Inspection on 02/06/08 for Dairy Close

This inspection was carried out on 2nd June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dairy Close 19/10/06

Dairy Close 09/02/06

Dairy Close 05/04/05

Dairy Close 29/11/04

Dairy Close 08/07/04

Dairy Close 15/03/04

Dairy Close 07/10/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Dairy Close 20 Dairy Close Leek Staffordshire ST13 6LT Lead Inspector Keith Jones Unannounced Inspection 2nd June 2008 09:00 Dairy Close DS0000041908.V355935.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 Dairy Close DS0000041908.V355935.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. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dairy Close Address 20 Dairy Close Leek Staffordshire ST13 6LT O1538 386762 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) Choices Housing Association Limited Mrs Donna Collyer Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2006 Brief Description of the Service: Dairy Close is situated in a residential area of Leek. It is registered with the Commission as a care home for four younger adults with a learning disability. The Beth Johnson Housing Association owns the property and is responsible for all building maintenance. Choices Housing Association is the care provider. At present there are four men permanently living at Dairy Close. The property is a bungalow situated in a cul-de-sac with good access to the front and rear of the building. It is of a domestic design presenting the same as the other properties around it, and therefore not standing out as a care setting. The home is within walking distance of the town centre and public transport is accessible, although in addition the home has access to a shared car for private transport. The gardens are spacious, secure and well maintained; there is a patio area with seating, tables, a barbeque and greenhouse. The inside of the property is very well maintained, homely and domestic in character. All four single bedrooms are large, airy, personalised and attractively decorated. Bathrooms and toilets are appropriately located throughout the home. The care charges are £988 per week, and service users pay for their own personal toiletries and magazines. The fee information included in this report applied at the time of inspection, the reader may wish to obtain more up to date information from the care service Dairy Close DS0000041908.V355935.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 3 stars. This means the people who use this service experience excellent quality outcomes. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. We considered that the information given to us confirmed that people were presented with the service they needed, and that the service was of a satisfactory standard to ensure peoples’ safety. We conducted this unannounced inspection with the care manager and deputy. We had the full cooperation and contribution of staff and service users present. There were no outstanding requirements or recommendations from the last inspection. A tour of the home allowed free access to all areas of the home and open discussion with service users and staff. All four men were at home at the inspection. Each was able to communicate to varying degrees, and was happy to chat, or have a presence throughout the inspection. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA) and three survey forms, returned by service users. We ‘case tracked’ all four people in order for us to look at all aspects of their care at Dairy Close over the past eighteen months. ‘Case tracking’ gives us the opportunity to follow the care of a service user from their first assessment to the care they receive. We also examined a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. A full verbal report was offered at the end of the inspection to the Care Manager and her deputy. We thanked all concerned for their contribution to a pleasing and constructive inspection. Potential service users and their representatives are able to gain information about the service from the Statement of Purpose and Service User Guide. Our inspection reports can be obtained directly from the Provider, or are available on our website at www.csci.org.uk What the service does well: Dairy Close offers a high standard of care and service, and was observed to be extremely well organised, with a committed Care Management and team. Emphasis goes into involving the service users and their families in the process Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 6 of care, ensuring a highly personal approach to meeting individual needs. This home provides the best service possible of an independent model of living. The people spoken with confirmed their pleasure in the daily routine, and their involvement. Comments received included: “They always try to accommodate the wishes of the residents and family”, “Staff treat me with respect”, “Always welcome, clean, well maintained, happy with care provided”. We acknowledged that assessment procedures and care planning is of an excellent standard, offering detailed information on each person’s progress in the meeting of objectives. The staff and people who use the service all contribute to the team approach to care. We confirmed the maintenance of satisfactory staffing levels, staff training and supervision, collectively established in safeguarding the interests of service users. Full attention is paid to the health needs of the four men. Each has a regular monthly review regarding their physical, social and mental health, and their well-being is assessed, with referrals to other health services when required. Overall the attitude in meeting caring and organisational demands is commendable, with a highly personable involvement and application, contributing to a first rate quality service. 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. Dairy Close DS0000041908.V355935.