Inspection on 27/03/08 for Coxwold and Priory

This inspection was carried out on 27th March 2008.

CSCI found this care home to be providing an Adequate 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coxwold and Priory 10/03/09

Coxwold and Priory 17/01/07

Coxwold and Priory 18/01/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Coxwold and Priory 9 Coxwold Grove Hull East Yorkshire HU4 6HH Lead Inspector Bev Hill Key Unannounced Inspection 27th March 2008 09:00 Coxwold and Priory DS0000064809.V357610.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 Coxwold and Priory DS0000064809.V357610.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. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coxwold and Priory Address 9 Coxwold Grove Hull East Yorkshire HU4 6HH 01482 508953 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) Avocet Trust Carl Ince Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Carl Ince is registered 17 Priory Grove, 33-35 Priory Grove and 9 and 9a Coxwold Grove and only undertakes managerial responsibilities for 186 Marlborough Avenue, Hull until 12th September 2005 and Flat 2 and Flat 3, 23 Trippett Street, Hull for up to 6 months from the date of registration. 17th January 2007 Date of last inspection Brief Description of the Service: Coxwold and Priory consists of 5 separate houses. They are all part of the Avocet Trust organisation. Avocet Trust is a registered charity. 9 and 9a Coxwold Grove are registered to provide care and accommodation for three adults with a learning disability in each house. The houses are in Gipsyville close to the Hessle Road shopping area, to the west of the city. There are shops, pubs, medical centre and post office all within walking distance. Public transport to various parts of the city is easily accessible. Both houses are three bedroom detached houses. Each house has a sitting room, kitchen/diner, a large rear garden and a driveway to the front with parking space. The integral garage had been converted into an extra downstairs room with the addition of en-suite facilities including a walk-in shower. In one house this room is utilised as a sensory room and in the other it is an activity room. Upstairs there are two bedrooms, one of which has ensuite facilities including a shower. There is also a separate bathroom and a third bedroom used as a storeroom and office for staff. 33 and 35 Priory Grove consists of two separate bungalows registered to support adults with a learning disability. One bungalow is small and supports one adult whilst the larger one is able to support four people. The homes are situated within a recently developed housing estate to the west of the city. There are a number of shops, a post office, park and medical centre within walking distance. Public transport to various parts of the city is easily accessible and in addition some of the service users have their own car arranged through their mobility benefits. The home for one has a lounge, kitchen/dining room, bedroom, bathroom, and utility room. The larger home has four single bedrooms, a sensory room, kitchen, lounge / dining room and utility room. Both have their own garden and separate private entrance. 17 Priory Grove is registered to provide care and accommodation for one adult with a learning disability. The house is in Gipsyville close to the Hessle Road shopping area to the west of the city. There are shops, pubs, medical centre and post office all within walking distance. Public transport to various parts of Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 5 the city is easily accessible. The home is a three bedroom semi-detached house. There is a large sitting room, kitchen/diner, a large rear garden with some landscaping and a driveway to the side with parking space. Upstairs there is a bedroom, bathroom and small sitting room for the service user, and a sleeping-in room for night staff. Weekly fees range from £976 to £1915 per person per week. Additional charges are made for the following: newspapers/magazines, hairdressing, chiropody, transport for social activities and sweets. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 *star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 17th January 2007, including information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke with one service user and several staff members to gain a picture of what life was like for people who live in the five houses. Most of the service users that live in the houses have complicated needs and are not able to tell us their views therefore in this report comments from relatives and staff have been used to help to form a view about whether service users needs are met or not. We received some surveys from relatives and staff. We also had discussions with the acting manager. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met whilst they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We observed the way staff spoke to service users and supported them, and checked out with them their understanding of how to maintain privacy, dignity and choice. We also checked that people were supported and protected in a safe and clean environment. What the service does well: Avocet Trust provides houses and personal care for adults with a learning disability and other needs. Their main aim is to help people to be as independent as possible, whilst helping them to be more confident and use community facilities. The houses are located in the local community and are on a bus route making all leisure facilities and shops easy to get to. All of the service users homes are nicely decorated and the staff members help people to keep them clean and tidy. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 7 All service users have a single bedroom, giving them a private area to their liking where they can spend private time or have visitors. Staff members support people to decorate their bedrooms and put up pictures and posters. Relatives are involved in the home and are made to feel welcome. This helps people keep in contact with their family and friends. The staff supported people to shop for their food and helped them to prepare their meals. The service users have a choice about what foods to cook and eat. People have a good social life are supported to carry on with the activities of their choice. They have a holiday every year. The staff team makes sure that people’s health needs are met and their medication is managed well for them. Staff members know the service users and their families well and have developed good relationships with them. New staff members have all the checks completed on them before they start. This helps to protect vulnerable service users. What has improved since the last inspection? What they could do better: The home only accepts people after their needs have been assessed properly but they don’t always obtain the assessment completed by the professionals. In two of the care files looked at the assessments were missing. Some peoples’ support plans didn’t contain all the information they should about their needs. This might mean that care is missed. The manager needs to Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 8 check the support plans put in place to help people. This should be done regularly so the manager is sure they continue to be correct. One person has to sit in a wheelchair and has a strap to secure them to stop them from falling out. They also had bed rails on their bed but they had not been assessed properly for them. The manager must make sure that when people are restricted like this they have proper assessments. The staff make sure that people have their health needs met but community nurses must be involved to help the staff complete full plans about peoples health needs and how to keep them healthy and fit. The staff have contacted the nurses but the plans have not been completed yet. The manager needs to follow this up and make sure the plans are completed quickly. Staff members have some basic training to guide them when administering medication. The manager needs to check whether this training is enough for their training needs. The home could make sure that important information is given to people in ways that they easily understand. For example the complaints procedure should be easier for people to read. They must also make sure that they keep any records about complaints and how they are investigated in the home. Each member of staff at the home must have a regular meeting with the manager to discuss the training they may need, support and other things. This has not been happening as often as it should. Staff must also tell professionals quickly if there are any serious incidents in the home between service users so support can be given quickly to them. The manager must look at staff training records and make sure people are up to date with important training. The acting manager needs to be registered with the Commission. This is where they are checked out to make sure they are the right person to manage the home. The acting manager needs to carry out checks in the home and ask people that live there questions about how they are helped by staff. They could also ask visitors to home their views about how the home is managed. When they get the replies they need to check them out and make plans to put things right if its needed. 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. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 9 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 Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 10 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users’ needs were assessed by professionals prior to admission which meant the home was able to determine whether they were able to meet needs, however documentation was not always available to support this. EVIDENCE: There had been no new admissions to the service since the last inspection. The acting manager confirmed that service users needs were assessed prior to admission to the home and assessments completed by care management were always obtained. However four care files were examined in detail and we were only able to see care management assessments in two of the files. This information was crucial in the decision making process as to whether the home was able to meet peoples’ needs and also used when formulating support plans. The acting manager was unable to account for the missing assessments. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 11 There was evidence that the home completed their own assessments, which covered preferences and likes and dislikes. Staff signed to state they were aware of assessments and care plans and that they had read them. For any new service users admitted to the homes the manager needs to routinely write to them or their representatives following the pre-admission assessment formally stating their ability to meet identified needs. Correspondence needs to be maintained on file. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 12 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 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by adequate numbers of staff, however the quality of the service users support plans and risk assessments continue to be inconsistent meaning that service users assessed needs may not be met. EVIDENCE: Four care files were examined, one from each house within the service, as part of the inspection process. All contained support plans that had been completed with the service user at the centre of planning. The care files had lots of information regarding the needs of the service users, including life histories, preference lists, risk assessments, moving and handling assessments, epilepsy management and treatment plans, reviews and various monitoring charts for behaviour, epilepsy, bowel care and nutritional intake. Some contained Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 13 guidance for staff on how to enable the person to maintain their independence to varying degrees. The individual care plans consisted of support plans and management plans. The management plans were added information for particular tasks and the manager confirmed these were usually put in place when some element of risk has been identified. The support plans