Inspection on 06/06/06 for Coppice House

This inspection was carried out on 6th June 2006.

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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coppice House 10/05/07

Coppice House 21/11/06

Coppice House 30/11/05

Coppice House 10/06/05

Coppice House 08/10/04

Coppice House 01/05/04

Coppice House 23/02/04

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 Coppice House Main Road Huntley Glos GL19 3DZ Lead Inspector Ms Tanya Harding Key Unannounced Inspection 6 and 19th June 2006 07:30 th Coppice House DS0000055593.V300811.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 Coppice House DS0000055593.V300811.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. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coppice House Address Main Road Huntley Glos GL19 3DZ 01452 831196 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) www.orchardendltd.co.uk Orchard End Limited To be appointed Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Coppice House is a residential care home for eleven adults with learning disabilities who may also have Autism and challenging behaviours. The home consists of the main building and an adjacent bungalow which is a few yards from the main house. Coppice House is situated approximately eight miles from Gloucester city in a rural location and is surrounded by extensive grounds. The main house accommodates seven service users, all having first floor single rooms. There are also two bathrooms and a small office on this floor. On the ground floor there is a large lounge, dining room, kitchen, laundry, office and bathroom. There have been alterations to the lounge, which resulted in creation of two small rooms with plans to use these as a computer room and as a sensory area. The bungalow accommodates four service users in single rooms. There is a lounge/diner, conservatory, kitchen and two shower rooms. Close to the main house there is a large patio and landscaped garden. Coppice House is one of five homes which are part of Orchard End Limited, a subsidiary of C.H.O.I.C.E Ltd. The Organisation has a policy about admission. The home has a Statement of Purpose and Service User Guide documents which sets out information about the philosophy of the home and about the facilities provided. This is available on request to prospective residents and their families. Fee levels for the home range from £1549.00 to £1870.78 per week. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in June 2006 and included two visits to the home on 6th (7.30 am – 3.45 pm) and 19th (10.00 am – 4.30 pm). The inspection lasted for over 14 hours during which the care of people living at the home was tracked and interactions between staff and residents were observed. The registered manager has left since the last inspection and this visit was supported by the acting manager and the quality assurance co-ordinator. Discussions took place with the acting manager, the quality assurance coordinator, the Operations manager and five members of staff. A number of records were examined including financial records, records relating to recruitment of staff and medication administration records. The care of three people living at the home was case tracked. This involved looking at their records, discussing their care with staff and observing them during the visit. A pre-inspection questionnaire was received prior to the visit. What the service does well: The process of admission of new service users to the home is comprehensive and aims to involve service users and their families from the beginning. The Organisation makes every effort to seek views of staff and where possible of service users and any changes to support plans are communicated to staff as quickly as possible. The home receives ongoing support from the assistant psychologist who is based on site and is involved in devising risk assessments and behaviour support guidance. The Organisation responds promptly and responsibly to difficult situations such as allegations against staff. Staff are provided with opportunities for training and development in a number of areas. The Organisation has a well-established recruitment process which ensures that the necessary checks are obtained for all staff. Coppice House DS0000055593.V300811.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. Coppice House DS0000055593.V300811.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 Coppice House DS0000055593.V300811.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of people wishing to move into the home are fully assessed as part of the admissions process. However, the process may not take into consideration the capacity of the staff team to deal with highly challenging individuals and this may potentially compromise the quality of life and safety of the service users in the home. EVIDENCE: The Organisation has a dedicated person to oversee all referrals and admissions. This ensures that the necessary assessments are carried out and the process of admission is well planned and co-ordinated. Two service users have left the home since the last inspection. Both service users were displaying behaviours which compromised the safety of others as well as themselves. One of the service users was discharged less than a year after admission and the home struggled to manage the behaviours of this individual for several months before terminating their placement. Recommendations have been made in previous inspection reports about the need for the Organisation to consider what degree of aggression can be tolerated and to provide this detail in the Statement of Purpose. This is Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 9 because the home accommodates several service users who do not themselves display aggression and are very vulnerable to aggression from others. This report provides evidence that the recent admission has had a significant impact on the service users and the staff team. There is evidence that the new resident poses a high risk to more vulnerable service users. The person’s behaviour could leave them vulnerable through the use of high-risk physical interventions, retaliation and resentment by others in the home. The Organisation has recognised the difficulty of the situation and steps have been taken to address the main issues of concern. It is felt that once the staffing levels improve, the staff team will have a greater capacity for more preventative work with the service users and incidents of violence may be reduced or avoided. The Commission has met with the registered provider following this inspection to discuss concerns around the last admission. The home has been reminded of its duty of care to protect the service users accommodated from harm and abuse. (see also Standard 23). Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Better consultation with the service users would increase their involvement in the care planning process and enable people to express their wishes and preferences about how they want to be supported. Improvements to care guidance should ensure that service users’ assessed needs are met more effectively by staff. EVIDENCE: The Organisation has taken steps to increase staff communication skills by employing a Total Communication Co-ordinator for the home. It was also planned for this person to develop Total Communication resources and to support the introduction of person centred planning through greater service user involvement. However, the person has failed to make progress in this role due to sickness and has now left the home. The home is looking for alternative ways to address the relevant requirements. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 11 Staff were observed using the few communication resources available in the home. This includes a staff picture board, which is changed at the start of every shift and a daily timetable for a service user who likes to be reminded of their routine and planned activities. Both resources were seen to be beneficial for the service users by making information in the home more meaningful and accessible. The home has taken on board the recommendations from past reports to simplify the way information about service users’ support needs is presented. The assistant psychologist who has been supporting the home has been putting together comprehensive risk assessments and behaviour support guidance for each person. The quality and detail of these documents shows considerable improvement when compared to previous guidance. The accessibility of this guidance to staff has also improved. The files containing guidance about individual support needs are more compact and are stored in a secure area to which staff have easy access. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of suitable transport has limited the opportunities for service users to access the community and engage in meaningful activities outside of the home. Service users may not be encouraged to use self-help skills regularly because of pressures on staff time, thus reducing the opportunities for independence. The variety of food served is likely to appeal to the service users, although concerns as to the quantity and availability of food should be addressed to ensure all people receive a nutritionally balanced diet which is appropriate to their age and lifestyle. EVIDENCE: The home employs a full time activities co-ordinator. Records are kept of activities and trips out and the acting manager hopes these will be further improved in due course. This activity log provided Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 13 evidence that despite the difficulties with transport service users are accessing the community on regular basis. The home has three vehicles which are used to enable the service users to access the community. However, at the time of this inspection two of the vehicles were off road, one requiring major repairs. The one operational vehicle was also in need of attention and required extensive cleaning. Staff spoken with confirmed that the state of the vehicles has impacted on the frequency of the outings in the recent weeks. Observations made during the visit provided evidence that staff make efforts to provide meaningful activities for service users in the home. The activities generally take place with one to one support as this may be more appropriate to the needs of people who live at Coppice House. One service user was enjoying kicking a football around the garden with a member of staff. The same person was later observed riding their bike. Another service user was occupied with their favourite activity on the floor (puzzles and ripping paper). Discussions with staff and observation made during the visit provided evidence that staff shortages have impacted on the ability of the team to promote independence and support self-help skills of the service users. For example lack of time may be preventing staff from encouraging the service users to feed themselves, dress themselves and to be generally more autonomous. Comments made during the visit were that when staff are limited for time, they are more likely to resort to doing things for the residents, not with the residents. This is not seen as good practice. The home employs a full time cook and the kitchen was seen to be well organised and stocked on the day of the visit. Snacks such as crisps and biscuits and fresh fruit were available. However, these could only be accessed by staff as access to the kitchen is restricted at all times. It was observed that the service users have to ask for snacks and drinks between meal times. Information for one service user stated that the person requires frequent small snacks and should be encouraged to eat high calorie foods. Apart from the set meal times, no observation was made of the service user having additional snacks. Lunch on one day consisted of sandwiches made from two slices of bread with a filling. Staff advised that crisps would also be offered with the sandwiches and that the choice of fillings given was based on the knowledge of likes and dislikes of each individual. It was not clear whether the service users were actually offered a choice of what to have in their sandwiches on the day. This would be seen as good practice. All of the service users in the home are young men, some with very active lifestyles. It was not possible to determine whether the amount of food served Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 14 on this occasion would have been appropriate to their daily nutritional needs and appetites. Records seen for one service user showed that they were buying additional food from supermarkets and garages. Whilst there is nothing wrong with the person spending their money on the things they like, the home needs to be sure that these regular purchases are not an indication that the person does not get enough to eat in the home. The home needs to make an assessment of the meals served for their nutritional values and calorie contents. There should be a consultation with a dietician about the appropriate calorie intake for each person in the home and any recommendations made should be implemented. Menu for the week was clearly displayed in the kitchen. This provides information about vegetables served with each meal. For breakfast service users are offered breakfast cereal and / or toast and fruit and for supper people can have cheese and biscuits, yogurts, fruit, soup or cereal bars. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Better recording and monitoring of health related appointments would enable the home to ensure service users are supported more comprehensively with any health matters. Medication administration records are maintained as necessary with the exception of minor shortfalls, which could potentially lead to confusion and errors to the detriment of the service users. EVIDENCE: Records seen on the day of the visit provided evidence that there are systems for monitoring people’s health. Records of health related appointments are kept, but with some gaps. For example for one service user there was no record on file of appointments / visits to the GP. The care plans for this service user suggested that there are arrangements for the GP to visit the person at home for regular check ups. There was no evidence of any such visits. The person was looking very thin at the time of the visit. An appointment with the person’s GP should be arranged to ensure the person is physically well. For another person a health check has been arranged with the GP following concerns about person’s weight. The home keeps records of food daily intake and records of weights. This is good practice. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 16 The acting manager confirmed that rectal valium is not used for a specific service user and that staff have been instructed to call out emergency services if the person is experiencing a seizure. Stocks of this medication should be returned to the prescribing pharmacy. Medication administration records were examined for May and June 2006. Overall these were accurately completed. However, on a number of records the staff signature was missing. And for one person there was lack of clarity as to the frequency with which one medication should be administered (one instruction stated this should be given every day and another instruction for the same medication stated this needs to be given every other day). This should be clarified. The home is reminded that medication administration records must be accurate to prevent potential errors. There was evidence that one person may be refusing medication regularly. The home needs to be sure that there has been consultation with the GP about best way forward with this. Information about how each service user wants to be supported to take their medication should be further improved. A best interest approach is being used to administer medication covertly to one person. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who have communication difficulties may not be able to effectively express their views and concerns due to lack of suitably trained staff. Service users who live at Coppice House may not be suitably protected from harm and abuse. EVIDENCE: The Commission has received a number of concerns and allegations in the recent months about practices in the home which have potentially compromised the wellbeing, dignity and safety of the service users who live at Coppice House. The Organisation was asked to investigate these allegations and has provided a report to the Commission of the findings and of the outcomes. It was found that there have been inappropriate actions by staff and poor practice by omission by support workers, team leaders and the previous manager. A number of disciplinaries were carried out resulting in either dismissals or retraining. One POVA referral has been made since the last inspection. The Commission has made a number of observations and recommendations about the investigation itself and these have been taken on board by the Organisation. Prior to this inspection more anonymous concerns were made to the Commission about lack of staff in the home, poor state of vehicles and Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 18 difficulties in supporting the new service user. These issues provided an additional focus for this inspection. All of these concerns have been substantiated and the findings are presented in this report under the relevant Standards. Requirements have been made for the home to address the shortfalls which have resulted in these concerns. There is comprehensive guidance for staff on how to respond to behaviours which challenge. It was observed that for the newest resident this guidance was being reviewed and updated at least weekly. This was to help the person settle in and to monitor the effectiveness of approaches used by care staff in response to different behaviours the person was displaying. This is seen as good practice. Discussions with care staff and records of incidents which have taken place since the last admission provided evidence that one person poses significant challenges for the team and risks to staff and other residents in the home. Staff have also noted an increase in aggression from other residents and there have been incidents of retaliation. The home is monitoring the number and nature of behaviour challenges from this person. It is required that this be extended to identifying which service users are involved, whether they are physically assaulted or affected psychologically, by being upset and frightened. This is to ensure that service users who are adversely affected are offered additional support. This may mean that the home gets in touch with significant people outside of the home who may be able to advocate on behalf of the service users. An incident of aggression which took place on the 14th May 2006 was examined in detail, as concerns have been raised about the use of physical intervention on this occasion. The incident was of extreme aggression by one service user, to