Inspection on 16/07/08 for Derriads

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Poor 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Derriads 21/01/09

Derriads 01/05/07

Derriads 27/06/06

Derriads 06/12/05

Derriads 16/06/05

Derriads 27/01/05

Derriads 15/09/04

Derriads 24/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Derriads Respite Care Home 70 Derriads Lane Chippenham Wiltshire SN14 0QL Lead Inspector Alyson Fairweather Unannounced Inspection 16th July 2008 09:30 Derriads DS0000032436.V361821.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 Derriads DS0000032436.V361821.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. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Derriads Address Respite Care Home 70 Derriads Lane Chippenham Wiltshire SN14 0QL 01249 652814 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) Wiltshire County Council Mr Mark Ashley Pearson Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only: Care home providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 4. Date of last inspection 1st May 2007 Brief Description of the Service: Derriads is an extended bungalow situated in a quiet residential area on the outskirts of Chippenham. The home provides respite care for up to four service users at a time, who have severe physical and learning disabilities. The home is owned and managed by Wiltshire County Council. The manager and staff team also run Meadow Lodge, which is part of the Chippenham Respite Service. There is 24-hour staff cover to provide support for service users. Derriads is an attractive home, with a large lounge and comfortable furnishings. There is a separate dining room, a kitchen and two bathrooms. There are four single bedrooms, all with wash hand basins and ceiling tracks for hoists. To the rear of the house is a large, secluded garden which is accessible to the service users, with aromatic plants and attractive features. Recently, one bathroom has been out of action, and plans are in hand to upgrade it. Fees for respite care range from £102.90 per week if aged 60 or over, £65.20 per week for people aged 25-59 and £52.65 per week for those aged under the age of 25. Derriads DS0000032436.V361821.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 0 star. This means the people who use this service experience poor quality outcomes. We recently asked the home’s manager to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing and it gave us information about their future plans. We also sent out surveys to the service users, to staff and to health care professionals, so that we could get their views about the home. Four service users replied, with help from their families, and one family member wrote to us. We reviewed the information that we had received about the home since the last inspection in May 2007. We made an unannounced visit in July 2008 and met some of the service users who have short breaks at Derriads, and met some of the staff and the manager. Because of the level of disability of the service users who were staying at Derriads, it was difficult to assess their wishes and feelings, but we observed that they seemed happy and relaxed. We also saw staff spending time with them and getting them settled in from their daytime activities. We looked around the home and saw a number of records, including care plans, risk assessments, health and safety procedures, staff files and medication records. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: There are good assessment processes in place to help decide if the needs of a prospective service user can be met. Referrals come from a Care Manager who will provide the service with a recently completed Community Care Assessment and any other relevant information. Following this, a visit will be arranged for the person, along with their Care Manager and/or any other appropriate carer, family member, friend or advocate. After that other visits are arranged so that the person can meet with other service users and staff. The next stage would be for the new service user to have an overnight stay. A Service User Guide is given to every potential service user, and is available in pictorial format. The family who responded to the questionnaire felt that they had had enough information about Derriads prior to admission Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. All service users have their individual needs assessed before they arrive, so that staff know how best to support them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home now has a comprehensive Statement of Purpose and Service User Guide which give an overview of the service which will be provided. This is given to every potential service user, and also gives details of the organisation’s complaints procedure. The booklets are available in pictorial format. The Statement of Purpose should be amended to include details of what happens when a service user becomes ill, and should be amended to include reference to the newly appointed Responsible Individual nominated by Wiltshire County Council. Referrals come from the prospective service users’ Care Manager who will provide the service with a recently completed Community Care Assessment and any other relevant information, in order to initially identify whether the service is appropriate for and able to meet the needs of the individual. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 10 Following this, if it initially appears that they are able to offer a service, a visit will be arranged for the person, along with their Care Manager and/or any other appropriate carer, family member, friend or advocate. If successful, another visit will be arranged in order that the individual can join existing service users for a meal and to spend time socialising and interacting with current service users and members of the staff team. The next stage would be for the new service user to have an overnight stay then gradually build up to longer periods of respite. This process is very flexible and can be tailored to meet the needs of the individual. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Care plans do not always reflect the needs and personal goals of service users. People are supported to make decisions about their own lives, although having service user’ meetings with independent advocacy would help to encourage this. They are supported to take risks where appropriate, and encouraged to be as independent as possible. Continued failure to review risk assessments means that people are at risk of accidents. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Service users’ support plans which include details of any personal care needs, medical and physical health, mental health needs, mobility and communication skills. The support plans also highlight people’s likes and dislikes, and what activities they like to take part in. Staff record residents’ activities well as their general wellbeing on a daily basis. Manual handling assessments were in place for those service users who need them, and behavioural guidelines were also in place. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 12 Staff reported that support plans are reviewed at the annual home visit, or after the six-monthly phone call to the service user’s family, although can be done more frequently if needed. There was no obvious way of telling where the review of care plans was done, although staff said that this was done on the front sheet of the home visit, and there were some which had no date of review against them at all. The manager has been asked to make sure that all care plans have clear evidence that support plans have been reviewed. There were numerous pieces of information gathered in people’s support plans, although some of the pages were completely blank, and others said “Not relevant”. Some of the information headings bore no relation to people’s lives; for example people were asked how they managed their garden and their home. As most of the service users who have a short break at Derriads have multiple disabilities, and live with their family, this is not always relevant information. It is recommended that support plans should be more tailored to the individual service user, and be more person centred. One person had no recent community care review on file, and staff and the manager were unaware if there had been one. It is recommended that service users should have up to date community care reviews, and that the home should have a copy of these reviews. This will make sure that staff are aware of any changes in the people’s needs and how to care for them. Service users are supported to make decisions about their own lives with guidance from the staff. Service users’ families usually help them to manage their money. Money brought in differs with each service user, depending on what day services or activities they wish to pursue. Receipts are kept when any purchase is made with or for a service user. Risk assessments had been done for each service user and these included things such as mobility, bathing and travelling, and ways of minimising risks were identified. Staff place great emphasis on encouraging service users to be as independent as possible, while trying to minimise any risk to their safety. However, one service user had a risk assessment for use of the house vehicle which had been written in June 2007 and was due to be reviewed in June 2008. This had not been done. There were other risk assessments which had not been reviewed on their due date, including one for somebody moving in and out of their chair, bed and bath. As the bath in Derriads was out of use, this person had been taken to another service to have a bath, making it even more important to have an up to date risk assessment in place. The risk to the service user had not been re-assessed to take account of the different surroundings and bathing facilities. This means the service user was potentially at risk of falls. The manager was told at the last inspection that he must ensure that risk assessments were reviewed on a regular basis and updated as necessary. He has failed to do this. This is viewed as a serious matter by the Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 13 Commission for Social Care Inspection (CSCI), and further action may be taken. The requirement is now made for the second time. The home is still using different formats for service user risk assessments, including the generic ones meant for the premises. Some of them also contain the name of another service which people used to attend. It was recommended at the last inspection that all risk assessments should consistently use the same format and should clearly state that the risk is applicable to Derriads, not any other service. Derriads DS0000032436.V361821.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 Social and leisure activities are varied and tailored to individual need, and use facilities offered by the local community. Service users can have as much or as little contact with family and friends as they wish, and are supported to do so by staff. They are offered a healthy diet, with their preferences taken into account. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: As Derriads caters for respite service users, many people already have outside activities which they enjoy, and they are supported to continue with these. All four service users who were staying that day had been out at their different day services and came home in the late afternoon. Activities are usually recorded in a person’s care plan. One service user likes to have a pub-lunch in Lacock and to go out for a drive to Melksham. Another person likes visiting garden centres and water features. Music is popular with many of the service Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 15 users and some attend the local Gateway disco. Some people also attend the local Phab club, as well as visit the local pubs, cafes and shops. Some of the activities people like to do indoors are puzzles, board games, watching DVDs and TV and listening to music. One person said that the “sometimes” could choose what to do during the day, but said they weren’t able to do this at the weekend. The reason given for this was “There are not enough staff”. Friendships both inside and outside the home are encouraged, and staff support links between service users and their family and friends, although the frequency of contact varies depending on the individual circumstances. Because Derriads offers respite care to families, some do not choose to visit at that time. Service users are free to visit friends outside the house at any time, and can entertain and choose to see who they like either in the privacy of their own bedrooms or in the communal areas available. Service users can choose when to be alone or in company, and when not to join in an activity. Daily routines are flexible, with people choosing what they want to do when they return from day services. Some people like to go to bed early. The menu supplied in the home is varied and nutritious, and is centred round the likes of the people staying in the home on a daily basis. Breakfast usually consists of cereal and toast, and lunch can be a cooked meal for those who are at home, or a packed lunch for those who go out during the day. The main meal of the day is at supper-time, and is usually cooked by staff, as the level of need of the service users means that cooking can be difficult for them. There was a good supply of fresh fruit and vegetables in the home, and juices and yoghurts are also available. Staff have records of the food likes and dislikes of all service users, and of any feeding support necessary. One service user was seen to need a diabetic diet, and staff were clearly aware of how to manage this. The supper on one day during the inspection was chicken chasseur, cauliflower and potatoes. Some staff members did not have any training in food hygiene, although they are responsible for preparing the service users evening meal and packed lunches for some people. The manager has been asked to make sure that all staff receive this training. Derriads DS0000032436.V361821.