Inspection on 17/11/08 for Church Street Short Breaks

This inspection was carried out on 17th November 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Church Street Short Breaks 28/11/07

Church Street Short Breaks 09/11/06

Church Street Short Breaks 25/01/06

Church Street Short Breaks 23/05/05

Church Street Short Breaks 16/11/04

Church Street Short Breaks 22/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOME ADULTS 18-65 Church Street Short Breaks 88 Church Street Golborne Wigan Greater Manchester WA3 3TW Lead Inspector Sarah Tomlinson Unannounced Inspection 17th November 2008 09:30 Church Street Short Breaks DS0000005730.V373120.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 Street Short Breaks DS0000005730.V373120.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 Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church Street Short Breaks Address 88 Church Street Golborne Wigan Greater Manchester WA3 3TW 01942 765411 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) Wigan Council Social Services Department (vacant) Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 Date of last inspection 28th November 2007 Brief Description of the Service: 88 Church Street is a small care home that provides a short-term break (respite) service. Wigan Social Services runs it. The home is registered with us (the commission) to provide care for up to four people at a time who have a learning disability. People usually stay one or two nights during the week or for a weekend. The home is a purpose built bungalow in Golborne, close to local shops and amenities. It is on a main road, with a small, grassed front garden and an enclosed patio area to the rear. There is a small amount of parking at the back, reached by an un-adopted road. There are 4 single bedrooms, each with a wash hand basin. There is a combined lounge and dining room, a kitchen, an assisted bathroom and an assisted shower room. During the week, the home is usually unoccupied between 10.30am and 3pm (as service users are out and staff are not working). The manager is based at a separate office. The current fees range from £71.39 to £121.39 per night. Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 5 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. Our inspection visit, which the home was not told about beforehand, lasted approximately 9 hours. We met 4 service users and spent time watching how staff supported them. We talked with one service user and also with the manager and 4 care staff. We also looked around the building and at some paperwork. Before the inspection we sent surveys to service users and their families. Three relatives returned them. Their views are included in this report. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year, telling us what they do well and what they would like to do better. At our last inspection the home had a temporary manager. A new permanent manager, Mr Mohammed Asafa, started in December 2008. However, Mr Mohammed Asafa had not been working in the home since June 2008. Mrs Jennifer Mills, a manager from another Wigan Social Services respite service (13a Green Lane), moved over in July 2008 to temporarily manage Church Street. What the service does well: Information given to service users was helpful and clear, with pictures and easy to read writing. A lot of care was taken to make sure new service users, their families and care staff got to know each other. This included having plenty of time to try out the home before coming for their first overnight stay. Service users benefited from good staffing levels, with staff who were kind, caring, able and patient. One service user said Church Street was “really good”. Staff and service users ate together, enjoying meals that service users liked. One service user said the food “wasn’t bad”. The home was attractive, clean, safe and comfortable. Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 7 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 Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 8 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, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users and their families benefited from a supportive and comprehensive moving in process. Better record keeping would strengthen this. Regard for compatibility had improved, ensuring service users individual needs were better met. EVIDENCE: Information about the home was provided in a brochure (Service User’s Guide) and a Statement of Purpose. Good practice was noted, as the brochure was in a format suited to the needs of people with learning disabilities, with pictures, photographs and easy to read, large print text. At our last inspection we had advised some minor changes were needed to the Statement of Purpose. These had generally been done. It now included a description of the service with the aims and objectives, plus the number of places. The complaints section had also been amended to explain a complainant could contact us at any stage. The Responsible Individual had still however, not been identified by name (with their contact details, relevant qualifications and experience). Details of staff members’ qualifications should also be of current ones rather than future, potential qualifications; the Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 9 description of monthly fire drills did not match actual practice; and the Registered Managers details were incorrect. The home continued to provide a very good introduction to new service users. This getting to know you process was personalised and flexible, shaped by the needs and wishes of the service user and their family. A series of visits took place between them and an allocated staff member. Visits were initially made to the prospective service users family home and possibly their day centre. Prospective service users then came for a number of ‘tea visits’ at Church Street, before their first overnight stay. We discussed how the