were written in a person centred way but did not cover all assessed needs in all the files examined. For example one service users file was very comprehensive and their support plan covered all the needs identified at the assessment stage, however others had sections missing. One person had nutritional needs and was under the care of the dietician but a support plan to manage this had not been formulated. The area of mobility had not been updated to reflect significant changes in their needs. Another service user’s file had information regarding the support required, in the preferred way, in a section on their life history. The information referred the reader to the support plan but when cross-referenced, sections of the support plan could not be located. These included the areas of mobility, diet and nutrition, financial management, feminine hygiene, emotional support and the promotion of continence. Staff spoken with confirmed the plans had been in place but were unable to account for them not being in the files. Care plans had been evaluated on a monthly basis and a summary written that detailed how effective the support plans were. This had not been completed thoroughly in some cases, as the missing sections would have been noted and addressed. Staff members spoken with were aware of service users’ needs and confirmed they had time to read support plans and update themselves with new information. Daily recording evidenced the care provided to people. Behaviour Management plans were in place that gave staff clear instruction in how to deal with issues as they arose and there were risk assessments for a range of activities and situations. However there were some important issues that required risk assessments and planning for one person. These included the use of bed rails and a wheelchair lap strap as they restricted their movements. There was evidence that reviews of care plans were held with family members and professionals present. The care files were signed by staff to evidence they had read and understood them. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff supported people to attend places and events of their choice and to participate in daily living activities. The homes provided a range of nutritional meals which offered choices and alternatives to service users. EVIDENCE: None of the service users were engaged in work placements however all of the service users participated in a wide range of activities to continue their opportunities for personal development. Each service user had a weekly activity plan, which included staff support with activities of daily living around the home for some people. These included Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 15 helping in the kitchen, assisting with meal preparations, or observing staff as they completed this, and tidying their bedrooms. Some service users liked to shop for their food and one person told us they liked to make their own breakfast every day, assist staff to make the main meals and always made their own drinks throughout the day. One relative stated in a survey, ‘provides a stable and caring environment in which she flourishes’. Another relative stated, ‘they think outside the box regards activities, which is excellent as he is easily bored’. Service users enjoyed an active social life in the community, which included bowling, swimming, shopping, visits to the hairdresser, walks and out for meals at the pub, visiting friends, two of the service users support Hull City AFC and have a season pass. One service user attended college and was enrolled at Avocets own day service. Service users had a holiday last year to Euro Disney and visited other local attractions. One relative was concerned about the limited number of care staff able to drive, which affected the amount of external facilities the service users could access. This also meant that the service users were not getting full use of their cars accessed via their motorbility allowances. This was mentioned to the manager and she confirmed that it had been raised with them and they were looking at how to resolve the situation. Recent staff employed by the company was able to drive. Service users were supported to either visit their parents/relatives homes or were visited by them at their own home. Contact was welcomed and relatives confirmed in surveys that staff kept in touch with them about important matters, although one did mention that this was an area that could be improved. The manager and staff promoted a healthy eating menu but tried to balance this with service users likes/dislikes and special treats on occasions. Any restrictions were clearly documented in the care file and where possible agreed to by the service user. Some of the service users have been assessed by the dietician and the home followed the recommendations given. One staff member stated they thought there could be more variety regarding meals for service users. Coxwold and Priory DS0000064809.V357610.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 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of the service users are being met by a combination of health professionals and staff. However there is an ongoing issue for the completion of health action plans with professionals. This will ensure service users long-term health needs are identified and planned for. EVIDENCE: Support plans had been produced that covered health and personal care needs. They included preferences and likes and dislikes. One support plan identified the preferred gender of the carer, which was respected. Monitoring charts, for example behaviour monitoring, epileptic seizure activity, bowel function, nutritional intake and weight records were in place. There was evidence that people accessed a range of health professionals, for example hospital consultants, specialist nurses, speech and language therapists, Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 17 dieticians, occupational therapists, and they attended appointments with dentists, chiropodists, and opticians. The home had produced a document for each service user titled, ‘Healthy Me’. This detailed