Inspection on 03/08/07 for Cintre Community

This inspection was carried out on 3rd August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cintre Community 19/12/06

Cintre Community 10/01/06

Cintre Community 21/06/05

Cintre Community 30/12/04

Cintre Community 22/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Cintre Community Cintre Community 54 St Johns Road Clifton Bristol BS8 2HG Lead Inspector Sandra Jones Key Unannounced Inspection 3rd & 8 August 2007 09:30 Cintre Community DS0000026532.V340169.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 Cintre Community DS0000026532.V340169.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. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cintre Community Address Cintre Community 54 St Johns Road Clifton Bristol BS8 2HG 0117 9738546 0117 9467842 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) Cintre Community Management Co Mr Gordon Charles MacDonnell Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 7 persons, aged 18 - 45 years. Date of last inspection 19th December 2006 Brief Description of the Service: The Cintre Community is registered with the Commission for Social Care Inspection to provide care for 7 adults who have a learning disability. The property is a large detached house in a residential location within walking distance of local amenities. There are 7 single bedrooms set over three floors. One of these rooms consists of an independent living flat. There is a large lounge divided into a homely seating area. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted unannounced over two days in August 2007 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined, a tour of the premises was conducted and feedback sought from individuals and staff. Four completed “Have your say” surveys were received at the Commission from people who use the service. Feedback from relatives and Health and Social Care Professionals was sought through comment cards. Two surveys were received from relatives. The Inspector Calls, A Photostory and questionnaire was used at the home with one person at the home. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the AQAA and notified incidences in the home, (Regulation 37’s). This information was used to plan the inspection visit. Four people living at the home were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the manager, staff and people using the service were gathered either by face- to- face discussions or by surveys. What the service does well: Feedback from individuals at the home was balanced, with positive and negative comments, which indicates that the people at the home are confident about expressing their views. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 6 Surveys from relatives stated “Staff support us as parents and our relative in all aspects of his life and care. Especially when he finds it difficult to express his feelings and problems” and the other said “Cintre continues to provide excellent care, opportunities, health checks where necessary, a good standards of house keeping and diet and a stimulating environment.” Members of staff comments that training is continuous supports a commitment to meeting the changing needs of the people at the home. What has improved since the last inspection? What they could do better: One requirement is outstanding from the last inspection, which relates to developing policies and procedures that set the approach for meeting needs. There are five requirements and two recommendations arising from this inspection visit. The Statement of Purpose must be reviewed to clearly specify the admission criteria at the home. The aims and objectives must be re-assessed to provide clarity about the direction the home will be taking in the future. Assessments for activities that involve an element of risk, including risk assessments for people that self medicate and for not providing keys to bedroom. This will ensure the individuals competency is assessed and action plans devised to meet the need. The Visitors policy should be reviewed so that individuals rights and choices are promoted and their protection considered. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 7 Criminal Records Bureau (CRB) must be kept until they are examined by the Commission to evidence a robust recruitment process. The Commission must be provided with copies of the Regulation 26 reports from the responsible individual to evidence that there is support and leadership from the organization. The Quality Assurance system must be linked to the business plan to demonstrate that the individuals at the home have input into the future plans of the home. 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. Cintre Community DS0000026532.V340169.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 Cintre Community DS0000026532.V340169.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Admissions are based on full assessments to ensure the staff are able to meet the persons needs. The Statement of Purpose must be reviewed to specify the admission criteria for living at the home. EVIDENCE: The Statement of Purpose describes the admission procedure for the home. The admission criteria must be made clearer to ensure that people wishing to live at the home, their representatives and placing agencies are informed about the range of needs that can be met at the home. The statement of purpose states that people will be helped to move on to independent living. However, in reality for some people, Cintre can be a home for life. The manager stated that a review of the aims and objectives of the home will be taking place in relation to supporting people to move from residential care into independent living environments. There is a vacancy and the manager confirmed that the organisation is actively seeking to fill the vacancy with a suitable person. A potential person is being considered for accommodation and the placing authority has provided a care plan. Documentation held at the home indicates that introductory visits have taken place at the home. For a smooth transition into the home the staff are Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 10 given an opportunity to make comments about the persons compatibility from the care plan provided. Four “Have your say” surveys from the people at the home were received at the Commission before the inspection visits. Three people indicated that they were asked if they wanted to move into the home and one person said that they were not asked about living at the home. Additionally, three people said in the survey that they received enough information about the home before moving in. Cintre Community DS0000026532.V340169.