service could ensure the allocated worker was on duty during these visits to Church Street, helping the new service user feel comfortable. At our last inspection, although staff had been able to tell us about this process, there was no record in individual care files. At this inspection, we saw brief entries of tea visits but again no other information (e.g. initial visits to the family home). Prior to admission, comprehensive information about prospective service users’ needs was received from their social workers. The home then produced its own specific guidance for staff that was relevant to Church Street. However, for one new service user with complex needs staff did not have this guidance. It was not in place until after the service user had been for three tea visits and completed their first overnight stay. Service users received service agreements, detailing the terms and conditions of a stay at Church Street. Good practice was noted, as these continued to be provided in an easy to read/pictorial format. At our last inspection, we had asked for clarification about fee information, as general details such as the minimum/maximum charge for an overnight stay were not in the brochure (giving prospective service users and their families an understanding of the cost of staying at Church Street). Also, individual charges were not in service agreements. Wigan Social Services finance department calculated the individual charge for each service user, sending the information direct to the service user and their family. We advised the home to consider how it can ensure this information is provided to service users (where appropriate) in a suitable format. There was a group of approximately 40 service users who stayed at the home. Their abilities ranged from people who were quite independent to people who had complex needs and required full assistance (including people with behaviours that challenged the service). At our last inspection, we had been concerned not enough thought and planning was given to the compatibility of service users who were staying at the same time (to ensure their individual needs were being met and conflict avoided), with places sometimes being offered when it was not appropriate to do so. At this inspection, the home confirmed work had been done to improve this situation, with a new matrix in place. This identified known issues between services users and was used to guide bookings. Although some staff disagreed, most felt this had resolved Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 10 previous problems. The home is aware it cannot offer a place to someone whose needs (including physical and emotional needs) it cannot meet. The issue of compatibility was also influenced by some families pre-booking certain dates and a high demand for the service (from existing service users and new referrals coming from childrens learning disability services as their service users become adults). We were reassured the service was taking the issue of compatibility more seriously, with the manager able to give clear examples of when stays had been rearranged or cancelled due to potential conflicts. Wigan Social Services had also established a working party with families of service users and other interested parties to look at how the service can develop (including how to increase capacity). This was looking at supporting service users in more flexible and creative ways, e.g. for an evening or day time rather than always overnight and also using other buildings, particularly to support more able service users who were likely to move on to their own accommodation. We discussed the need to liaise with us at an early stage regarding any potential registration issues (e.g. regarding the provision of care away from the registered building). At our last inspection, we advised the registration certificate (which must be on display) needed replacing with a new version. This had been done. However, a further certificate had since been issued in September 2008 and was not yet on display. We again advised this needed to be displayed. Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users received good, personalised support from caring and skilled staff. Improvements in record keeping supported such care practices. The failure of systems designed to support successful, one to one work put this at risk. EVIDENCE: We looked at the care records of four service users in detail. At our last inspection, care records contained good information. However, this was not always being reviewed regularly and risk information was not properly documented or when it was, it was unhelpful as it was not specific to the service (putting both staff and service users at risk). Information had also been difficult to find, with a lot of past documents kept in current working files and some Church Street records also difficult to identify. Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 12 At this inspection we found improvements had been made. Files were easier to use, with old information archived. Although there still some gaps, staff were now generally signing and dating documents they produced. There was detailed, personalised and helpful information about care needs, clearly taking into account the service users and familys wishes and preferences. Risk issues were now clearly being thought about, with considerable improvement in how these were being documented (with service specific risk assessments now in place). Recent photographs were also now generally in place. However, we were concerned to find that although now recently reinstated, the key worker system had broken down. Also, whilst individual care records were up to date, the homes own six monthly reviews (that focused solely on the service user’s time at Church Street) were not taking place. We were told these were all out of date. To help track changing care needs and identify when the service first started, we again advised a