the health professionals involved in their care and the dates of appointments. The Community Team Learning Disability had been approached to assist in the preparation of Health Action plans. Each service user must have health screening undertaken and the development of a health action plan. This is to ensure that their health needs are identified, the provision of specialist support is planned for and provided, and that service users are helped to lead a healthy lifestyle. This was a requirement from the last inspection and is still outstanding. One relative was complimentary about health care and stated in a survey, ‘they are careful of his health, they involve us but don’t expect us to make any decisions’. One service user had recently been identified as requiring a specialist chair and the manager was investigating the cost implications for its provision. A meeting had been arranged with the local authority in order to discuss sharing the cost. There were no service users able to self-medicate. There were written policies and procedures in place for staff to adhere to regarding administration of medication. Records were examined as part of the visit and found to be in good order. Medication was stored and recorded appropriately. The homes had information leaflets maintained with the medication files to ensure staff were aware of what the medication was and what side effects to look out for. Staff members completed a one-day medication awareness course in addition to competency checks by the manager and they also completed training in how to administer epilepsy medication in an emergency. We were unsure as to whether the medication training was accredited and the manager needs to check this out. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home did not always have full details of complaints investigated by management, which meant they could not evidence that complainants were satisfied with the outcome. Management did not fully follow safeguarding policies and procedures regarding the notification and referral of incidents between service users. This meant that the incidents were not investigated quickly enough and support delayed. EVIDENCE: The homes had complaints procedures that were displayed. Staff members were aware of the procedure and the documentation used to record complaints. The procedure could be produced in a format more easily understood by service users and the complaints form used could contain an outcome section to evidence complainant satisfaction. On examination of the complaints file there had been one complaint. There was a letter of reply to the complainant but there did not appear to be any record of the investigation or whether the complainant was satisfied with the outcome. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 19 The home had policies and procedures to cover safeguarding adults from abuse, whistle blowing, aggression, physical intervention and restraint and management of service users money and financial affairs. The staff had received briefings in how to safeguard vulnerable adults from abuse and some had completed training in how to manage behaviours that could be challenging to others. The staff on duty displayed a good understanding of how to safeguard vulnerable adults from abuse and they were confident about reporting any concerns. Since the last inspection there had been two incidents between service users. Staff had reported these to the previous registered manager and a review had been organised with the local authority. However the manager had not notified the Commission or followed up the issues by completing safeguarding referral forms to the local authority until advised to do so by them. Since the last inspection the Commission had received three notifications about incidents in the home relating to staff conduct. One resulted in a police investigation, staff dismissal and their name forwarded to the protection of vulnerable adults register. Another resulted in staff disciplinary action as policies and procedures were not followed and another resulted in no further action as the situation was resolved. The commission was also contacted by the Avocet Trust to state they were looking into how service users money had been spent on some items in one of the home. The fact this was picked up by senior management suggested they proactively monitored how staff spent money on service users behalf. The checks are still ongoing. The acting manager is aware of their responsibilities regarding the referral and investigation procedures, however it is advised they complete safeguarding training with the local authority specifically for managers. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment provides service users with comfortable, homely, welldecorated and safe surroundings in which to live. EVIDENCE: 33 Priory Grove was not assessed, as service users from another house within the company were currently using the home. 9 and 9a Coxwold Avenue are two detached properties, each with three bedrooms, one en-suite and one, which is used as a staff office. Each house has a sitting room, kitchen/diner, a large rear garden and a driveway to the front with parking space. The integral garage had been converted into an extra downstairs room with the addition of en-suite facilities including a walk-in shower. In one house this room is utilised as a sensory room and in the other it is an activity room. There is also a separate bathroom in each house. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 21 35 Priory Grove is a large four bed-roomed bungalow with an assisted bathroom, complete with ceiling track hoist, a sensory room, a kitchen, a lounge/dining room and utility room. One service user did not have a bed and chair suitable to their changing needs, however the manager was aware of this and had taken some steps to address it. A mobile hoist had been obtained but it could not be used with the existing bed. During the writing of this report the manager confirmed an alternative specialised bed was obtained. 