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 Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 The quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are thoroughly assessed before they are offered a place in the home. In this way they and their relatives can be confident that the home will be able to meet their needs. EVIDENCE: There have been no new admissions to the home since the last inspection, the last being in 2004. The revised Statement of Purpose and Service User Guide were discussed and found to provide an informative description of Dairy Close’s aims, and the way it operated, this includes information on fees payable. There was sufficient information for prospective service users and their family, to make an informed choice as to the suitability of the home in meeting their needs. We recognise that the service user guide is also available in audio and video (DVD) versions. A new development is an admission booklet, designed in such a way as to smooth the whole process that explains the procedure for a Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 9 possible move to Dairy Close, in a communication friendly design. We looked at an advanced version, and acknowledged a potentially valuable addition. Our examination of service user’s care records and plans clearly demonstrated the extensive efforts to see through the admission procedure and assessment, notwithstanding the difficult referral and admission process. Each record showed the attention to individuality and people’s unique needs, normally undertaken prior to them moving into the home, during a six weekly assessment period, to ensure all individualised needs can be met by the service. Comments received from service users and families included: “P. Was introduced to Diary Close via short visits, these were increased to overnight stays, due to low communication skills and capacity staff, observed x behaviours and relationships with men, to access suitability”. “S. came for visits at diary close prior to moving in”. “Initially came on visits during the day to know other residents and then stopped over”. Person Centred Planning (PCP), and Health Action Plans are developed for individual service users. The care manager assured that such an assessment would always take place in the future to enable the home to meet the person’s individual needs, and to ensure compatibility with the current service users. Dairy Close DS0000041908.V355935.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): 6,7,8,9 and 10 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are involved in decisions about their lives and play an active role in planning the care and support that they receive. EVIDENCE: We inspected the care records of all four-service users. Each of these care records detailed a 24 hour plan of care, identifying certain times in the day, expected activities and the degree of support that was needed by each individual. We found a clear account in relation to rising, retiring, mealtimes and the general procedure of their day, to promote independence, and positive behaviour. These plans were seen to be highly individualised, reviewed on a three-monthly basis, and risk assessed. Individual care plans clearly identified the key worker, designed to maximise attention to the specific areas relevant to the service user. They were detailed, Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 11 meaningful, well thought through, reviewed on a three-monthly basis or more often dependant on change. Each record identified any specialist input required by the service user. There were individualised procedures in place focusing on positive behaviour for people who had the potential to become aggressive. The Person Centred Plan (PCP) is provided in pictorial and simple printed English to aid understanding. We were able to see that there were easily recognised key values, which underpin PCP: Individuality, competence, rights, choices, friendships, continuity, presence of mind, and status recognition. A monthly key worker progress report of desired outcomes, constructed with the service user, provides a valuable insight into the well being of the people involved. We confirmed that the plans are reviewed on a six monthly basis, with relatives, and when relevant, other professionals are invited to the review. We observed during the visit the day-to-day activities of people, who were seen to be relaxed in dealing with routine household chores, or generally engaged in social discourse. Where they did not want to do something at a particular time there was no pressure to conform. All four men were in the home throughout our inspection. They contributed, and were encouraged to participate, in all elements of the day’s visit, and when asked were able to respond to a range of subjects raised. A communication plan was in place for each person, in which staff were guided by observation, into what to do in certain situations, reading signs and behavioural signals, a particular phrase, or what they thought from experience of reactions, and what it really meant. We noted a pictorial presentation, contributed to by the people using the service. An impressive piece of work, reviewed regularly according to circumstance. We followed through risk assessments for the ‘Management of Actual and Potential Aggression’ (MAPA), which had the signed agreement of a multi professional team, and service users where this was possible. Tangible evidence of practical value was seen following two recent episodes of aggressive outbursts, which had been contained successfully. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 The quality in this outcome area is good. This judgement is based on the examination of the Home’s policies, procedures, practices and discussions with the service users, staff and management. The wishes and choices of service users are at the heart of service provision, and the home is operated to achieve these goals. EVIDENCE: Throughout the inspection we saw that service users were enjoying a high degree of encouragement to express themselves in positive and meaningful ways. Bedrooms were seen to demonstrate that individuality to match personal outcomes. The overall emphasis on the importance of nurturing a solid foundation of trust and respect with the local and wider community is impressive and merits particular recognition. We were pleased to see that all of the men are Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 13 integrated into the local community by pursuing social activities linked to their particular interests, as documented in their individual care plans. There are records showing visits to the pub, cafes (especially St Johns), the library, bowling, and activities linked to various forms of transport. One man enjoys group walking as part of a rambling group. One man had, until recently attended a day centre on a regular basis, but due to cutbacks that option was now closed. However he had decided to continue with his college course for pottery, showing off his work with a sense of achievement. A variety of day trips based on their interests had been organised, with attention to Blackpool as a particular favourite. Staff attend on these breaks, and were seen to have been given the appropriate briefing. The manager ensures that the key workers monitor the activity programmes monthly to ensure that community presence and social inclusion is maintained. A fully flexible open visiting policy was stated as the policy although no visitors were present during the inspection, however the policy reflected the importance placed upon family or friends’ regular contact. People’s life-styles and interests are recorded in their care plans, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Relatives wrote in an internal satisfaction survey: “Can’t say any more, as I am so glad P was taken here from his previous placement, staff are very good”, “They always try to accommodate the wishes of the residents and family”. There was evidence to show that relatives are invited to regular review meetings. Personal choice and self-determination are respected in policy and action. We saw that the service users’ bedrooms were, with the men’s willingness and some pride in presenting their domain, well appointed personal areas. Those who wish to bring in personal possessions are encouraged to do so. Service users are involved in risk assessed, domestic type tasks in the home as part of social skill development, this includes ironing, cooking, cleaning bedrooms, washing, etc. Observed practice showed that interaction between staff and service users was friendly and appropriate. We saw that staff only enter their bedrooms with prior permission, and always knock before they enter. Choices were available for every aspect of daily living and menus provided a varied and good choice of food available on a flexible, person-orientated programme, with a variable option basis. The men go out on shopping trips to buy food with staff. The care staff involvement demonstrated their consciousness of the need for healthy eating, and a balanced diet. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 14 The dining area was homely and friendly, adjacent to the kitchen area, offering a pleasant, conducive ambience for a social meal. The kitchen was seen to be clean, organised and with satisfactory equipment. Safety figured highly in the layout and use of kitchens, and appropriate risk assessments had been taken. Two of the men assisted staff with lunch preparation, taken in the pleasant dining area and lounge, in a relaxed manner. None of the men has particular dietary needs, and no one needs assistance with eating at that time. The meal choices book, organised with the service users preferences was seen, and this showed that a varied and balanced diet is provided. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Principles of respect, dignity and privacy are at the forefront of the approach of the service when meeting the personal and healthcare needs of the service users. EVIDENCE: Staff had a very good understanding of the service users’ personal, emotional and physical support needs. Building on a comprehensive assessment, a 24 hour plan of care is organised to identify specific times relative to people’s routines, likes and needs. Each plan is individualised to match personality and personal expectations. We confirmed that this has established that the home operates a clear policy of a flexible routine, founded to meet and encourage self-determination, tailored to meet their needs, in a non-patronising manner, and delivered with an observed empathy of close bonding. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 16 so. All rooms examined showed a uniqueness and individual selection of décor and ornaments, trophies and mementos. The general atmosphere throughout the home was one of family, confidence, warmth and contentment. Staff were observed in addressing service users in a respectful and dignified way. Each person has a Health Action Plan that addresses all aspects of their individual health needs, including medical and family history, and treatment consent monitored on a monthly basis. It poses key questions of ‘what will you do, where, when and how many times? Will you need support?’ The administration of medicines adhere to procedures to maximise protection to service users. The manager and deputy manager are qualified nurses, but all staff are trained to administer medication. The receipt, administration and return of medicines were documented and accurate. Storage was secure in individual locked metal containers held in the manager’s office. It was noted that spillage from liquid medicines bottles had made the lockers sticky. A suitably qualified member of staff completed (Medication Administration Record) MAR sheets accurately, with accountability recorded throughout the process. No service users have been assessed as able to self-administer their medication, although all had an assessed capacity to be involved in the process, and be aware of the regime. When attending medication administering each man’s chart was read out starting with a common thread statement of: “ S. it’s (9am) lets do your medication”. Consent to medication was recorded in each individual’s care plans. We checked each service users MAR sheet on drugs prescribed. Each man had appropriate medication to match his clinical needs. There was no evidence of a regime to pacify or restrain. We saw an up to date authorised staff signature list, an appropriate homely remedies list, agreed by two General Practitioners (GPs), and stock control sheets and (as and when required) PRN protocols in place. There are no controlled drugs used in the home, although there is the potential. The manager was advised to obtain a suitable fixture and register for that potential. Specialist support and advice are sought as needed, with each service user being registered with a local GP, Dentist, Optician, Chiropodist, and Occupational Therapist and have access to appropriate physical and mental health services, as required, including a psychiatrist. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a meaningful complaints policy. People are given opportunities to freely express any concerns and these are quickly responded to. They are protected from abuse and their human rights are promoted. EVIDENCE: We examined sources of information including the Service Record, Survey returns, care records and the complaints policy. There were no recorded complaints or allegations made since the last inspection. There were few minor ‘niggles’ assessed, all dealt with at the source. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Comments received from both service users and family members included: “I have service user guide on DVD which helps me understand how to complain”. “S. has limited capacity but will approach staff with any problems. Staff have made an audio tape on how to complain and make it easier for S.” “I have an audio tape which I keep in a drawer in my room, my key worker made for me, explaining how to complain”. Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to service users needs, and readiness to test the robustness of their information and report structures. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 18 We acknowledge that staff receive training on abuse at induction, and there is also a planned programme of internal courses across the Choices organisation for more established staff. This includes the right to ‘whistle blowing’, consistent with the Public Disclosure Act 1998. We also noted that staff working receive extensive training on MAPA (Management of Actual and Potential Aggression), on recognising and handling untoward expressions of aggression. We inspected records of recent aggressive and violent incidents, which evidenced that there had been two recent incidents that required intervention, to manage the behaviour of one individual in particular. Appropriate non-violent crisis intervention was taken, and the situations effectively defused. There was no evidence that chemical or physical restraint had to be used. Peoples’ legal rights are protected by the systems in place in the home to safeguard them. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 19 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): 24,25,26,27,28,29 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Dairy Close provides a safe, well-maintained and comfortable home for the people who use the service, with a layout that encourages independence. EVIDENCE: The property is a four-bedroom bungalow on a small housing development of similar properties, in a quiet cul-de-sac, walking distance to the town of Leek, as are a range of community facilities. We observed attractive, well maintained gardens to the front and rear of the property. There is good quality garden furniture, and a secure shed holding Barbeque equipment and sundry items. Ramps are built in to access the house. The internal environment is purposefully homely, well maintained and in a good state of decoration. All of the bedrooms are individually decorated, i.e. favourite football teams, family memorabilia, and others with posters of Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 20 favourite pop bands or entertainer. Each bedroom was well maintained and personalised with Televisions, collections of videos and personal possessions that reflected the interests of the individual. All the men showed off ‘their space’, each stated how much they liked their bedrooms, and the privacy afforded to them. Each of the bedrooms is lockable, with each person having the opportunity to retain their own keys. All of the men have chosen to keep personal items and money in locked boxes within the manager’s office. On touring the building we acknowledged that bedrooms were highly personalised, with their own television, a range of CD’s, DVD and video players. All had been PAT (Personal Appliance Tested) tested although done on an annual basis. It was reinforced that any new personal equipment must be tested before use. All internal services were well maintained and functioning. Each of the men took some responsibility for domestic activities, including cleaning, laundry and assisted cooking. The heating arrangements throughout the home are by central heating through protected radiators, providing an ambient temperature. Lighting facilities, including individual bed lights and overall emergency lighting were installed and regularly checked. Water supplies met prevention of Legionella requirements, although the re-testing is advised. Water temperature were randomly tested, and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm, ventilation is by direct door and window airing. The home was clean, fresh, tidy, and comfortable. Discussion with staff evidenced that dirty linen, and the disposal of incontinence waste was being dealt with appropriately, with the washing machine having a sluicing facility. Disposable gloves and aprons were seen in use. Throughout the tour we noted that communal areas were of a high standard, offering social as well as private reflection, as the mood takes. The lounge is a very pleasant area of the home, with furniture and fittings of good quality. There is a pleasant dining room adjacent to the kitchen, clean and fresh smelling. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odour-free. One bathroom was seen to be well appointed to meet needs, with the appropriate fittings and aids. A new walk-in shower room has been commissioned to a high standard, proving to be popular with all service users. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 21 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): 31,32,33,34,35 and 36 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staffing levels ensure that adequate staff are provided to meet the needs of people who use the service. Recruitment processes are consistent and robust, protecting the people who use the service from harm and abuse. EVIDENCE: Staffing have maintained consistent levels to ensure equilibrium between numbers, skills and qualifications, with a strong presence of long serving, stable and experienced staff. Three weeks of off-duty were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of the service users are met. There are two Registered nurses leading a team of five carers, collectively working 238 hours a week. There are two, sometimes three, staff on duty during the morning, and two in the afternoon/evening, with one sleep in member of staff at night. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 22 All staff receives appropriate induction, which involves a LDAF (Learning Disability Award Framework) training over a period of six months, leading to a LDQ (Learning disability qualification). The service acknowledges that it needs to improve further in this area by ensuring that all staff are enabled to undertake the Learning Disability Qualification. The care manager emphasised the home’s commitment to training, and to achieving targets for NVQ level 2. There are four care staff with NVQ level II, representing 80 achievement, with one carer undertaking training at this time. We examined records that evidenced a comprehensive account of a meaningful and important schedule of training, to meet internal and external demand. Mandatory training is provided for all staff, involving: fire safety awareness, food hygiene, abuse and movement and handling. Consideration has been given into the implications of the Mental Capacity Act 2007, for all staff through a cascaded programme. The service told us in their Annual Quality Assurance Assessment (AQQA) that ‘Personnel records held for all staff including copy of application form, two references, copy of formal identification, CRB reference, POVA first check. And employee record form. Full recruitment programme in line with equal opportunities and employment legislation’. We found this information to be correct; we examined three staff files and found them to confirm consistently good standards in the process of appointing staff. It was evidenced that POVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks have been made. Choices management have a procedure for interview, selection and appointment of staff, that has proven effective. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of service users. These effective recruitment processes are good in that they help to protect people who use the service and keep them safe. We felt it was good practice in that the Annual Quality Assurance Assessment (AQAA) provided by the service told us that they have improved their recruitment processes during the last 12 months in that a second interview for staff takes place in which the people who use the service are involved which means that they do have some say in who is appointed to care and support them. The Head office holds the interview notes, letter of appointments and Contracts of employment. Staff were able to verify that they had received a contract, and a letter confirming their appointment. A suitable, and up to date staff photographs on file would be advised. All staff had been issued with the General Social Care Council Code of Conduct booklet. Before our inspection the service provided us with written information about the training staff receive which included; Mandatory training to all staff Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 23 including Emergency aid, food hygiene, fire safety, personal safety, lone working, origins of behaviour and behaviour management, moving and handling, safeguarding adults, medication. Staff we spoke to confirmed that this information was correct. Two on-duty members of staff were interviewed, each expressing their working conditions openly and with confidence. Each individual was complementary as to the level of training they receive, and the management arrangements. One stated clearly, and with purpose that she “Had enjoyed the acting-up experience over the last 6 months, has learnt a great deal, with good support from the Provider organisation”. Supervision (termed as appraisal) was seen to complement an effective induction and training programme. A three monthly system was evidenced, and staff indicated its value and constructive help. The Commission discussed diversity and equality issues regarding staff, and confidence expressed, as to the issue being recognised and accommodated. Most members of the staff had dealt with issues of sexuality and awareness for service users through in-house training attendance. There were no issues outstanding at the time of inspection. Service users spoken with were very complimentary about their relationship with all staff. In house survey returns regarding the staffing situation were positive: “The service is excellent” “I like caring attitude towards the residents” Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42 and 43 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered manager has appropriate qualifications and experience, and is highly competent to run Dairy Close. The care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests. The ethos of the home is based on openness and respect. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) provided by the service told us: ‘Registered manager qualifications; RMLD, MAPA trainer. Seen fit for position by CSCI, in position since 2004, prior 2003-2004 as Deputy manager. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 25 Deputy Manager RMN, in position from 2005, Qualified Nurse Acting deputy RNLD. All mandatory training completed. Effective relationships maintained with service users, families, and staff. Effective communications’. We found that that this information was correct as the Care Manager has demonstrated evident competence over the past five years in running Dairy Close, in establishing a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. She is a qualified nurse and she has also completed the Registered Managers Award. An experienced Nurse with a professional portfolio of practical and managerial experience, ably supported by a well-qualified deputy who is also a Registered Nurse, and a solid foundation of able carers, whom collectively represent an effective care management team. We were impressed by the openness, professional, and pleasing confidence in the observed interactions of staff and service users. The relationships were seen to be of mutual trust and respect. Appropriate risk assessments are in place for service users, through care planning and recording, staff selection and for the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the Home, although the use of institutional instructions would be more appropriately situated in more discrete places. The Registered Providers, Choices Housing Association, present a high profile in direction and managerial involvement in the smooth running of the Home, delegating a wide range of management responsibility to good effect. The Provider with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. This includes a care plan review process that is recorded once a month, regular reviews of communication, PCPs, and progress of outcome. We evidenced a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. The home has an open door policy and a commitment to equal opportunities. We examined administrative, monitoring, planning and care records, which showed an organised and professional attitude to effective record keeping. The Care Manager offered evidence of procedures in place including: - First Aid, Abuse awareness (Safeguarding), including Whistle blowing, and a Code of Conduct. Surveys received identified: “Always welcome, clean, well maintained, happy with care provided”. “Can’t say any more, as I am so glad P was taken here from his previous placement, staff are very good”. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 26 We identified during the inspection, individual financial records that was a straightforward, simple system, in place to protect people from any financial abuse. Records were clear and receipts were kept. The Company Accountant is recommended to audit the books every year. We discussed relevant legislation with the care manager, i.e. changes from Commission for Social Care Inspection, AQAA submission, updates on Health and Safety issues, Mental Capacity Act 2007, diversity, etc. The health and safety of residents and staff are promoted with safe storage of hazardous substances and annual electrical PAT (Personal Appliances Testing). It was advised to increase safety and prevent risk to people who use the service that PAT should be done on acquisition of new equipment. Servicing of electrical and gas appliances and regulation of the water system were examined. It was advised that an up to date water inspection is appropriate, whilst other records inspected were found to be satisfactory. We examined the accident procedure and records, and found them to be in order for staff, and residents, and with appropriate reporting arrangements to Riddor. Cross-referencing with care records identified the need to ensure that a ‘cause and effect’ situation to care plans was undertaken following the reporting of incidents and accidents. Before we visited the service we checked our information systems (service history) and found that the service had not had to inform us of any accidents or untoward incidents from October 2006 to present. This evidence shows that accident and incident prevention systems in place are effective and prevent risk to people who use and work in the service. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. Dairy Close DS0000041908.V355935.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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 4 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 4 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 3 4 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 4 4 3 3 4 3 Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Good Practice Recommendations Standard YA20YA20.6 That drug storage cabinets be kept clear of spillages, and that bottles of syrups be cleaned after administering the medicine to prevent any medication error and risk to people who use the service. YA20YA20.7 Secure a suitable metal; wall (rag) bolted container, for Controlled Drugs, and provide a suitable Controlled Drugs administration register to increase safety and prevent any risk. That Control of Substances Hazardous to Health (COSHH) YA42YA42.3 laminates is displayed in all areas involving the use of (i) hazardous chemicals, to complement existing procedure sheets and help prevent risk to people who use the service. YA42YA42.3 That Personal Appliances Testing is completed at the (iii) appropriate time for all new electrical appliances, before use by service users to make sure that they are protected from risk or accident. YA42.3 (iv) That an up to date testing of the water supply to check for DS0000041908.V355935.R01.S.doc Version 5.2 Page 29 2 3 4 5 Dairy Close 6 Legionella be conducted to increase safety and protect the people who use the service. YA43YA43.3 That the Provider conducts an annual audit of the financial arrangements on site to increase the safety of peoples’ money. Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Dairy Close DS0000041908.V355935.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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