record of the original admission date, plus subsequent admission and discharge dates, was kept in the front of service users’ files. The potential impact some service users behaviours had on others was also discussed (e.g. constant rattling of a string of beads against a hard floor), with regard to documenting the possible impact on other service users and agreed management strategies. We observed service users in control of their daily lives - making decisions, and with staff support, carrying these out (e.g. going to bed early, having a bath). Staff had an excellent understanding of the help and support service users needed, and most importantly how they liked this to be provided. We discussed how night and day staff shared information with each other about service users night time care needs (e.g. so day staff could confidently and ably support service users if they wanted to go to bed early or get up late). Daily records of the care provided had improved. Entries regarding what service users ate were no longer routinely recorded (this information was already separately kept in a menu record). To further improve the quality of daily care notes, we again advised in view of the Mental Capacity Act (2005), staff should record the different ways they facilitate everyday decision making for service users. We had also previously discussed how service users could find support from independent advocacy groups. The manager was aware of local groups. We advised ways of ensuring service users knew how to find and access such support were considered. With regard to opportunities for service users to participate and influence the running of the home, as noted, the six monthly internal reviews that key workers organised were not operating. However, other forums with a wider focus were being set up. A new working group with service user representation had started, looking at how the service could develop. Further good practice was noted, as new service user surveys had been produced, in a Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 13 suitable format with pictures and easy to read, large print text. We were impressed with the innovative plan to hopefully provide independent support to help service users complete these, with therapeutic earnings to be paid to other day centre users to provide peer support. Church Street Short Breaks DS0000005730.V373120.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 good. This judgement has been made using available evidence including a visit to this service. Service users were benefiting from improvements in the range and frequency of social activities. The re-establishment of systems designed to ensure good quality, one to one work will support this. EVIDENCE: During the week, service users spent their day away from the home, attending day centres, colleges and other social, educational and therapeutic activities. Service users left after breakfast and returned late afternoon (the home was unoccupied and not staffed between 10.30am and 3pm). Good practice was noted, as staff were expected to support service users to take part in ordinary leisure activities outside the home (e.g. visiting the local pub, going out for a walk in nearby fields or shopping). These activities usually happened at weekends. Further good practice was noted, as staff were Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 15 providing more activities. Baking, cooking and the making of Christmas cards and decorations had taken place over the past few weeks. Day trips that reflected the interests of the service users staying at the time were also being organised, with a train trip to Liverpool the day before our visit. Themed activity weekends (e.g. men’s/women’s/pampering weekends) were also being planned. Staff rota patterns were currently being reviewed. This aim was to create parity within the staff team and also shift patterns that enabled staff and service users to more easily enjoy days out together. The home was often busy, particularly at weekends, with usually 4 service users and up to 4 staff present. At our last inspection we had found the limited amount of communal space restricted some service users ability to engage in activities they enjoyed (e.g. being on the floor). Although the new compatibility matrix plus changes in the needs of some service users had now helped with this, the lack of a second communal room did impact on social activities. Families and friends were welcomed. One parent had formally thanked the staff for the support and care they give after calling in unexpectedly. The manager explained how arrangements were currently being made for the partner of a service user to visit. Good practice was noted, as daily routines, particularly during the weekend were flexible. As noted, service users were encouraged and supported to make decisions, e.g. what time to get up and go to bed. Where able, service users were given a key to their bedroom and encouraged and supported to use it during their stay. With regard to meals, shopping and food preparation was the responsibility of staff, who had all received food hygiene training. There was no fixed menu, as staff prepared meals based on the preferences of the service users staying at the time (with often up to four different meals provided at one sitting). One service user said the food “wasn’t bad”. Good practice was noted, as staff supported service users to eat in a discreet, individual and patient manner. Further good practice continued, as staff were expected to eat with service users. The recording of meals had improved, with details now in the menu diary only (reducing previous duplication). Church Street Short Breaks DS0000005730.V373120.