Inspection on 24/09/07 for Church Lane

This inspection was carried out on 24th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Church Lane 12/03/08

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 Key Unannounced Inspection 24 & 25 September 2007 09:10 th th Church Lane DS0000065345.V349450.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.V349450.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.V349450.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 Jenine Uzor Care Home 20 Category(ies) of Learning disability (0) registration, with number of places Church Lane DS0000065345.V349450.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 19th May 2006 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, and two managers, who take responsibility for each separate home, manage it on a day-to-day basis. One manager, Jenine Uzor is registered with CSCI. The other manager is gathering information to submit for registration. 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.V349450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key visit took place on 24th and 25th September 2007. Because the house is divided into two homes, each home had a separate inspection. But, as this is one overall registration, the findings from the two days have been brought together to give an overall impression. We have not, as far as is possible, separated the two findings, as this would limit the anonymity we need to give people living at the home. A range of service user comment cards were sent out, but none returned with service users views. Mainly, staff had made the statement that residents were ‘non-verbal’. Because of this feedback and comments from care managers and relatives, the Short Observational Framework for Inspection (SOFI) was used. This involved us being in a communal area and observing the lifestyles, engagement and staff interaction people were experiencing. People who were able to give verbal feedback or use pictures and gestures to explain how they felt had separate time allocated. The views and experiences of people who live at the home are included throughout this report. Staff gave both verbal and observation (through SOFI) feedback, and one manager was available during the visit. Senior staff helped where the other manager was unavailable, and an area care director was also available to offer support. The inspection process consisted of information collected before, during and after the visit to the home. We saw information such as assessment and care plans, duty rota, risk assessments, incident report forms and medication records. The managers each completed a CSCI Annual Quality Assurance Assessment (AQAA), which was received before the deadline for return. These showed that the managers had considered some areas of improvement, but needed to focus much more on the lifestyle and experiences of people using the services. 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. 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. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 6 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. What has improved since the last inspection? What they could do better: The SOFI observations gave a clear picture that the ethos of staff needs to be challenged and changed. There is an institutional acceptance of poor practice in one part of the home. People are not being treated with dignity and respect, or acknowledged as having equal status. Staff were seen to wheel people away in chairs without speaking to them first, to take away their spoon or cup without acknowledging them, to support feeding from a standing position and groups of staff had conversations over the top of the heads of people when they were having lunch. Records and care plans have not focused on meeting people’s support needs best, but have been generated to meet the perceived requirements of regulation. Staff see the plans as difficult to use, and this was our findings too. There is lots of repetition and contradiction, which makes consistent support impossible. The plans do not embrace the person as a whole, and are fragmented into units. This is the same for the daily records, which do not reflect the person using the services experience or feelings. Because of the problems in support planning, review of support is poor, especially around developing the individual to be more competent or independent. Risk assessments that appear to have come from environmental Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 7 risk assessments for the building and have been applied generically to people. These have not enabled opportunity, and have been restrictive. Communication assessments are either absent or very poor. Speech and language therapists have clearly had input to the home, but none of the schemes developed have been maintained. In one part of the home, staff feel that people cannot communicate unless they can do it verbally. This is a social model of disability, and must be challenged and improved without delay. 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.V349450.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. Service users support and individual aspirations are assessed, but are not being carried forward into the care plan in a way that staff can use to benefit people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear system in place for new and prospective service users to have their needs and aspirations assessed. These were of mixed quality, some very clear information received from previous placements had not been transferred into the support / care plan in a way that staff could easily use. Important health issues had been replicated into care plans, but no monitoring or assessing process put in place. Family involvement in some assessments was good, but others missing. Social issues for people had been recognised, but were not given the attention needed to make sure these took place. Particular assessed and diagnosed conditions highlighted a need for knowledgeable and confident trained staff to support, but had not triggered this to be implemented before the service user took up residence. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor People’s individual plans are not clearly supporting assessed needs and goals and do little to support a person make decisions in their own lives. Risk management has not enabled a fuller lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The plan has not used key information about known support needs well. Although the right information is in the plan, from 3 samples seen, it was a fragmented, long-winded document that was described by a staff member as ‘a monster to use’. Although a ‘person centred’ plan template is in place, many staff have not had training using these, and the people they are about have had little input into them. Some very good pieces of planning and development have taken place in one part of the home, using picture communication aids. But little attention has been given to communication in the other part. That which is in place has focused on the person’s lack of ability. Understanding of the importance of thorough communication Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 11 assessments was poorly understood, and staff strongly focused on a person’s ability to verbalise. There was very little recognition of other forms of communication. In one part of the home speech and language input using communication aids such as ‘Big Mac’ have been implemented some time in the past. These have been inconsistently used, and were not regarded as useful by staff. Observations using SOFI showed staff had little regard for service users input in day-to-day activities, and did not consult them in decision-making. Poor practice was seen during mealtimes and toileting, where service users were not told they were about to be moved in their wheelchairs, have their utensil taken away or given the chance to say if they wanted the toilet or not. Risk assessment forms were in place, but these gave little value for people to take risks as part of improving skills or independence. Many seen were from a generic format, which gave everyone, regardless of ability, the same risk factors for general things, such as being in the kitchen, having a bath. Although space was available to tailor these to individual support requirements, the emphasis was more on restricting, rather than enabling participation. Reviews of all documents were poor, and often only offered a date and signature, with a statement ‘no change’. Records of personal day-today lifestyle were a series of tick boxes or short statements, which did not reflect personhood or the individuals direct experience. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is poor. Some aspects of individual lifestyle preferences have not been explored. General well being and dignified support that would enhance daily living is not taking place. Some people are not experiencing the lifestyle that a person not receiving residential care would tolerate or enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The range of activities within and away from the home is varied, and some photographs displayed showed people having a good time doing these. In one part of the home a photo board was displayed at standing eye level in the service supporting many people who use wheelchairs, so the inclusive nature and benefit to people was slight. People had enjoyed holidays, and small groups, or individual breaks were planned and taken throughout the year. Some people have been supported to find and maintain paid and voluntary work experience. Staff said, and records showed, that most people get out and about in the community often. The level of enjoyment and what the Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 13 individual got out of these trips was recorded in single sentences, not reflecting the person’s own experience. One poor example put the person in a child-like position, stating ‘went to college in the afternoon and misbehaved’. This had triggered a review of support, but the action had not been documented. Some people have chance to meet a variety of people, with or without disabilities, while others have limited access to social events outside of their peer group. In one part of the home, staff work with particular people intensively, discussing emotions and achievements. We were told later that very personalised plans had been created by people and displayed in their favoured way in their bedrooms. A person told us they wanted to form relationships and find people to talk to, especially someone who shared their interests. They said they had a ‘plan’ that they were building to achieve their goals and dreams, but it was kept in the office. They did not know why day-to-day staff did not help them to discuss issues in their personal plan. Mealtimes varied between services, one part of the home encouraged people to be fully involved and staff were seen to get people involved in small parts of a task as they came into the kitchen area. The other part of the home, through SOFI observations, was seen to exclude people from involvement. The manager said that people were involved usually, and a low work surface was available for people to use. The mealtime seen was poorly organised, and staff behaviour during this time showed little respect for service users as human beings with rights and feelings. Observations included people being moved away from their food without warning, having their utensil taken away from them and their food rearranged without warning, being stood over and talked over the top of, and being inconsistently helped during supported feeding. However, one staff member was seen to consistently support with dignity, remaining on the same level as the service user, giving eye contact, and making the mealtime a pleasurable, unrushed event. Support plans identified that healthy eating options should be offered, and a particular person be supported to make their own menu to help with weight loss. This had not happened, records and observations showed that this identified need was not being supported, and despite a consistently high weight being recorded over 6 months, no action had been taken to support the person better. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 14 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. People cannot be certain that personal support and emotional healthcare needs will be sensitively and soundly supported, but physical and medical issues are reasonably well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal plans make clear what support each person needs, but few indicate how much support is being given to promote a more independent lifestyle. Throughout one of the homes, posters were stuck on bathrooms walls giving personal and general information about care requirements and manual handling (which the manager removed during the tour). This is an indicator that high agency staff usage has an impact on service users dignity and ordinary lifestyle support. Observations of staff offering personal support was poor, people were told ‘toilet time now’, not asked discreetly if they needed the loo. Several persons were wheeled off in their chairs without any warning. Feedback from the physiotherapist showed that staff were providing good support to physical health needs, and generally Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 15 healthcare needs were met to an adequate or good standard. Documentation for specific health support was in place, but in several examples, was duplicated and gave conflicting information. Some out of date information remained, which could be misleading, especially in respect of the high staff numbers and turnover the home has. A blank ‘health action