17 Priory Grove is a three bedroom semi-detached house with a sitting room, kitchen/diner, a large rear garden with some landscaping and a driveway to the side with parking space. Upstairs there is a bedroom, bathroom and small sitting room for the service user, and a sleep-in room for night staff. The houses assessed were clean, well decorated and furnished, and homely. All had secured gardens. Staff had helped people to personalise their bedrooms. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by sufficient numbers of staff that are aware of service users’ complex needs and are generally able to meet them. However gaps in induction, training and supervision means that staff will not be monitored robustly and service users needs may not be met. EVIDENCE: The manager reported that since the previous inspection there had been some staff changes, which had affected morale. Service users and relatives had not been consulted about some of the staff changes and this had led to some feelings of discontent. The situation now appears to have been resolved. The homes were now fully staffed and some service users had one to one funded support. On the day of the visit the staff team were observed to be caring, considerate and respectful. There was a relaxed atmosphere in all the houses and people Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 23 appeared to be well supported. One relative stated in a survey, ‘dedicated staff – excellent understanding of her needs and individual requirements’. Another stated, ‘they are sensitive to his needs and try to make him happy’. The induction of new staff consisted of an orientation to the home and some mandatory training, which is covered in the first few weeks. However we could not see evidence that induction covered the required common induction standards, which ensures competence is assessed prior to completion. One person had started an induction process on the 14th January but the last input was 1st February. Induction needs to be followed through and signed off by senior staff when the persons’ competence has been checked. Individual training records were examined and evidenced that some mandatory training had been undertaken or booked and updates recorded when required. The manager confirmed that training records were forwarded to HQ for continual planning. The records enabled training requirements to be tracked and mandatory updates recorded and addressed. There was evidence that some staff had completed specific training in how to manage epilepsy, behaviours that could be challenging, autism, depression in old age and person centred planning. All staff members have had briefings on how to safeguard Vulnerable adults from abuse. There were gaps in mandatory training, which need to be addressed. The manager needs to audit the staff files and develop a training plan based on information gained in supervision and staff appraisals. Staff members complete a medication day with Lloyds pharmacy. Staff confirmed they have to prepare in advance by checking what medication the service users take and discuss these with the pharmacist. They also have their practice observed by senior staff. It did not appear that staff completed accredited medication courses and this needs to be investigated. The numbers of staff that have completed national vocational qualifications (NVQ) has changed since the last inspection as a result of staff movements. The service has twenty-five staff in total, nine of which have completed NVQ level 2 or 3 and the manager has completed NVQ level 3 and 4. Two further staff members are progressing through the course at level 3 and one person is registered to start the course at level 2. This level of activity equates to 36 of staff trained to this level. The service needs to aim for 50 . The acting manager was currently arranging a programme of supervision and some staff had received some limited supervision sessions. However this had not been consistent and staff had not received the required minimum amount of six sessions per year. Some staff spoken with advised they had received a session but there was no paperwork to confirm this. None of the staff had received an annual appraisal that identified their training needs. Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 24 The company’s recruitment process was robust. Application forms were completed and references and police checks obtained. Potential applicants were selected via a solid interview process. There had been some new staff recruited to the homes since the last inspection and some staff members had transferred from other units in the company. The manager confirmed new staff would only start employment after the return of their criminal record bureau check. In exceptional circumstances they could start after the initial check of the protection of vulnerable adults register but the company’s Head of Service had to sanction this so stringent supervision arrangements could be in place. Staff confirmed this and stated, ‘we couldn’t start until all the checks were completed’. Coxwold and Priory DS0000064809.V357610.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 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The new acting manager provides leadership, guidance and direction to staff to ensure that service users receive care that is appropriate to their needs. A period of management stability is required to promote and safeguard the health, safety and welfare of the people using the service and to ensure the required improvements, identified in this report, are completed. EVIDENCE: The registered manager had recently resigned and the acting manager had been in place just a few days. In discussions with care staff and examination of documentation it was clear that the previous registered manager had not been Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 26 completing the management tasks required for the safe running of the home. Staff had not been receiving formal supervision, and incidents reported to the manager had not been followed through to the Commission or the local authority. The annual quality assurance assessment, required by the Commission had been completed and returned but was basic in detail and