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 good. This judgement has been made using available evidence including a visit to this service. Support was provided in a caring, respectful and individualised manner and to a good standard. Improvements in medication record keeping and adherence to the home’s procedures would strengthen healthcare support. EVIDENCE: Due to their complex and specialised needs, most service users were unable to tell us what it was like to stay at the home. Consequently we spent time watching how staff spoke to and cared for service users. Staff were warm, considerate, patient and respectful (e.g. crouching down to make eye contact with service users who were in wheelchairs). Staff actively listened to service users who were able to speak and responded to non-verbal communication from others. As noted, staff had a good understanding of how each service user liked their care to be given, guided and supported by detailed records. One service user spoke positively about the home, telling us Church Street was “really good”. Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 17 We received feedback from 3 parents. The home had also received feedback from 14 relatives in response to their own surveys (sent out in July/August 2008). These were all very positive about the actual care provided. With regard to healthcare, service users’ health was actively promoted and maintained. External advice and support had recently been sought for service users with additional specialist needs for speech and language, eating, and moving and handling. We again advised to enable this information to be tracked over time, between stays, a separate health record should be kept (e.g. detailing who was seen, when, the reason why and the outcome). With regard to medication, families continued to complete an information sheet for each visit, detailing current medicines. We again advised the home to routinely confirm this information with the prescribing GP (e.g. at the 6 month review). There was generally a clear audit trail showing medicines received, administered and any returned to the service user’s family. However, the design of the medication administration record (MARs) was unhelpful, with no designated space to detail the balance on admission and on discharge. This had been recognised by the service and was being looked at. Due to the nature of the service, MARs were not pre-printed by a pharmacist and were written out by staff instead. We were concerned these were not being checked and countersigned. We advised this was necessary to reduce the risk of error (and did not need doing at the same time but could be done by the staff member who next administered medicine from the new supply). Medicines were stored safely. Improvements had been made since our last inspection, with new individual boxes in each bedroom. We did have concerns about staff not following the home’s own revised medication procedures. Following an error, these had been changed to require medicines to be administered by two staff (until the team had all received medication refresher training). We discussed this matter with the management team after our visit. Church Street Short Breaks DS0000005730.V373120.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. Arrangements were in place for protecting service users from abuse or harm. With regard to complaints, ineffective follow-up action risked the home not putting things right and learning from them. EVIDENCE: Information about how to make a complaint was in the home’s brochure. Good practice was noted, as this was provided in an easy read, pictorial format. Whilst notices were not generally displayed (to promote a more homely environment), we advised ways of supporting service users to know about and understood this procedure should be considered (e.g. formally discussing and giving the leaflet out during the 6 monthly review; displaying a copy of the procedure in a service users’ notice board). Surveys from families confirmed they knew how to raise any concerns they might have. At our last inspection we had been concerned the complaints record book was unavailable, as it had been taken as part of a complaints investigation. We had advised it should not leave the premises, unless for a very short period. At this inspection, although the record book was on site we found a full record of complaints was not being kept. One complaint we had passed to the home had not been recorded. Others did not have enough detail, with no information about how they had been investigated, whether they were upheld and if so, any action taken to put things right. A clear record must be kept of Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 19 all concerns and complaints made, with details of the investigation, action taken and the outcome. A new pro-forma had been introduced, which will hopefully help address the above gaps. We advised details of both informal and formal complaints should also be kept (although for formal, externally investigated complaints only a summary was needed). Keeping details of all complaints demonstrates the service takes all issues seriously and shows any action taken to put them right. Of the three complaints recorded, although it was unclear how they had been followed up and their outcome, these were of a minor nature. One referred to a problem with bookings (this issue was repeated in the service’s own survey, with several families mentioning a breakdown in booking arrangements and/or not receiving their agreed entitlement of stays). The service’s own survey also identified three people who felt when they raised issues, they were not confident they had been listened to, with one person saying they felt “fobbed off”. A serious, formal complaint had also been made to the home. It related to a poor management response to a possible safeguarding incident. It had been investigated by an independent external body, which found most of the complaint upheld. Wigan Social services had accepted the findings and apologised for its failings. Steps were being taken to put things right with a new management team in place and the new working groups with families and service users. At our last