which staff had responded initially with diversion tactics and then by using restraint. Regulation 37 completed for the attention of the Commission stated that seated restraint was used. The actual incident record was not entirely clear as to the restraint method used, but through discussion with staff who were present, it was determined that ‘supine’ restraint was used with the service user being held on the floor for 15 minutes by three staff. The record of debriefing stated that staff resorted to this physical intervention because other less restrictive techniques were not effective. Staff felt that this was the only way to prevent the service user from harming other people in the home. The Commission is aware that the Organisation no longer trains their staff in the use of floor restraint, as this is a high-risk technique which requires a degree of force to execute it and may potentially compromise the wellbeing of the service user as well as staff. It must be acknowledged that many incidents of aggression and challenging behaviour are dealt with without the use of physical intervention and this is good practice. However, the above incident does again raise questions about Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 19 the ability of the home to accommodate people who are likely to display extreme aggression and violence. This incident also raises concerns about the quality of the recording, systems for debriefing and monitoring of incidents in the home. The home is required to: 1. Review this incident in greater detail and provide another debrief to the staff involved. 2. Consult with the Adults at Risk team about the risks which the service user poses to others in the home, and assess whether the measures, which are being taken to prevent harm to other residents are satisfactory. 3. Notify the relevant placing authority and other significant people, as appropriate, with regards to the floor restraint and invite their views on the matter. Another incident of aggression was observed during the visit to the home. This involved the service user who has recently returned from an assessment and treatment unit. The person requires time to get back to their routines in a quiet setting and this display of aggression, seen as unusual by staff present, may be an indication that the person is finding it hard to do this in the present atmosphere. The home has arranged a meeting with the Community Learning Disability professionals to review how the person was settling back into the home. This is good practice. The majority of the service users in the home need support with managing their finances. All service users receive weekly allowances and an additional clothing allowance. The home maintains records of service users’ expenditure. Financial records for three service users for May and June 2006 were examined in detail. A number of observations were made which show that there are shortfalls in the current system that may leave service users vulnerable to financial misuse. For example £35.00 was found to have been taken out on 24/05/06 from one persons wallet stating this was for activities, but there were no receipts or any other evidence to explain what the money was used for. Another record of expenditure stated that one service user had paid for a CD player for another service user. Discussion with the acting manager did not provide a reasonable explanation for why this was done. For some purchases there were no receipts evident. Some receipts did not clearly show what has been purchased. Some entries were not correctly added up and resulted in mistakes being made in some cases. Financial records must be accurate at all times. Consideration should also be given to reducing the costs for one service user who frequently requires batteries. The acting manager suggested that rechargeable batteries may be tried or buying from supermarkets where the Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 20 service user will get better value for money. The same service user tends to buy CD players regularly, sometimes two or more per months. The home should consider whether there is scope to improve record keeping around what is being purchased and what is being thrown away, to ensure there is less chance of misusing the person’s money. Coppice House DS0000055593.V300811.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an ongoing programme of improvement and maintenance, which ensures that the environment is welcoming and allows flexibility of use. EVIDENCE: Part of the large living area has been partitioned off to provide two additional rooms for the service users. It is proposed that one will house a computer and the other will be used as a quiet sitting / relaxation area. This work is ongoing. One of the bathrooms has been refurbished since the last inspection and looked welcoming and pleasant for use. The home needs to ensure that the privacy and dignity of the service users who use the toilet on the ground floor is suitably protected. At the moment there is no way of knowing whether anyone is using the toilet or not. Some service users may choose not to lock the door and are then at risk of people walking in on them. The home needs to come up with a simple but effective solution to put this right. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 22 The home has large grounds which are very well maintained and offer service users space to relax and partake in activities such as football, cycling and walking. A bench which is used regularly by one person was found to be very wobbly and could have potentially collapsed with someone sitting on it. This was replaced with a new bench during the inspection, but highlights the need for better hazard spotting by staff. The home does not employ a cleaner and all cleaning tasks have to be carried out by support staff. Some staff were concerned about being able to complete the cleaning tasks on the days when there are insufficient staff. (See also Standards 31-36). Staff were observed cleaning communal areas on the day of the inspection. Records of maintenance and services for the home’s vehicles could not be viewed on the days of the inspection. There were significant maintenance issues with all of the vehicles and one vehicle was very dirty on the inside. A requirement was made for the home to provide evidence that all of the vehicles are road worthy. This information has been forwarded to the Commission shortly after the inspection. The interior of one vehicle must be suitably cleaned and cleanliness and state of repair of all vehicles should be monitored regularly. Coppice House DS0000055593.V300811.