Inspection on 05/02/08 for Cossham Gardens

This inspection was carried out on 5th February 2008.

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

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

Other inspections for this house

Cossham Gardens 16/05/06

Cossham Gardens 21/10/05

Cossham Gardens 20/05/05

Cossham Gardens 12/11/04

Cossham Gardens 17/05/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Cossham Gardens Lodge Road Kingswood South Glos BS15 1LE Lead Inspector Sandra Jones Key Unannounced Inspection 5 & 8th February 2008 9:30 th Cossham Gardens DS0000020230.V353207.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 Cossham Gardens DS0000020230.V353207.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. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cossham Gardens Address Lodge Road Kingswood South Glos BS15 1LE 0117 9673667 0117 9670849 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.leonard-cheshire.org.uk Leonard Cheshire Juliette Nicola Millard Care Home 16 Category(ies) of Physical disability (16) registration, with number of places Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Staffing Notice dated 29/03/2000 applies Manager must be a RN on parts 1 or 12 of the NMC register May accommodate persons aged 19 years and over only. Date of last inspection 16th May 2006 Brief Description of the Service: Cossham Gardens is registered as a Care Home with nursing for a maximum of 16 residents with profound disability, all of who require nursing care. The Home is situated in Kingswood, behind Cossham Hospital and is set in its own grounds. The home is a purpose built property providing accommodation in 16 single en-suite rooms designed for people with physical disabilities. There is communal and activity space in 5 areas. It has easy access to local community facilities and is less than 1 mile from local shops and services and 4 miles to Bristol city centre. It can be accessed by car, or by bus with a short walk. There are pleasant gardens to the rear and side of the property. All parts of the home are accessible to wheelchair users as well as the able-bodied. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection was conducted unannounced over two days in February 2008 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 procedure. During the site visit, the records were examined and feedback sought from individuals, their relatives and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the Annual Quality Assurance Assessment (AQAA). This information was used to plan the inspection visit. “Have your say” surveys were sent to people who use the service, their relatives, staff and health care professional. Feedback was received at the Commission from four people that use the service, five relatives and social and health care professionals. Six people were case tracked. 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 assistant manager, staff and people using the service were gathered through face- to- face discussions. What the service does well: People giving feedback during the inspection said that the staff had the skills to meet their needs, their rights were respected and named the person that they would approach with complaints. The following comments were made through surveys by relatives, “The staff are fantastic and perform well in sometimes difficult circumstances” and “The staff are particularly caring”. One person said through the surveys, “Wouldn’t want to go anywhere else for respite.” Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 6 Members of staff are clear about their roles and responsibilities, confirmed that access to training maintained insight into peoples needs and systems for consistency are in place. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cossham Gardens DS0000020230.V353207.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 Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (2) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. There is an effective admissions procedure in place, which enables new people to make an informed choice about moving there. They can be reassured that the home will have the skills and resources to meet their assessed needs. The Statement of Purpose must be reviewed to ensure people wishing to live at the home have enough information to make decisions about living at the home. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager states that the Leonard Cheshire Assessment processed followed for referrals ascertains the suitability of the potential placements, this assessments is completed by competent staff, who is a qualified nurse with a support worker. The home has a Statement of Purpose which details the arrangements for living at the home, with procedures and criteria for admission at the home appended. The Statement of Purpose must be reviewed to fully specify the range of needs that can or cannot be met and the ages of the people that will be offered accommodation at the home. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 9 While it is accepted that within the Principles of care the commitment towards privacy and dignity is stated, a policy on Dignity and Privacy must be included within the Statement of Purpose. A more specific procedure will inform individuals about the way their rights to dignity and privacy will be respected by the staff. The case files of the most recently admitted individuals were examined and it is evident that assessments before admission to the home took place. The experience of the admission process was sought from a recently admitted individual. This individual stated that a Service User Guide was provided and staff sought information about likes and dislikes before admission to the home. Four people living at the home responded through “Have your say” surveys and stated that they received enough information about the home before moving in. Comments made included “I was invited to look around when the building was formally opened”. Four relatives that responded through the surveys stated that the get enough information about the care home to assist them with making decisions about the home and one person said this was sometimes. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (6), (7) & (9) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. There are effective care planning systems in place so individuals benefit from receiving an individualised and consistent service. They can expect to be involved in making decisions about all aspects of their care. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) said that Individual Service Planner (ISP) documentation identifies personal needs and choice, the keyworker system offers improved support and risks are assessed. The nurse in charge described the admission process followed at the home, it was stated that visits to individuals home that wish to move into the care home are conducted and from the initial visit care plans are developed. These care plans are further developed during the trial period and reviewed with the Primary Care Trust (PCT) six weeks from the day of the admission and from then on annually by the home. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 11 Five people were case tracked during this inspection and their case records included personal details, nursing assessments, ISP and personal profiles. There are risk assessments for activities that involve and element of risk, reviews and other correspondence from social and health care professional. Personal profiles are written in the first person and give some background history about the person. Nursing plans assessments show that the needs of the person are assessed before admission to establish that the staff can meet the needs of the person. Nursing assessments are based on communication, mobility, nutrition, behaviour, continence, respiration, medication and nursing needs. ISP’s follow from the assessment and state the required outcome and action plan. Individual needs are reviewed annually with the staff and where appropriate the person and relatives attend review meetings. It is evident from the information recorded that steps are being taken to adopt a person centred approach to meeting needs. ISP’s could be further developed by including perceived likes, dislikes and preferred routines within action plans. Individuals consulted confirmed that discussions about their needs took place. One person described the process followed, it was stated that a trained nurse would discuss in detail the ISP with the person. Members of staff were consulted about their involvement in the care planning process and a registered nurse said that nurses have responsibility for developing ISP’s for people in their keyworker group. It was explained that the home reviews individuals needs annually and Continuing Care also reviews placements annually, which means that individuals needs are reviewed six monthly. Support workers consulted said that ISP’s are available and they are not involved with developing ISP’s. Support workers are involved in the Keyworker system and are generally responsible for arranging appointments, spending time with their key person and shopping for toiletries. The nurse in charge stated that a Communication Support Officer is employed by the Leonard Cheshire Disability to assist people to make decisions about the way their care is to be delivered. Speech and Language therapists are also used to empower individuals to make decisions. Communication form part of the care planning process and ISP’s are clear about the means used by the person to communicate. The registered nurse giving feedback said that offering choice empowers individuals to make decisions about aspects of their lives. Aids, facial movements and verbal communication are used by the people at the home to express their wishes and feelings. Support staff said that body language and eye contact is observed to establish decisions made by individuals. For individuals that exhibit aggressive and violent behaviours ISP’s and risk assessments are developed to guide the staff to consistently manage these situations. ABC forms are used to identify triggers, patterns of behaviours to develop ISP plans. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 12 ISP plans state the required outcomes, explains that aggression and violence is a form of communication and action plans set the steps to be taken to prevent an escalation of the situation and to protect staff and other individuals. For one person the ISP action plans instructs staff to complete ABC forms, however, ABC forms were not completed. Daily reports are completed by the staff about the activities undertaken and outcomes of visits from friends and family. The nurse in charge said that there were no restrictions imposed on individuals. Risk analyses are completed for activities that may involve an element of risk including Health and Safety. Within the risk analysis the identified risk is described and the action plan to reduce the level of risk form the risk assessment and are reviewed. Three relatives that responded through the surveys stated that the home always gives the support agreed to their family member and, one said this was usual another said it was only sometimes. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (12), (13), (15), (16)& (17) Quality in this outcome area is (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 EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states that Service users are involved in menu planning; there is appropriate training for staff and service users in posture and seating. Facilitating service users to have personal telephone line in their rooms. Independence living skills development is set with appropriate clients. Goals plans are part of the Individual Service Planner (ISP). It states the aspirations and goals of the person and is sectioned into short, medium and long term plans, with an action plan on meeting the goals identified. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 14 While the records show that goals are reviewed the progress made on the goals is not reported. Goal plans must be monitored along with the ISP’s to fully support that individual’s personal development is part of the care planning process. One person stated through the survey that they make decisions about what to do each day and two people said this was usual and another said it was sometimes. Comments made include “There has currently been a shortage of staff, but I believe every effort is being made to remedy the situation”, “ Not enough staff at times for day trips” and “depends on the day to day activities and appointments of all 16 residents.” A support worker on duty explained that there is an activity coordinator and there is an expectation that staff participate in in-house activities. It is the activities coordinator and keyworker that arranges day trips, swimming, clubs and theatre visits. Information about events is on display in the notice board, church services are arranged and take place three-four times per year. The manager said that the home has its own transport and individuals living at the home also have their own vehicles. Regarding the running cost of the home’s vehicle, the manager said that people outside the block contract, pay towards the running cost of the vehicle. It was also stated that public