inspection we had concerns we were not being notified about serious issues (e.g. aggressive behaviour from service users and a safeguarding issue, although this had been investigated appropriately, with no abuse found). Since then we have been appropriately notified of a range of issues. This included a further allegation of abuse from a staff member towards a service user. Good practice was noted, as other staff had understood their safeguarding responsibilities by ‘whistle blowing’ and bringing this matter to the attention of the management team (ensuring the safety and welfare of the service user). This allegation was properly investigated, with formal police involvement. The staff member had subsequently been dismissed. With regard to money held on service users’ behalf, this was being stored safely and securely, with appropriate records kept. We checked one cash balance at random and found this to be correct. Church Street Short Breaks DS0000005730.V373120.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 good. This judgement has been made using available evidence including a visit to this service. The home provided an attractive, comfortable and safe place to stay. EVIDENCE: The home was comfortable, bright and welcoming. There was a good standard of décor and furnishings, which were domestic and ordinary in style. Although the kitchen was not designed for wheelchair users, there was a range of adaptations in the rest of the home, including lowered light switches, raised sockets, an assisted bathroom and an assisted shower room. Two bedrooms had rise and fall beds, the third had a double bed and the fourth a large padded headboard. There was level access to both the front and rear of the home. Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 21 Several minor issues were identified at our last inspection. Some of these had been acted upon, although some of the bedroom furniture and vanity units was still very worn and tired looking (including numerous handles missing). Due to a spending freeze, these could not be replaced during this financial year and were to be repaired for the time being. We again discussed the need to provide practical and suitable lockable storage space in all bedrooms. Other maintenance and renewal work had been done since our last inspection, with a new settee and armchairs, dining table and chairs, shower table and new flooring throughout. With regard to communal space, as noted at our last inspection, the lounge/dining area was quite small. The revised compatibility matrix had helped in considering the spatial needs of residents. However, due to its size the lounge could become cramped with four service users (some of whom may be wheelchair users) and up to four staff present. We found the home clean and tidy. This was confirmed as usual by a relative. Care staff had some domestic duties, with a cleaner also working 2 hours each weekday evening. Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally good recruitment practices and staffing levels protected service users. Gaps in training and induction however, had not. Staff had not been supported by lapses in supervision and team meetings. EVIDENCE: On the day of the inspection enough staff were on duty to meet the needs of the service users. As noted, the home was not staffed during weekdays, from 10.30am to 3pm. At weekends it was staffed all day. A minimum of 2 staff were on duty during the day, with staffing levels at times rising to 4 (as some people required 1 to 1 support). There was a minimum of 2 staff at night, usually 1 waking night staff and a day staff who slept in. On occasion, to meet the needs of some service users, a second waking night staff replaced the sleeping day staff. Good practice was noted, as shift patterns provided a paid handover between day and night staff. As noted, shift Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 23 patterns were currently under review, with one planned change being the reduction of the evening handover (from one hour to half an hour). We discussed how the rota ensured sufficient staffing levels at busy times of the day. Afternoon start times meant staff started work before service users arrived, allowing time to read care records, the communication book and to begin evening meal preparations. Most service users arrived from 3.30pm onwards (via Wigan Social Services transport). Staff were then busy welcoming and settling people in. We discussed staff having enough uninterrupted time to carry out tasks such as booking in medicines and money. Service users benefited from a small staff team, 7 day and 3 night staff. This team had experienced considerable change over the past year. Three new day staff had started work (employed on temporary contracts). The current staff team worked well together, supporting each other and supporting service users in a warm, caring and committed way. We did have concerns about the lack of formal induction provided to the new starters and the absence of any learning disabilities training for them (which would have a negative impact on their understanding of service users disabilities and their confidence in working with them). At our last inspection we had advised a robust and detailed induction programme was developed. This is of particular importance due to the specialised and often complex needs of service users, many of whom have communication difficulties. For example, a checklist of tasks and skills to be observed and demonstrated could be developed. This would also allow the new starters competence to be assessed; informing their individual training needs analysis. We also looked at ongoing training completed by staff. With regard to NVQ training, there was a clear commitment from Wigan Social Services for staff to achieve training that exceeded our minimum standards. Eight staff (80 ) had at least the NVQ level 2 award (two of whom had attained the level 3 award). The remaining two staff were