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff shortages have significantly impacted on the quality of the support provided to the service users. There are good systems in place for recruiting and training staff and this should benefit the service users in the long run. EVIDENCE: Concerns have been brought to the attention of the Commission about staff shortages in the home. Previously requirements have been issued to the home to ensure there are sufficient staff on duty at all times. Staff rotas were examined for May and June 2006. There are four service users in the home who require 1:1 support. There needs to be a minimum of seven support staff (day shifts) when the home is full. At the time of the visit there were 9 service users accommodated. Some shifts were covered with only five staff. Staff spoken with felt that when there are insufficient staff on duty, supervision of service users is compromised and this may mean that vulnerable service users could be put at unnecessary risk. There are also difficulties in monitoring when people need support with personal care and this may mean that continence pads may not be changed as often as necessary. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 24 The Organisation has developed a good procedure which gives guidance to the manager and senior staff on what to do if there are insufficient staff. This should be extended to provide guidance on prioritising tasks when staff shortages cannot be avoided. Records seen provided evidence that staffing shortages have been recognised as a problem and were being monitored on weekly basis. There has also been active recruitment and three new staff commenced their induction during this inspection. The staff shortages can be attributed to high sickness levels and to a number of staff leaving the home almost at the same time. Since the last inspection to the home nine (9) staff have left including the registered manager. The Organisation has developed absence management systems, which include return to work interviews. The manager was seen to be putting the procedure into practice for several staff. Consideration should be given to whether stress is one of the factors which has contributed to staff sickness. Discussions with care staff indicated that this might be the case. The Commission has not been notified of times when the home has operated below the agreed staffing levels and a requirement is made for this to be done in the future. The Organisation has issued a memo reminding all home managers of this. The acting manager has identified a number of training needs for the staff team. This includes additional training for the team leaders in order for them to perform better in this role. There are plans to devise a ‘guide to running a shift’ with pointers and reminders for the team leaders and a checklist of daily tasks. Information about training planned for the near future has been provided in the pre-inspection questionnaire. This will include more staff attending the course on epilepsy, ongoing programmes of LDAF (Learning Disabilities Award Framework) and NVQ, courses in Autism, Health and Safety, First Aid and Food Hygiene. There was evidence that suitable training has been sourced for individual staff where shortfalls in practice and performance have been identified. This is good practice. The Organisation has a well-established training team with the responsibility for co-ordinating all training and the training matrix provided at the inspection showed that there is a commitment to invest in staff training to include mandatory courses, specialist courses and updates where necessary. Recruitment records were not examined in detail on this occasion. CRB disclosures were seen for 12 staff employed since the last inspection. Coppice House DS0000055593.V300811.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts by the acting manager to identify and address numerous shortfalls in the way the home is run should present a clear picture of where improvements are necessary. The home would benefit from a competent and experienced manager to action the required improvements in order to safeguard the needs and best interests of the service users. Shortfalls in health and safety checks and in fire training for staff could potentially compromise the safety and wellbeing of the service users. EVIDENCE: The acting manager has been working in the home since March 2006 and has made progress in identifying shortfalls in the way care and support is provided to the service users. She has received ongoing support and guidance from the Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 26 Operations Manager, Project Development Manager and from the Quality Assurance co-ordinator. Since the inspection a new manager has been appointed and will have the task of addressing the significant number of requirements in this report. Priority must be given to protecting the service users from physical and emotional harm, addressing staff shortages and availability of vehicles. The home maintains records required by Regulation and overall these are sufficiently detailed and regularly updated. However, better accuracy of records should be maintained in some cases. This includes providing a clear record of which staff have worked each shift. This could be ensured by staff signing their names in full in the team leaders book, as an acknowledgement that they are working a particular shift. Records available for the team leaders when trying to cover staff shortages should be completed as necessary. There were discrepancies when cross-referencing the staff rotas with the names/ numbers of staff in the shift book (team leaders book). For example there were occasions where the rota would show six staff working, where as the actual number on shift was only five. This can be misleading and should be regularly checked for accuracy. The fire logbook was examined. This showed that recent checks of fire alarm operation have been regular (in May and June 2006). However, the testing of fire alarms until May 2006 has been very irregular, with no tests