could be expanded to show the manager fully self-assesses the service the homes provide to people. Avocet have developed a quality assurance system for use within the home, however the quality assurance monitoring of audits and questionnaires to service users, relatives, staff and other stakeholders had not been completed. The management difficulties were echoed in a statement from a relative, who said, ‘clients don’t always come first in management decisions’ and ‘staff do not seem as happy as they should be’. However the company had taken action when difficulties became apparent to them and an acting manager had been newly appointed with a proven track record of management skills. For this reason the Commission believe improvements in the management of the homes is imminent. Already care staff spoken with described a more organised situation and felt confident the acting manager would resolve any issues they took to her. The registered manager advised us they were looking into the moving and handling needs of one particular service user. This was mentioned to us during the visit and when checked it was clear there had been some deterioration in the service users’ mobility and ability to transfer with assistance. An occupational therapist had advised the use of a hoist to move and handle the person safely. However the bed they occupied was not suitable for a hoist and had bedrails that could potentially cause an entrapment due to the size of the service users limbs. An immediate requirement notice was issued for the manager to address this safety issue. A new bed suitable for the service users needs was acquired by the home very quickly. The homes were safe for service users and staff. Daily safety checks were carried out and monthly audits covering a range of health and safety issues. Equipment was serviced and fire alarm checks took place. Coxwold and Priory DS0000064809.V357610.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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 2 2 X 2 X 2 X X 2 X Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement The registered person must ensure that the home consistently obtains assessments of service users needs completed by care management. For future new admissions the manager must write to service users or their representative following the assessment indicating the homes ability to meet the persons needs. Documentation to be maintained on the care file. The registered person must ensure that all service users have a detailed individual plan that covers all aspects of personal, social and health needs. Care plans must be evaluated thoroughly to check they are still meeting needs (previous timescale of 30/06/07 not met) Timescale for action 30/04/08 2 YA6 15 30/06/08 3 YA9 13 The registered person must 30/04/08 ensure that risk assessments are completed for the specific service user who had limitations placed on their movements by a lap strap and bed rails. DS0000064809.V357610.R01.S.doc Version 5.2 Page 29 Coxwold and Priory 4 YA19 13 (1a and b) 5 YA20 18 (1) The registered person must ensure that health action plans are prepared for service users in partnership with health professionals (previous timescale of 30/06/07 not met). The registered person must ensure that all staff responsible for administering medication have received accredited training and have their competency assessed (previous timescale of 31/03/07 not met). The registered person must ensure that full records are maintained of any future complaints investigated and evidence, where possible, that the complainant is satisfied with the outcome. The registered person must ensure that all staff are familiar with the safeguarding policies and procedures regarding alerting and referral and use them to alert the local authority to any reportable incidents that occur rather than just calling a review. This will enable a quicker response and prevent a delay in support. The registered person must ensure that a training plan is developed for the staff team in the home based on information from supervision and appraisals (previous timescale of 30/06/07 not met). Induction of new staff must be in line with skills for care common induction standards. 31/07/08 31/07/08 6 YA22 17 30/04/08 7 YA23 13(6) 30/04/08 8 YA35 18 (1) 30/06/08 9 YA35 18(1) The registered person must DS0000064809.V357610.R01.S.doc 31/07/08 Version 5.2 Page 30 Coxwold and Priory ensure that all staff are up to date with mandatory training (previous timescale of 31/03/07 not met). 10 YA36 18 (2) The registered person must ensure that all staff receive formal supervision at least 6 times per year (Timescale of 30/06/07 not met). All staff to have received at least one supervision session by timescale for action date. 11 YA37 8 The registered person must ensure that the manager completes registration with the Commission to enable stability to the home. The registered person must restart the quality monitoring of the services provided by the home and include consultation with the service users, their relatives, staff and professional visitors to the home. The registered person must ensure that a specific service user with bed rails in situ has a thorough risk assessment completed in line with health and safety guidelines. This will ensure the correct match between the service user, the bed used, the mattress and the bed rails. Immediate requirement notice issued with a fortyeight hour timescale. 30/06/08 30/06/08 12 YA39 24 31/07/08 13 YA42 13(4) 29/03/08 Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 31 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 YA23 Good Practice Recommendations The acting manager should consider completing the safeguarding training provided by the local authority for managers. The home should continue to work towards 50 of care staff trained to NVQ level 2 and 3. The acting manager should consider completing the registered managers award. 2 3 YA32 YA37 Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Coxwold and Priory DS0000064809.V357610.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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