right information had been collected. This included references and police checks. We saw that new permanent and agency staff had completed an induction. This helps to give them the underpinning knowledge they need to meet resident’s needs. We saw one of these completed inductions and found it covered the ‘Skills for Care’ criteria. There were clear records of private supervisions taking place. We saw the training matrix, which shows which staff have attended what courses. Training is organised by the training department. Some of it, such as Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 27 manual handling, has taken place in house. It was good to learn all staff (apart from the very new) had received practical training using the hoists in the home. Health and safety training was provided on a rolling basis. Gaps were being identified and we saw that dates had been arranged for staff to attend further sessions. We saw that training which focus on residents support needs still needs improvement. For example, several residents can use or understand some Makaton (sign language) so they need staff that sign to them to be able to benefit by it. Person centred planning and challenging behaviour training is planned for this year. Other service user focused training, such as advocacy, complaints and active support could be beneficial, especially around supporting people make decisions. The home is using a significant amount of agency staff. The manager said that they try to book the same staff to give service users consistency. The manager told us that recruitment had been successful; in January 2008 there were 11 vacancies, now there are only 5 vacancies left to fill. The manager said she and the consultant were actively seeking to recruit people who had experience of working well with people who have learning disabilities. As identified through SOFI observations, the quality and type of support needs to be explicit in the care plan. The basic principals of care need to be made plain to the new and / or inexperienced support staff. Some people are funded for extra one to one support. Staff said that sometimes this support is planned to suit the staffing needs of the service rather than to suit the individuals’ needs. This was reflected in one person’s plan in that there was no plan to support a recently identified aspiration even though the person has 20 hours a week personal support. Staff said they have a lot of paperwork to complete taking time away from residents. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 28 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, 42 People who use the service experience adequate quality outcomes in this area. The home is running more smoothly now. Residents are benefiting from the improvement plan that is being kept under review by the manager and organisation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building is divided into two separately staffed homes. It currently falls under one CSCI registration, and for the foreseeable future, remain this way unless the organisation chooses to register it differently. At the moment there is no registered manager in post. Each part currently has its own separate manager. One of these managers has been employed to Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 29 run the whole house. It is hoped, after probation, she will apply for CSCI registration. She has lots of experience and is qualified. She will have experienced senior staff to carry out the direct, daily support and supervision in each part. This should give the manager time to spend observing and supporting seniors to maintain the improvements that have already begun. Additionally, a consultant and the area manager are on hand to support and improve direct practice. The quality assurance manager has told us that new care plan templates will not be available for around 4 to 6 months, as they are going through a consultation process. It was clear to us that in order to meet people’s immediate needs, something more simple and to the point needs to be put in place quickly. This will help the manager get to grips with individual support needs and be clear on what is expected from the staff team. Agency staff need to get to know people quickly, and the quality of support, although improving, still needs developing. In discussion, the manager felt this to be appropriate, but concerned that the organisation would expect the current format to be adhered to. Quality assurance processes are clearly having an impact. The improvement plan shows that the organisation is committed to challenging and sorting out problems. The manager must be sure that improvements reported have actually taken place, as this has not always been the case. The process of consulting with residents is quite well developed in some parts of the service, but even here, communication training for staff is limited. This means that really finding out what people are saying relies on general interpretation. Both managers sent us a new AQAA. This was a voluntary gesture, and showed that they were keen to identify that areas that were meaningful for residents had already improved. They identified where areas for improvement were needed and told us what their plans were. The AQAA’s told us that maintenance of equipment in the home was up to date. We have been kept informed of all incidents and problems as they have occurred. The manager has told us what they or the organisation have done to resolve problems, and we are confident that the home is improving. Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 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 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X 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 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 3 X Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 31 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 YA18 Regulation 12(4)(a) Timescale for action To make sure that personal care 18/04/08 is the least aversive method available and is delivered with individual consent, an assessment using the Mental Capacity Act 2005 must take place for a particular named individual. 18/04/08 Requirement 2 YA24 23(1)(a)(2) So that residents on the first (a, o) floor and ‘flat’ area of the house can have independent access to the garden, the use of the fire escape staircase must be fully assessed. Action to improve freedom of access and reduce restrictions must be documented. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Church Lane DS0000065345.V359244.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Church Lane DS0000065345.V359244.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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