recorded at all for October 2005, November 2005 and April 2006. There was only one test recorded in January 2006 and two tests in February 2006. These tests need to be carried out weekly. The only recorded tests of the emergency lighting was seen to have taken place in May 2006. These tests need to be done at least monthly. There was no record of the date/s of staff instruction in fire safety. The home has already identified this as a priority and will be providing training for all staff as soon as possible. The last visit by the fire officer was in July 2004. The home hopes to request a visit in the near future to ensure there is compliance with fire safety regulations with regards to the alterations in the lounge and to review the fire risk assessment for the home. There is guidance for the team leaders to follow in the event of a fire and additional guidance for night staff. This should be reviewed in consultation with the Fire Officer to provide clear detail on whether service users can / should be evacuated or not. Relevant health and safety records were seen in the kitchen, including records of fridge / freezer temperatures and food probe tests. Coppice House DS0000055593.V300811.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 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 3 X 2 2 X Coppice House DS0000055593.V300811.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 4 Requirement The Statement of Purpose must clearly define the ‘behaviour challenges’ which the home is able to support / manage. (Amendments were made to this but need further detail). Care plans must demonstrate that people have been consulted about what is important to them and distinguish between the aspirations of the individual and expectations of others. (Timescales of 31/10/05 and 31/03/06 not met). Systems must be in place to formally seek views of service users in the way which is meaningful to each individual (Timescale of 31/10/06 and 01/03/06 not met.) Medication administration records must be accurate at all times. The home needs to ensure that there has been consultation with the GP about how to support Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 29 Timescale for action 31/07/06 2. YA6 15 31/08/06 3. YA8 12 31/08/06 4. YA20 13(2)(6) 31/07/06 5. YA23 13(6) service users who refuse their medication. Monitoring of aggressive incidents for a specific service user needs to be extended to identifying which service users are involved, whether they are physically assaulted or affected psychologically, by being upset and frightened. These records must be available to the Commission on request. Service users who are adversely affected following an incident of violence or aggression by others must be offered additional support. This may mean involving people outside of the home who can advocate on their behalf. The home is required to review this incident of floor restraint in greater detail. Significant others who are involved in the care of the service user who was involved in the incident must be informed of the restraint. Financial records must be accurately maintained at all times. The home needs to ensure that the privacy and dignity of the service users who use the toilet on the ground floor is suitably protected. There must be sufficient and suitably experienced staff on duty at all times. The Commission must be notified of times when the home has operated below the agreed staffing levels. 31/07/06 6. YA23 13(6) 31/07/06 7. YA23 13(6) 31/07/06 8. 9. YA23 YA27 17 12 31/07/06 31/07/06 10. YA33 18 31/07/06 Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 30 11. YA35 18 Staff require further skills and development in the area of Total Communication and relevant training must be provided. (Timescales of 31/12/05 and 01/03/06 not met) 30/09/06 12. YA42 23 Fire tests and emergency lighting 31/07/06 tests must be carried out weekly and monthly respectfully. 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 YA6 Good Practice Recommendations Person centred planning with the use of Total Communication strategies should be used for all service users with communication needs The home should make an assessment of the meals served for their nutritional values and calorie contents. There should be a consultation with a dietician about the appropriate calorie intake for each person in the home and any recommendations made should be implemented. 3. YA19 An appointment with the GP should be arranged for a specific service user to ensure the person is physically well. Stocks of the medication which staff are not able to use (rectal valium) should be returned to the prescribing pharmacy. The frequency with which one medication should be administered should be clarified. 5. 6. YA20 YA23 Better information should be provided on how people would like to be supported to take their medication. Feedback from relatives and involved professionals about care provided should be sought and recorded DS0000055593.V300811.R01.S.doc Version 5.2 Page 31 2. YA17 4. YA20 Coppice House 7. YA23 Consideration should be given to reducing the costs for one service user who frequently requires batteries. The home should improve record keeping around purchases of CD players by one person, to better monitor what is being brought and what is being thrown away, to ensure there is less chance of misusing the person’s money. 8. YA30 The interior of one vehicle should be suitably cleaned and cleanliness and state of repair of all vehicles should be monitored regularly. Better accuracy of records should be maintained as follows: 1. There should be a clear record of which staff have worked each shift. This could be ensured by staff signing their names in full in the team leaders book, as an acknowledgement that they are working a particular shift. 2. Records available for the team leaders when trying to cover staff shortages should be completed as necessary. 3. Staff rotas should be regularly checked for accuracy. 9. YA41 10. YA42 Guidance for the team leaders to follow in the event of a fire should be reviewed in consultation with the Fire Officer to provide clear detail on whether service users can / should be evacuated or not. Coppice House DS0000055593.V300811.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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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