transport is not used, as the individuals would find it challenging because of their levels of physical impairments. In addition, individuals rarely use the local roads because they are in poor condition and individuals generally need two staff for support. Individuals are registered onto the electoral roll, which is their right as citizen. The arrangements for visitors are stated in the Statement of Purpose and Service User Guide. It states that visitors are welcome and requests that visitors record the nature of their visit and the person they are visiting. Four relatives that responded through the “Have your say” surveys stated that the home always helps the person living at the home to keep in touch, and one said this was sometimes. On person made the following direct comment “ The home always telephones me if my relative wants to pass a message to me.” People giving feedback said that they their relatives and friends visit and visits could be conducted in bedrooms for additional privacy. The manager was consulted about the way people at the home are respected as individuals. It was stated that independent living skills routines are dependent on the long-term future of the person. Through discussion, the manager has acknowledged that independent living skills must form part of the care planning process for the person. In terms of respecting individuals rights the manager said that there are corporate Privacy and Dignity policies and procedures and through training staff are made aware of the expectations. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 15 Individuals at the home agreed to give feedback about the way their rights are respected by the staff at the home. It was stated that staff knock and wait for an invitation to enter bedrooms, provide discreet personal care and are addressed in the preferred manner. One person said that staff sometime answer the knocks on the door instead of the individual. The property is wheelchair accessible, which ensures that the property does not restrict the individuals from moving around the home without staff support. The manager said that line managers use observations, induction and training to ensure that support workers engage with people at the home. Individuals consulted said that there are no rules at the home and the manager said that there are Terms and Conditions of residency. There is a housekeeper employed at the home and is responsible for catering and supervising maintenance, cleaning and laundry staff. It was stated that menu planning is discussed with people at the home during the admission process and, questionnaires are used to seek individuals eating habits, their likes and dislikes. However, the people accommodated have communication needs and information about likes and dislikes are based on relative’s knowledge of the person. Ten people have “PEG” feeds and six eat the meals served. Individuals are informed about the day’s menus and where necessary alternatives are provided. There is a wide range of fresh, frozen and tinned foods, which show that people at the home have a varied diet. A record of fridge, freezer and cooked meats is maintained. However a record of meals served at the home is not currently kept. A record of the meals served to individuals must be maintained. Two people consulted were able to give feedback about the meals and stated that the meals are generally good and confirmed that alternative are provided. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (18), (19) & (20) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. Individuals can expect sensitive and prompt support for their personal and health care needs from a skilled staff team. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager states that there GP’s from local practices visit the home and individuals are supported to access NHS facilities including the dentist, optician and chiropodist. There is input from health care professionals. Health and personal care form part of the Individual Service Planner (ISP) and from the ISP examined it is evident that a person centred approach to meeting needs is being used. For some individuals their personal care needs were specific about the way that needs are to be met. ISP must be more person centred about the way their personal care is to be provided which can be achieved by including the individuals ability to meet their assessed needs and the preferred routine. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 17 Four relatives stated through the surveys that they are always kept informed about important issues that affect their family member and one this is sometimes. One person said, “Communications with the carers is excellent, they always ring me if there are any medical or health issues”. A social and health care professional said through the survey that the home always meets the care needs of the people living at the home. A physiotherapist is employed at the home and the nurse in charge said that the mobility needs of the people accommodated have improved because of the input. Each person has a rehabilitative programme, which state the need, the treatment and the goals with recommendation for future treatment. Feedback from the physiotherapist was sought and stated that roles and responsibilities of the post includes maintenance of muscular strength, assessing needs, teaching staff and prevention. ISP’s state the needs identified in terms of mobility and through the action plans and risk assessments the level of risk is identified. Moving and handling risk assessments include the individual’s ability, medical history and constraints. An assessment is then devised on the need, the techniques, equipment and staffing needed to perform the manoeuvre. The home currently uses hoist, slings and wheelchairs to assist individuals to maintain their level of independence. A number of individuals have “PEG” feeds, which are done by the trained nurses and senior care staff that have received training to undertake” PEG” feeds. The trained nurses are responsible for monitoring the site of the “PEG” liaising with the nutrition nurses and senior care assistants follow instruction from the trained nurses. A pharmacist inspection took place on 19/09/07 to establish that suitable policies for safe handling of medication are in place and staff take action to address the medication errors seen. Medications are administered through a monitored dosage system. The records of administration were examined against the medications held and gaps were found in the records of administration. The nurse in charge stated that gaps in the recording are being addressed and systems for addressing discrepancies were introduced to reduce gaps in the recording. It was stated that with the new system staff must return to the home and sign records sheets also medication form part of supervision for staff. However, gaps in the administration records sheets remain outstanding. The manager must ensure that appropriate action is taken when performance issues are identified. Members of staff giving feedback said that trained nurses are responsible for administration, receipt, storage and disposal of medications. Trained nurses confirmed that refresher medication training is provided. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 18 The home has suitable arrangements for the disposal of medication. Assessments are conducted for people that self-administer their medications, potential risk are assessed to determine the suitability and where necessary develop action plan to support the person to administer their medications Cossham Gardens DS0000020230.V353207.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): (22) & (23) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People at the home can expect their concerns to be listened to and to be protected from abuse. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager states that the home adheres to Local Authority policies for complaints, Whistleblowing and Protection of Vulnerable Adults (POVA). The manager said that the complaints procedure is available in specific formats and in CD to ensure that individuals can understand it. It was further stated that copies of the Complaints procedure are re-issued regularly to people at the home. A record of complaints received at the home is maintained and since the last inspection three complaints were recorded. A neighbour made one complaint and two were made by relatives about the delivery of care. The manager has responded to the complainants in writing on the actions to be taken to resolve the complaint and to seek their level of satisfaction. This shows that the manager has acted appropriately to complaints received at the home. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 20 Three people said that they know who to speak to if they are unhappy and how to make a complaint. Four relatives stated that they know how to make a complaint and four said that the home has responded appropriately to their complaints. One person said that they did not know how to make complaints and that the home sometimes responded appropriately to their complaints. One person said, “If I or my family have any issues all carers are good at responding”. People consulted about the way the home resolves complaints named the person that they would approach with complaints. The comments made by the individuals giving feedback indicated their confidence with the actions to be taken to resolve complaints. Members of staff were consulted about the steps to be taken to resolve complaints made by people at the home. It was stated that for individuals with communications needs, eye contact and body language is used to determine if the person has complaints. The Whistleblowing and Protection of Vulnerable Adults (POVA) are in place. The manager said that member of staff must attend POVA training to ensure that staff know the factors of abuse and the actions to be taken to safeguard individuals from abuse. POVA training is provided in-house from a Leonard Cheshire Disability trainer with updates every 2-3 years. Members of staff giving feedback were asked to describe their responsibilities towards reporting poor practice. Members of staff confirmed that they attended POVA training and described the features of abuse and the actions to be taken. The manager said that staff attend Challenging Behaviour training to ensure staff have the skills to manage aggressive and violent behaviours exhibited by people at the home. Cossham Gardens DS0000020230.V353207.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): (24) & (30) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. The home is well maintained so that the people at the home can benefit from living in a comfortable and clean environment. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager states that the home is purpose built with appropriate specialist equipment. The house was purpose built for people with a physical disability and generally it is decorated to a good standard and the design of the property is fit for the people living at the home. The home is suitably equipped to meet the care needs of the people. Bedrooms are single and en-suite with a ceiling tracking system to assist individuals that have mobility needs. Bedrooms are personalised by their personal belongings and equipment. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 22 All bathrooms and WC’s are large and suitable for disabled use and have a range of specialist baths and showers. Two of the four separate communal areas are currently used as part dining rooms. As well as the four lounges there is one activity room, a Physiotherapy room and sensory/multimedia room. The home was clean, tidy and in good order. The kitchen was clean and in good order. The food hazard analysis has been updated. Detailed cleaning and temperature records are maintained. Four people that live at the home said that the home is always fresh and clean and one person said this was usual. Cossham Gardens DS0000020230.V353207.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): (34) & (35) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. Individuals are supported by a competent, qualified and skilled staff team who are well supervised. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager states that the organisation’s recruitment process is robust and individuals living at the home are involved in recruitment. It also states that 22 of the 28 staff have NVQ level 2. The personnel files of the four most recently appointed staff were examined and records show that potential employees must complete an application form, give a full employment history, provide the names of two referees and sign a declaration of criminal background. While it is evident that references from the last employer are sought, personnel references were accepted for a number of staff, instead of seeking other professional references. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 24 The manager said that sometimes staff have not been employed for significant periods and therefore personal references are better because these referees have had more recent contact. There are 12 volunteers currently working at the home and the volunteer team leader is employed to manage the volunteers. The team leader said that the role entails recruitment, training and supervision of the volunteers. It was further stated that the recruitment for volunteers is the same as for all employees of the Leonard Cheshire Disability. Statutory training is provided for volunteers to ensure that they are able to undertake the role they are to perform. One person stated through the survey that staff always treat them well and two said this is usual. One person made the following comments “ As a respite patient I feel when I arrive I am left to settle myself in, and rarely have a visit from the manager when I am here.” The manager said that a training and development officer is employed at the home and establishing the training needs of the home and sourcing training is part of the role. There is a planned training programme that includes Health & Safety, Tissue Viability, Manual Handling, Communication and Understanding Brain Injury for staff at the home. The manager said that for qualified nurses there are focus groups and “PREP” to maintain their qualification and all staff attend the courses specified within the programme. Members of staff giving feedback said that training is encouraged and accessible to all staff. Two people were consulted about the skills of the staff and one person confirmed that staff have the right skills to meet their needs and generally listen to the person. One person said that one or two staff can be “heavy handed” and the manager will be investigating this individuals comment. Three relatives said that staff have the right skills and experience to look after people properly and two said it was usual. “Carers are well-experienced and staff with specialist nursing skills are available where necessary.” Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (37), (39) & (42) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. Individuals 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 has listed through the Annual Quality Assurance Assessment (AQAA) the training completed (RMA, DMS and nursing qualification) to provide strong leadership. The Leonard Cheshire conducts a three yearly audit. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 26 The manager described the arrangements in place for the day-to-day operation of the home. It was stated that the post is supernumery and staff meeting, team leader meetings and supervision ensure that consistency is maintained. In terms of supervision, it forms part of line managers role and the general manager visits monthly to assess the conduct of the home. In addition, the manager said that there is a new planned extension for five additional placements. Members of staff giving feedback about the leadership style of the manager said there is an open and honest working relationship with the manager. Members of staff stated that the manager was approachable, issues raised are resolved and confirmed that systems in place ensure consistency at the home. One individual at the home said that the staff treat them well and two said this was usual. Individuals comments included “ As a general rule the staff are caring and attentive, however, I feel that I must “fit in” with the staff timetable and routine and do things at times that suit them than me.” In response to this statement the manager said, “ Every effort is made to provide the person with a framework so that rigid routines are expanded and the person is not limited by their own experiences.” The method used to monitor the quality of care at the home was discussed with the manager. The manager said that Leonard Cheshire Disability has achieved Investors in People Award through a framework for improving service delivery and the MS Society awarded the home for their respite provision. Regarding audits of the home systems, the manager said that the Individual Service Planners (ISP) are part of supervision, the Trust has assigned areas of responsibility to each home and this home was delegated medication. The Trust seeks feedback from people that use the service annually and the manager is taking steps to develop an action plan that draws on the all the audits conducted at the home. The action plans includes goals identified through audits conducted, progress made and the outcomes. The arrangements for the payment of fees are dealt with at the Trust office and the home receives notification of the fees paid by the Local Authority. Facilities for the safekeeping of cash exist at the home, each person is provided with a lockable safe to keep cash and valuables. For individuals that are supported with budgeting the keys are held in the office and staff record each transaction conducted, these records are checked weekly to ensure that records are up to date and accurate. Staffing levels were discussed with the member of staff that organises the rota. The ratio used for sixteen people is eight support workers and one RGN from 7:30-2:30pm, four support workers and one RGN from 2:30-9:30 and at night there is one RGN and two support workers. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 27 It was stated that a weekly meetings to discuss staffing levels takes place, which include discussions about additional support needed on appointments by individuals. It was further stated that vacant shifts are covered by existing staff, Trust bank staff or as a last resort agency staff. An accident book is maintained by the home and recorded are injuries sustained by staff, people living at the home and visitors to the home. The manager ensures that the environment is safe boilers and hoist/bath equipment are service annaully. Portable equimepemt is checked by an outside contractor and fire risk assessments are undertaken by outside contractors. Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 29 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 (a) Requirement Timescale for action 30/05/08 2. YA6 12 (3) 3. 4. YA17 YA20 17 (2) Sch.4.13 13 (2) The Statement of Purpose and Service User Guide must be reviewed to ensure people wishing to live at the home enough information to make decisions to live at the home. Action plans must include the 30/08/08 individuals likes, dislikes and preferred routines for the approach to be fully person centred A record of the food provided 30/03/08 must be maintained The manager must ensure that 30/03/08 there are safe systems of medication. Gaps in the recording of medications must be addressed RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cossham Gardens DS0000020230.V353207.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 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 Cossham Gardens DS0000020230.V353207.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. 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