plan’ template was available. Plans to involve service users to obtain a health screening check and complete this document are in place, which will bring all information together, and should improve support. For the protection of residents, medicines were stored securely and tidily at the correct temperature. Clear records were kept of medicines coming into and leaving the home, as well as when medicines were administered to residents. A stock control system was in place for medicines not supplied in the monitored dosage system. No residents held and administered their own medicines. Three carers said that they had received corporate medication training and six monthly assessments. Seven completed six monthly assessments were seen. In one part of the home staff had completed questionnaires about medication but there was only one six monthly assessment on record. Later evidence provided showed that one part of the home conduct a full competency assessment on a 6 month rolling basis. Typed guidelines for medicines to be given when required were available, which were not all signed and dated. For three residents, a doctor had signed a clinical advice form consenting to covert administration of medicines. Two of these forms were more than two years old. For one resident a pharmacist had given advice on mixing two medicines with food. No evidence was available to indicate that the decision to mix medicine with food had been multi-disciplinary or involved relatives. The senior care in charge said that a new GP was due to visit within the next two weeks to carry out medication reviews. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 16 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): 23, 23 Quality in this outcome area is adequate. Ways of communicating with people need to improve so that residents know their views will be listened to and that they can feel confident they will be protected from abusive situations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a simple complaints procedure available, but it is kept in files, rather than be made available to service users. Those who have communication difficulties do not have access to any alternative in accessible format. Complaints received have been documented and resolved. In one part of the home two residents have made complaints that were successfully resolved. The communication profiles are not detailed sufficiently to help staff recognise when a person is, by their behaviour, ‘complaining’ or in distress. Some staff were clear that they would look for signs of abuse and report it, stating that they had received adult protection training. Other staff behaviour seen during this visit was degrading and did not treat people equally, indicating that staff do not recognise poor practice. Some staff behaviours seemed to have become institutionally accepted, for example, standing over people to help them eat, removing utensils, speaking over them, not speaking to them, treating people in an infantile manner. There have been several adult protection alerts raised in the last 8 months, some of which remain open. Action plans detailing what action the home will take to improve particular issues have been submitted to Social Services POVA department. Clear agreement was reached for part of the service to not admit Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 17 any further service users until particular issues had been resolved, but the home proceeded to admit a further resident. Communication between the safeguarding adults team and the home had not taken place, and information received from within the organisation was not confirmed by the registered manager with the safeguarding team as accurate. Resident’s money is kept centrally and accounted, and this system has recently been reviewed following a large sum of money going missing. There is an action plan, submitted to the local safeguarding adults team, detailing how improvements will be made in this area. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 18 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. The houses are quite homely, but people need support to keep their bedrooms, bathrooms and other facilities hygienic. Infection control protocols need to be followed to keep people safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The two services within this one registration both have spacious environments that are suitable for the people they offer support to. There is free access to most areas of the home. Access to the kitchens is limited through risk assessments. Some of these have been identified earlier as needing improvement to offer more opportunity. In one part of the home, we saw people spontaneously being supported in kitchen activities. Each part of the home has a separate garden, which is freely accessible. There are spacious, comfortable and well decorated communal areas, but the dining area downstairs is rather tight for space for multiple wheelchair users. We observed that a service user nearly had their foot twisted against a table leg during a tight turn in a wheelchair, which was pointed out to staff before harm was done. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 19 There are sensory and quiet areas, which are freely available and used often. Laundry facilities are not easily accessible to residents, but the flat has its own dedicated, fully self-contained facilities. One of the laundries seemed hazardous (access to the rear of the machines to change detergent involved climbing or crawling), and had no clear ‘dirty to clean’ route. One bathroom was being used as a wheelchair and hoist store. Sacks containing clinical waste were on the floors of bathrooms, despite bins being in place for their use. Some bedrooms were very homely, while others were stark and needed a thorough clean, as they had stained and dusty hard floors. Maintenance issues concerning the hot water were being sorted out during the visit, which later reports confirmed the whole building now enjoyed continuous hot water independent of the heating system. In one part of the home, continence products were stored on the floor of en-suites, and bathrooms had bundles of communal, threadbare towels available. Food hygiene measures were not being followed, as pork chops were out defrosting at warm room temperature within the main kitchen. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is poor. Service users need to help choose staff to make sure they are supported by people that value them as unique individuals and treat them with courtesy and respect at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the services within the one registration has its own core group of staff. Neither of these groups are well established, and very much rely on agency staff support. Between the two services, over 300 shifts (of around 7 hours each) was provided by agency staff in the 3 months before this visit. Thirtythree percent of overall staff have NVQ 2 or above qualification. A range of training has been given to staff, but mainly this has been of a medical or health and safety nature. Very little social needs training (Autism, mental health support, communication, person centred approaches, empathic support) have been provided. Staff said that the communication-training course did not help them to support people better. Observations using SOFI showed that some staff acknowledged people as humans with equal rights (telling people what was going to happen, getting Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 21 eye contact, not rushing), while others treated people as objects. Examples of poor practice were dismissive support during activities, and not paying attention to the activity or people’s enjoyment; communications were order like ‘sit properly’, with no praise or comment for trying to obey the command. Speaking to people like children ‘take that out of your mouth, its not nice’ and ‘don’t speak with your mouth full’. Not telling people when they were about to move their wheelchair, or take away their spoon or cup. Staff had conversations standing next to seated people who were eating, speaking over the top of them. These and other observations strongly indicate that the ethos and understanding of job role needs to be re-evaluated and the equality between staff and service users rapidly improved. Recruitment processes to make sure the right checks are in place have been centralised, and confirmed as safe. There is a recruitment drive at present, to try to build a permanent staff team. More able residents get involved with recruitment, but said they could do more. The manager confirmed that this is being developed. Others had very little say, which should be reviewed, as they are the experts at receiving care. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is poor. Quality assurance systems need to focus on the lifestyles of service users, increase managers time observing and identifying problem areas and focus on improving staff working practice to improve service user experience. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both managers have experience running residential homes, but neither have been in post very long. The written aims and objectives are not being achieved, and this will require the managers to look carefully at the shortfalls and identify the best way to support the staff to support service users. Quality assurance measures are in place, but they are not effective and do not focus on the experience of the people living in the service. There is more concern with paperwork than outcomes for people, and although Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 23 documentation is very important, it has overtaken the principal aims of the home. The organisation have recognised that quality outcomes need to improve, and a dedicated team of people have recently been employed to support managers in this large task. This is an evidenced work in progress, as such, no requirement has been made here. Attitudinal changes are urgently needed, so service users, regardless of disabilities, are seen as active participants in their own home with equal status. Physical health and welfare is reasonably promoted, but assessments to keep both staff and service users safe have come from a generic viewpoint. This has left people vulnerable, for example, in dining areas where insufficient turning room is available to wheelchair users, or fire assessments assumed to be OK, but a level of uncertainty remaining. General environmental health and safety assessments for staff around laundry areas needs improvement, and access to ordinary things, like the kitchen to do ordinary activities, needs to be reviewed. There are sufficient numbers of staff that have had first aid training available within the whole house to give cover. Other training, such as food hygiene and infection control has been given, but the principals are not being applied. There was uncertainty if a ‘competent person’ had approved the fire risk assessment. Records showed that risks noted had not had any action taken to reduce them. Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 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 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 X X 2 X Church Lane DS0000065345.V349450.R01.S.doc Version 5.2 Page 25 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 YA2 Regulation 14 Requirement To promote service user wellbeing, the information collected through the preadmission assessment triggers action to support people in a clear way. The home must have staff with skills that meet particular assessed needs before admission. To improve and increase service user involvement in their own lives, an approach, which seeks their views and opinions, must be put in place. This must be reflected in the service user plan and be kept under review. To promote an ethos of inclusiveness and stamp out disability discrimination, service users must be assisted to make choices about their lives and the risks they take. Clear and useable communication profiles must be in place. This requirement covers standards 6, 7, 9, 12, 15, 16, 17,18, 19, 20 For the protection of service users, decisions on covert administration must be reviewed, taking into DS0000065345.V349450.R01.S.doc Timescale for action 01/11/07 2 YA6 14 15 01/12/07 3 YA7 12 (2, 3) 01/11/07 4 YA20 13 (2) 31/10/07 Church Lane Version 5.2 Page 26 5 YA22 22 (2, 6) 6 YA23 13 (6) 21 7 YA30 13 (3) 23 (2, a) 8 YA32 12 (4, a; 5, a & b) consideration the Mental Capacity Act 2005. Pharmaceutical advice must be sought when it is intended to crush any medicine. Training in medication must meet the needs of the service users. To make sure service users views are listened to, respected and acted upon, a clear, accessible and effective complaints procedure must be in place. To protect existing and future service users from degrading treatment, the safeguarding adults protocol must be reviewed and action taken to make staff aware of every type of abuse. To protect staff and service users environmental risk assessments and relevant policies (including infection control, manual handling) must be kept under review and action taken to make sure these are followed. This is also applicable to standard 42 To improve and maintain service user dignity and human rights, staff must respect service users and have attitude and characteristics that support this value base. This is also applicable to standards 34 & 39 01/12/07 01/11/07 01/12/07 01/11/07 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.V349450.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection 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.V349450.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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