currently undertaking the level 2 award, with two other staff nominated for the level 3 award. At our last inspection, individual staff training records were unclear. We had also been concerned service users had been put at risk, as annual moving and handling and fire safety refresher training had not been completed. At this inspection, training records were again unclear. After our visit the manager confirmed all staff had now completed either annual on site service user specific moving and handling training and/or an off-site general refresher course. Long-term staff had also now completed annual fire safety refresher training or participated in a full, formal fire drill. New staff were due to attend formal fire safety training shortly. At previous inspections, we had recommended staff received training in specific conditions of service users, e.g. Retts syndrome. Staff confirmed information Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 24 about this condition had now been provided. Staff had also received on site training regarding the support needs of specific service users (including supporting people who were fed artificially (via a PEG system)). We again advised all training (whether on-site; formal courses; or training provided during staff meetings) should be recorded on individual training records (with the length of the session detailed). We were concerned to find staff meetings had lapsed. These were particularly important for this staff team as they usually worked without direct supervision (plus the impact of three new starters). Team meetings had restarted in July 2008 and were now taking place monthly. They had a clear format, with any required action noted and followed up, and all staff signing to confirm when they had read the minutes. We advised meetings should occasionally be held during the evening (e.g. 9pm) to enable night staff to attend. At our last inspection, whilst staff were receiving formal supervision, annual appraisals had not yet started. At this inspection, whilst appraisals had recently started, we were concerned to find supervisions had lapsed, only restarting again within the last few months. Private, one to one time was vital for providing the opportunity for formal dialogue and support, as well as focusing on practice and performance (including key worker responsibilities and service user issues) and training needs. Staff recruitment records were held centrally at Wigan Social Services’ head office. A sample of these was looked at during a visit by two of our inspectors in August 2008. These were in good order and in the main, evidenced that the appropriate checks and information had been gathered prior to new staff starting work. We advised the appropriate level of criminal record check must be in place (for staff who changed roles, with an increased contact with service users and hence, requiring a higher level check). Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 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. There had been a lack of clear, positive leadership, which had resulted in the unsatisfactory day-to-day running of the home. Changes in the management arrangements had begun to address these issues, with service users and staff starting to benefit from a better run home. EVIDENCE: The home has had a series of managers. A new permanent manager, Mohammed Asafa, was appointed in December 2007. However, Mr Asafa had not been working in the home since June 2008. Mrs Jennifer Mills, a manager from another Wigan Social Services respite service (13a Green Lane), had Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 26 moved over on 7th July 2008 to temporarily manage Church Street. Mrs Mills is the Registered Manager for Green Lane, which she initially retained responsibility for when she moved over. However, the importance of focusing solely on Church Street was recognised and Mrs Mills has had responsibility just for Church Street from 26th August 2008. Senior managers were aware they need to notify us when a permanent manager appointment was made or if there were any changes to the current arrangement. There had also been long term instability in the senior management team that supports and line manages the home’s manager. Interim arrangements had been in place, although these had been of a part-time nature. Two new senior managers were now in post. One staff member commented on the above, saying how they had felt “unsettled” and there had been “a lot of changes”. There had been a period of significant difficulties. In addition to the new manager being away from work, there had been a serious upheld complaint; a whistle blowing alert resulting in a staff member’s dismissal; and failure to follow procedures (regarding medication, key working, six monthly reviews, supervisions and team meetings). However, with the new senior managers and the home’s temporary manager in place, things were beginning to improve. One staff member said they had faith in the new management team. As noted, key working, supervision and team meetings had restarted. Staff were being given more responsibility (helping to motivate, build skills and confidence and improve the service received by service users). Other initiatives were also taking place, including better consultation with relatives, with a working group set up to look at service development. In previous inspections, we had advised that as the manager was not based at the home and as many service users had complex needs, the manager should regularly work alongside staff during evening and weekend shifts (to provide support and monitor care practices). At this inspection, the temporary manager was visiting the home on a daily basis and also worked shifts when cover was needed. We advised due to recent events, the manager regularly worked shifts (rather than waiting for a staff absence), with these hours recorded on the rota. With regard to how the home monitored the quality of its