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The care planning system is individualised and the people at the home benefit from a person centred approach to meeting needs. Individuals are supported to make decisions about their lives. Assessments must be completed for activities that involve an element of risk. EVIDENCE: Case records contain copies of the Service User Guide, terms and conditions of residency, full assessments, care plans and copies of reviews. Care plan review meetings are convened with the individual, senior staff and where appropriate their relative. Copies of the reviews are sent to health care professionals and placing agencies to keep them informed. A historical overview of the person is incorporated into the care plan, which is generally sectioned into eight areas of need. These include mental health care, physical health, behaviour, self-care, finance, education, relationships, leisure and Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 12 aspirations. A development plan is then devised for each area of need. Consideration should be given to producing an action plan from information drawn from each development plan. The manager explained that reviews are coordinated every six months but they are not always linked to the care plans because individuals needs are changing. The progress of the care plans in terms of goals and aspirations are monitored through portfolios, which are in picture format with a brief description of the activity. There is a keyworker system in operation and the people consulted were able to name their keyworker and describe the role they perform. Keyworkers generally support individuals with independent living skills, provide 1:1 time with the person and assist the person to make decisions about their lifestyle. Each person has supervision with their keyworker to discuss events and these are recorded and kept in case files. Individuals giving feedback during the inspection visit were aware of their care plan and one person explained that they write their care plan on the computer. Two completed surveys were received at the Commission from relatives and indicate that the home always meets the needs of the people living at the home. Care plans are written in the format that best suits the individual, which is signed by the person, and indicates that people living at the home have meaningful input into the care planning process. The manager said that formats used are specific to the person’s level of understanding. It was further stated that advocates were used in the past to assist individuals to make decisions and are available if needed. One keyworker explained that to support an individuals to make decisions visual choices are used. Risk assessments are developed for people that exhibit aggressive and violent behaviours and are reviewed monthly. The assessments are detailed and inform staff on behaviours observed, triggers, strategies for prevention and diffusion and the use of physical intervention. The home imposes sanctions for destroying property of other people and the organisation, which is specified in the Service User Guide. Individuals sign an agreement about the sanction, the cost and method of payment. One person confirmed that sanctions are imposed and further commented that sanctions are less frequent than before. While it is acknowledged that risk assessments are in place for behaviours that challenge there is a lack of assessments for activities that involve an element of risk. These must be undertaken so that risks to service users are reduced/eliminated wherever possible. These include risk assessments for people that self-medicate and for not having keys to bedrooms. Daily records are completed by the staff about their observations of the person, outcomes of activities and visits. The manager said that where there Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 13 are persistent issues recorded, the appropriate forum is used to manage the situation. For example, house meeting and staff meetings. Cintre Community DS0000026532.V340169.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are good support systems in place for individuals to lead active and interesting lifestyles and to be valued members of the community. Service Users’ privacy may be compromised by the visitors policy which needs to be reviewed. EVIDENCE: Three people were consulted about their daytime activities and their comments confirmed that they undertake a variety of in-house and community based activities. These are 1:1 time with keyworkers, free time, leisure activities, structured community activities and employment. The manager said that three people are currently employed and five people attend college. Individuals leisure, educational and aspirational needs form part of their care plan. Within the care plan the educational experiences of the person, employment history with comments from the keyworker and individual Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 15 are detailed. From the information sought through in-house activities, interests and community activities, a development plan is then formulated. The individuals ability to use community facilities without staff support is also listed in this section. There is a timetable of activities for each person, which is in an appropriate format and held in their case file. The manager said that the individuals at the home access community facilities and are registered on the electoral role. It was further stated that currently four people leave the home without staff support. Where possible individuals are encouraged to use public transport to develop their independence and currently four people have bus passes. Individuals at the home also have access to the two house cars and the weekly fees cover the cost of the home’s vehicles. Individuals consulted during the inspection stated that their visitors are welcome to the home and for additional privacy their bedrooms are used. This conflicts with the visitors policy which currently states