service, Wigan SS carried out an unannounced monitoring visit each month. Surveys were also now being sent to families. There had been mixed feedback. Families were very positive about the actual care provided. Plus, they described how the service successfully gave families a break, allowing them to recharge their batteries. Relatives also said service users enjoyed their stay, with some Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 27 gaining in confidence, whilst others enjoyed the chance to socialise with peers. However, there was negative feedback regarding a breakdown in booking arrangements for some families; not receiving their agreed entitlement of stays; and as noted, an unsatisfactory response for some when trying to raise issues. The home was requesting respondents details in order to follow up areas of dissatisfaction. However, as part of the new working groups, a senior manager had also met with relatives to discuss any areas of concern. With regard to feedback from stakeholders (e.g. day centres, community health professionals), very positive informal feedback had been received regarding a welcoming atmosphere and good communication. The service was aware they should also seek formal feedback and were planning to do so by early next year. At our last inspection we had been concerned information that should have been held on site was not available to either staff or us (e.g. some care records and as noted, the complaints record). This situation had now been resolved. However, at this inspection, we were concerned to find three service users confidential personal care files had gone missing. The home had taken appropriate action but they had not been found and the home could not explain what had happened. We were also concerned Wigan Social Services had not notified us of this occurrence, which they were required to do. With regard to safe working practices, at the last inspection the testing of portable electrical appliances was out of date and there was no record available regarding the soundness of the home’s electrical wiring system (an NICEIC test). These matters were subsequently addressed. At this inspection we received formal confirmation in the home’s AQAA that all safety and maintenance checks were now up to date. During our visit we checked hoist and gas safety certificates, which were satisfactory. At the last inspection we had serious concerns about fire safety. The fire alarm was not tested weekly, the means of escape were not checked at all and fire drills were not being held. At this inspection, records and staff confirmed these matters had now been rectified (although as noted the frequency of fire drills needs clarifying). We again advised, to encourage familiarity and confidence in the fire alarm system, different staff should be involved in conducting the weekly fire test. Fire drills should also be planned to include new staff (and where possible new service users). Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 2 3 X 2 3 X Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 YA3 Regulation 15 (1) Requirement To ensure new service users needs are met, their Church Street care plan and risk assessment must be in place before they start using the service. To ensure service users’ care records are an accurate reflection of their needs, skills and aspirations, they must be updated at least every six months. To ensure complaints are listened to and acted upon, a full record must be kept of their investigation, detailing action taken and the outcome. To ensure service users needs are met, all staff must receive training about learning disabilities. Timescale for action 31/03/09 2 YA6 YA9 YA14 15 (2) (b) 31/03/09 3 YA22 17 (2), 22 (3) 31/03/09 4 YA32 18 (1) (a) (1) (c) (i) 31/03/09 5 YA34 19, schedule 2 To protect service users, criminal 31/03/09 record checks must be undertaken at the appropriate level depending on the staff member’s role and DS0000005730.V373120.R01.S.doc Version 5.2 Page 30 Church Street Short Breaks responsibilities. This includes long serving staff that have changed roles within the authority. 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 YA1 Good Practice Recommendations To ensure information about the home is correct, the Statement of Purpose should be revised and updated (with regard to the points identified in this report). The Statement of Purpose should then be kept under review. CSCI and service users (or their families) should be notified of any revision within 28 days of any change. (These recommendations were made at the last inspection). 2. YA4 To evidence the support provided to a new service user, more details should be kept of their ‘getting to know you process. (This recommendation was made at the last inspection). 3 YA20 To ensure accurate medication records and reduce the risk of error, handwritten MARs should be checked and countersigned. To protect service users, staff should follow the home’s medication procedures for dealing with medicines. 4 YA22 To ensure families’ and service users’ concerns are taken seriously and acted upon, a record of informal as well as formal complaints should be kept (with details of action taken and the outcome). To guide and support new staff, structured induction training should be provided. DS0000005730.V373120.R01.S.doc Version 5.2 Page 31 5 YA35 YA32 Church Street Short Breaks (The above recommendation was made at the last inspection). To ensure staff training needs are met, up to date individual training records should be kept. It would be helpful if these identified Wigan Social Services mandatory courses, with their expected frequency; those considered mandatory by the home due to the specialised needs of service users; plus any additional local training (e.g. as provided by a healthcare specialist). Church Street Short Breaks DS0000005730.V373120.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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