that individuals must seek permission to have visitors in their bedrooms. While it is acknowledged that the home must safeguard adults from abuse, individuals have the right to take risk. Individuals must have the freedom to have visitors in their bedroom unless a risk assessment determines that the risk is too high. The manager must review the arrangements for visiting at the home. Two relatives stated through the survey that the home supports individuals, at the home, to maintain contact with relatives and friends. One relative stated “ my son rings me most days from the payphone so we ring him back. The staff will speak to explain if he is having any problems.” Individuals relationships with family, friends and carers are clearly described within their care plan. The development plans arising from discussions about maintaining relationships is based on the individuals wishes. The manager was consulted about the systems in place that respects individuals at the home. It was explained that part of the ethos of the home is that individuals are given choices. The Privacy and Dignity policy, Codes of Conduct and induction of staff supports this ethos whilst respecting the person. The Privacy and Dignity policy is included in the Statement of Purpose and confirms that bedrooms are single and lockable, there is an expectation that staff knock and wait for an invitation to enter bedrooms and any information written about them is kept locked. Individuals consulted stated that staff knock on bedrooms doors, toilets and bathrooms before entering. Another stated that staff treat individuals with respect. House rules are based on the expectations towards other people, the home’s property and household chores, with singed copies of the house rules kept on the person’s file. There is an expectation that individuals participate in household tasks for which they receive £5 to used for activities. People who refuse to undertake household tasks do not receive the allowance. There are Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 16 further sanctions for people that persistently refuse to undertake household chores. Within the Service User Guide the expectations that individuals living at the home adhere to House Rules, attend weekly house meeting, participate in weekly supervision with their keyworker and pay for wilful breakages and damage is stated. Individuals giving feedback describe their designated household chores and reported that sanctions are not as frequent. Individuals sign agreements about the sanction imposed, which are generally financial, and specify the cost and method of payment. Records of house meetings are maintained and indicate that house meetings take place weekly and are well attended. Current issues about new people moving into the home, staff leaving and the premises are discussed during the meetings. People were consulted about the meals served at the home and positive comments were made. The people living at the home made the following comments, “The food is brilliant and I can go into the kitchen when I want”, “ The food is great and I help with preparing the meals” and “ We eat good healthy food.” Members of staff maintain a record of food provided to the people living at the home, which indicates that meals are varied and three meals are served each day. Breakfast and lunchtime meals are generally buffet style, individuals choose from a selection of dishes and evening meals are more defined. Fresh fruit is available and there is a wide range of fresh, frozen and dried food. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals can expect sensitive and prompt support for their personal and health care needs from a skilled staff team. Medication systems are safe. Risk assessments for people that self medicate must be developed to assess their competency. EVIDENCE: Individuals at the home were consulted about the routines of the home. It was stated that there are rules about going to bed, there is an expectation that people are in their bedrooms by 10:00 p.m. It was also stated that times for getting up are more relaxed at weekends because they don’t attend day care centres and colleges at weekends. The manager said that individuals are expected to go to their rooms by 10:00 pm because that is the time sleepingin staff come on duty. It was also stated that while individuals are expected to go to their rooms, they are not expected to be in bed or asleep by that time. One person consulted about personal care, said they require assistance with personal care from staff. Additional comments were made about staff Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 18 ensuring that their privacy is maintained when they are in the bathroom. SelfCare and Daily Living form part of the care plan, describes the individuals abilities with personal care. Preferred routines with personal hygiene and development plans support a person centred approach. Medical profiles include a pen portrait of the person, with the input from the health care professional, medical histories and the access to NHS facilities. A record of the medical consultation and reason for the visit is maintained for each person. Documentation in place indicates that the people at the home visit GP’s, have input from the Community Learning Disabilities team (CLDT) and regular check-ups with the optician and chiropodist. Individuals at the home said the staff accompanied them on GP’s visit and one said, “ staff come on GP’s visit but they stay in the waiting room, I go in on my own”. Two relatives gave feedback through the “Have your Say” surveys about the home. Their comments indicate that they are always kept informed about important issues that affect their relative. Members of staff were consulted about the way medical advice is consistently followed, it was stated that previously the information would be written into a report book but it was rarely actioned. Since the introduction of a memo system, where a report of the outcome of visits are written by the manager and staff sign once the memo is read, advice from professionals in consistently followed. Medication profiles are in place for individuals that have regular prescribed medications. The nature of the medication, the purpose and side effects are detailed within the profiles. Medications are administered from a monitored dosage system and staff sign the administration record sheets once the medications are administered. Homeopathic medications that stimulate the body to heal itself because it is a natural system of medications are also administered at the home. Two individuals currently self-medicate and risk assessments must be completed to assess the individuals competency and level of risk. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Individuals can expect their concerns to be listened to and to be protected from abuse. The imminent introduction of policies and procedures that set the approach for Safeguarding Adults will increase the protection of service users from harm. EVIDENCE: The Complaint procedure was reviewed to ensue that the people for whom it’s intended could understand the format. The format is symbolised and includes words and pictures, with signed copies held in individuals files, bedrooms and notice boards throughout the building. “Have your Say” surveys from individuals state that they know who to speak to if they are not happy. Two people said that they know how to make a complaint and two said that they sometimes knew how to make complaints. The three people consulted during the inspection visit named the people they would approach with complaints and mainly they would approach their keyworker or the manager. Members of staff were consulted about the way individuals are supported to raise concerns. One member of staff stated that not all the individuals at the home are able to express their concerns. Through their behaviours and 1:1, their concerns are discussed and where appropriate passed onto the manager. Another stated that there is an expectation that Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 20 staff support individuals to take their complaints forward. Relatives stated in the “Have your Say surveys” that they know how to make a complaint and the home has responded appropriately to their concerns. The manager stated that there are no current Safeguarding Adults referrals. The organisation used consultants that specialise in behaviours that challenge to assess the systems in place and a document was produced to set the practices of the home. Policies and procedures that set the organisations approach to safeguarding vulnerable adults in their care are being developed and will be introduced in the near future. The manager said that changes, which arose from the organisation looking back on previous incidents have occurred in Control and Restrain (CNR). It has changed from Physical Restrain (P.I.) to understanding challenging behaviour. Through the training programme members of staff the changing ethos is endorsed. Two staff were consulted about their responsibilities towards safeguarding adults from abuse. Members of staff confirmed that Safeguarding Adults training formed part of the home’s programme of statutory training. One person said that it was each person responsibility to safeguard individuals from abuse. Both members of staff knew the factors of abuse and the procedure to be followed where allegations of abuse are made. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals live in a homely and safe environment. Minor repairs and redecoration must continue for individuals to live in an environment that suits them. EVIDENCE: Cintre is a large detached period property, which has the appearance of a domestic dwelling and blends well with its residential location. It is within walking distance of shops, amenities and bus routes. The accommodation is arranged over three floors with bedrooms on two floors and shared space on the ground floor. On the ground floor there is a lounge, dining room, kitchen and downstairs toilet. There is a large lounge divided into a television lounge and arts and crafts area. The lounge area has two large comfortable sofas, individual chairs and window seat for the people at the home. In the dining room there is a large table for staff and individuals to sit and have meals together, there is also refreshment making facilities and easy chairs for people to Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 22 use outside of meal times. The kitchen is large with seating and is used as social space for individuals. There are 7 single bedrooms set over two floors and accessible by stairs. On the first floor there are four bedrooms and two bathrooms and on the second floor there are three bedrooms, one of these is an independent living flat. Bedrooms are single, lockable and furnished with a combination of the home’s furniture and personal belongings, which reflects the person’s lifestyle and interests. Three people were consulted about their bedrooms and two people stated they had keys to their bedrooms and one said keys were not provided. Since the last inspection the lounge was redecorated and the manager stated that steps to replace the central heating systems are being taken. While it is noted that there is a maintenance programme in place, areas of the property are in need of minor repair and redecoration. The manager acknowledges that repairs and redecoration are needed in some areas of the property. The laundry room is set away from the kitchen and, it has a tiled floor and painted walls for easy cleaning. There is a domestic size washing machine and tumble dryer, with sluicing and hand basin. Three “Have your say” surveys from people at the home indicate that the home is always fresh and clean and one said it was sometimes. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home’s recruitment process must ensure that people that are suitable to work with vulnerable adults are employed at the home. The needs of the people at the home are met by skilled staff. EVIDENCE: Three “Have your say” surveys from individuals at the home state that staff treat them well and always listen to and act on what they say. One person stated that the staff sometimes treat them well and sometimes will listen and act upon what they say. Three people at the care home were consulted about the staff at the home and one person said “The staff are brilliant” and another said, “ We do argue a bit and when I have cooled down I say sorry.” The case records of the three most recently employed staff were examined during the site visit. Personnel files contained completed application forms, two written references and terms and conditions of employment. The manager reported that previously, personnel records were kept and managed by the organisations Human Resources (HR) but these tasks are to be given to home managers to undertake. During the examination of personnel records, it Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 24 transpired that HR destroyed Criminal Record Bureau (CRB) disclosures for twelve staff before an inspector saw them. As the serial numbers were recorded in a spreadsheet with additional information regarding dates of issues and convictions, the manager will not be required to seek CRB disclosures for these staff. However, future CRB disclosures must be kept until an inspector sees them. The organisation employs a training consultant and during the inspection visit a discussion with the consultant about the training programme took place. It was understood that the Common Induction Standards that follows Skills for Care package is completed by new staff. External First Aid, Food Hygiene and Health and Safety training, with internal Safeguarding Adults training form part of the statutory programme for all staff. Members of staff are also encouraged to undertake vocational qualifications and it was stated by the consultant that the policy of the home is for all support staff to have NVQ level 3 training. It was further stated that while training packages become more individualised the longer they stay at the home, the home is currently in a transition phase. During this period the training that meets the needs of the individuals at the home is the priority. The two “Have your say” surveys from relatives state that the staff have the right skills and experience to look after people properly. Two staff were consulted about the training package that ensures they have the skills to meet the individuals needs. One member of staff said that training is continuous and, there is vocational, refresher and specific in-house training. A recently employed member of staff described the induction programme and statutory training provided at the home. In terms of their role the staff were aware of the responsibilities and expectations as support workers and keyworkers. Cintre Community DS0000026532.V340169.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals at the home can expect to live in a safe environment and can be re-assured that standards will be the subject of ongoing monitoring. EVIDENCE: The manager was consulted about the management skills that ensure the aims and objectives of the home are met. The manager stated that the open door policy and addressing issues as they arise is the style of management used to achieve the set standards. Systems such as staff meetings and individual supervision provide stability and consistency of care to the people living at the home. By getting involved with “hands on” care, contact is maintained with the individuals living at the home. Two staff were consulted about the Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 26 managers leadership skills and it was stated that the manager was supportive. Additional comments were made that rotas have a good balance between new and existing staff. The other member of staff said that the manager is approachable and will listen to what is said. Members of staff also confirmed that individual supervision takes place six times per year. Monthly visits to assess the conduct of the home are undertaken by the responsible individual. Although the visits are taking place, the most recent record of a visit under Regulation 26 is dated March 2007. Records do not support that the visits are undertaken consistently. The manager described the Quality Assurance system in place and, the process entails the completion of questionnaires by the people at the home. Questionnaires are then analysed and issues arising are either discussed at staff meeting or with the individuals during key time. The questionnaires are based on catering, and food, personal care and support, daily living, premises and management. The Quality Assurance system is not currently linked into the development plan of the home. Cash is held in safekeeping on behalf of the people at the home and a sample check of money in safekeeping was undertaken. Records cross referenced with cash held and record contained receipts to further evidence the purchases made and records are signed by the person and a member of staff. Fire risk assessments are completed in line with the Regulatory Reform (Fire Safety) Order 2005. It requires that fire alarm and fire fighting equipment is routinely checked and staff attend training and fire drills to ensure the safety of the people at the home. The manager ensures compliance with other legislation by the annual checks of the gas central heating and portable electrical equipment checks are undertaken by a competent person. Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 27 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 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x x 3 x Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 28 yes 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 YA1 Regulation 6 Requirement Timescale for action 30/11/07 2. YA9 & 20 13 (7) The Statement of Purpose must be reviewed to specify the admission criteria and clarify the aims and objectives of the home. Risk assessments must be 01/10/07 developed for activities that involve an element of risk including self medication a) A policy and procedure must 30/09/07 be developed about Challenging Behaviour and Physical Intervention is managed at the home. b) The procedure must also include the responsibilities of the staff that assist to manage aggressive and violent behaviours. Copies of Regulation 26 reports from the Responsible individual must be sent to the Commission. The Quality Assurance System must be linked to the home’s business plan 30/08/07 30/12/07 3. YA7 13 (7) 4. 5. YA37 YA39 26 (5) (a) 24 Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA7 YA15 Good Practice Recommendations The manager should consider formulating an action plan from each development plan. The Visitor’s Policy should be reviewed to ensure individuals rights and choices are promoted Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Cintre Community DS0000026532.V340169.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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