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 Personal care needs of service users are written in care plans so that they can receive support in the way they need and prefer, although insufficient bathing facilities have been an on-going issue. Service users’ physical needs are compromised, and they are at risk of harm because staff do not always have appropriate information. The lack of training for some staff means that people are at risk of not being able to have their prescribed medication. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: All service users have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment and the home’s own assessment and staff knowledge of the service users. People have guidelines in place which say how they like to be helped to get washed and dressed, assisted with food and helped to and from bed. At the moment, service users are not able to be helped in the bath, as it has been deemed a health and safety risk. The bathroom is due to be refurbished in September. Since the last inspection, there have been concerns Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 17 raised by two sources about the lack of hygiene and the personal care offered to service users at Derriads. If the families live locally, the person’s own general practitioner (GP) is used, and the home’s local GPs are used for those who live further afield. Medical professionals are seen as and when required. This varies according to the needs of individuals and the situations arising while having respite care. One service user is supported to access chiropody and dental appointments by staff and the community nurse when on respite at Derriads. The home has good links with the local learning disability teams, which enables them to get help in any crisis periods which may arise. Derriads has various adaptations and pieces of equipment in place to help with service users’ physical needs, including hoists and ramps. One service user had an epilepsy profile, but this referenced another service not Derriads. Another person with epilepsy had no epilepsy profile. This meant that there was no record of how this person was to be managed if they had a seizure. The manager and staff have been asking for this for some time, but had been unsuccessful in getting one. The manager was told at the last inspection that he must ensure that another service user had an up to date epilepsy profile. In this case, although he had been trying to obtain one, it was not in place. This is viewed as a serious matter by the Commission for Social Care Inspection (CSCI), and further action may be taken. The requirement is now made for the second time. Staff were not clear about when service users should go home when they are ill, or whether to keep them in the home. This has obvious staffing implications, where a service user who is ill may need one-to-one care. Staff were also concerned about infections transferring between service users, and also between service users and staff if they have to stay in a confined room with a service user. The manager has been asked to make sure that clear directions about this are available for staff and families. The storage and recording of medicines in Derriads is good. Medication is kept in a designated room and is kept in a locked cupboard in this room. Medication support is recorded on a Medication Administration Record (MAR) and when checked this was seen to be accurate. Records of medicines received, administered and disposed of, including those sent out with service users to day centres were examined, and seen to be in order. The home has a policy in place for all medication, although unfortunately, the document seen said it was for another service. However, since the last inspection we have been notified about three medication errors made by staff. These included failure to give service users prescribed doses of medication. One person who was staying at Derriads had a care plan which said he had epilepsy and may need to have Diazepam administered. This is a medication to Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 18 assist service users who may need emergency treatment in the event of a seizure. Neither of the staff on duty together in the morning had received training in how to administer this medication. They both described how they would deal with the situation, and appropriately said that they would call an ambulance. This meant that a service user having a seizure could potentially have to wait some time before medication could be given, and this could ultimately be very serious. This situation was considered so serious that a letter was sent to Wiltshire County Council and the manager to tell them that they must deal with it as soon as possible, and to ask them how they planned to do this. They told us that they were booking training in the administration of medication for seizures for staff, and that an Epilepsy Awareness session would be given to staff by a community nurse from the learning disabilities team. They said staff who have not yet had the training would not be supporting service users who are prescribed this medication. Some other staff had no evidence of any recent medication training. This issue had also been picked up during the home’s audit. The manager has been asked to make sure that all staff have this training so that service users will be supported by staff who have been trained in all aspects of their job. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 It was impossible to see if complaints by service users or their families had been dealt with appropriately as no records had been kept. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm, although training for all staff in safeguarding adults would enable them to be more aware of abuse issues. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a complaints procedure which outlines the steps to take if there are any complaints, and all service users get a copy of this. It also gives details of how service users and families can contact CSCI. The family member who wrote to us said that they knew how to make a complaint if they needed to. There had been no recent service user meetings, so there was no opportunity to see if people’s concerns or complaints had been addressed. When they returned our AQAA, the home told us that they had received four complaints, none of which had been substantiated, and two of which were awaiting an outcome. None of the details of any complaint were on file in the complaints folder. The manager has been asked to ensure that he keeps a log of all complaints made to the service. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. All staff members are encouraged to report any incidences of poor practice, and a Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 20 “Whistle Blowing” procedure is available. There are guidelines in place for the management of challenging behaviour. Some staff have not had safeguarding training, and the manager has been asked to make sure that all staff receive this training. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Service users live in a homely, comfortable and safe environment which is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Derriads is an attractive bungalow, with level access throughout the home, and a ramp up to the front door. Care staff look after the general household cleaning and chores. The lounge is a large, comfortable room, and has some sensory equipment in one corner. It is fitted with an overhead hoisting system and has a TV, DVD, video player and stereo system for communal use. The kitchen is bright, and cheerful, with a stable type door to the kitchen, so that service users can be safe whilst staff are occupied cooking. The bedrooms are fully furnished with TV and CD players and each bedroom has a washbasin. There is a very attractive garden, suitable for wheelchair access, with a seating area under shade and a swing for people to use. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 22 There are plans to extend the bathroom, and these plans mean that the service users’ dining room would be used as an office. The plans were that a dining area would be set up in the sitting room. As this room also houses sensory equipment, there would be very little space available. It would also mean that hot food would need to be carried down the hallway, which could be a health and safety hazard. During our visit all four people staying were walking up and down the corridor. We emphasised to the manager the importance of having enough communal space for people to use, as several of the people who have respite care at Derriads use wheelchairs, and need space to move around. Some people are also a bit unsteady on their feet. Some of the bedrooms at Derriads are rather small, and would not be always the best place to spend a lot of time. In addition, some service users get anxious or agitated and need a space where they can be alone with a staff member and relax. The current dining room is used as an extra space where people can sit and perhaps read or play a game whilst they do this. It is recommended that the registered providers should make sure that there is enough communal space for service users to be comfortable and safe. One staff member has responsibility for the infection control measures in the home, and ensures that the rest of the staff team are aware of any new policies which are introduced. However, some staff had not had infection control training, and the manager has been asked to ensure that this is done. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Service users are supported by competent and qualified staff, although some training is needed. There was no evidence of training for agency staff. They are protected by the home’s recruitment policies, although there was some confusion about storage of information, and some files did not contain appropriate information. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: We observed several staff interactions with service users. All staff were seen to be patient and good humoured, taking time to talk with residents and encourage them to express their thoughts and opinions. When asked what the home did well, the family member who wrote to us said: “It makes a friendly place to stay for respite”. There are usually three staff on-duty in the mornings and evenings and two staff overnight. Waking night staff are available according to the assessed needs of individuals. One service user who wrote to us said that they were not able to do the things they would like to do at weekends because there were not enough staff. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 24 The manager reported a high use of agency staff, and care staff we spoke to said that some agency staff had told them that they had not been trained in the work they were supposed to do. This in particular related to medication administration and manual handling training. Wiltshire County Council uses a “preferred agency” system, where carers from certain agencies are employed to work across their homes. There may be an agreement whereby only staff who have had their CRB checks and appropriate training are used, but this does not always seem to be the case. Staff in the home were unaware of any agreement. The manager has been asked to ensure that there is written evidence in the home that all agency staff have had their CRB checks and relevant training. This can be done by Wiltshire County Council or in writing from the agency. If Derriads staff find that this is not the case, they must report the matter to their manager. All new staff receive induction training, and have also started using the Learning Disability Qualification (LDQ) to assist their training, which means that the needs of service users with learning disabilities will be more fully understood. There are currently nine staff members who have completed their NVQ Level 3 and one who has completed their NVQ Level 2. Others are working towards their qualification. Staff training during the last year has included manual handling, first aid, medication, fire instruction, food hygiene and health and safety. However this was not the case for all staff. Some people had not had training in manual handling, or medication administration, or safeguarding adults or food hygiene. None of the files we looked at showed any evidence of infection control training. The manager has been asked to make sure that all staff have training in the above areas. Staff recruitment is assisted by Wiltshire County Council’s human resources department. All staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Two written references and a medical declaration are also required. There was a confused mixture of information on staff files. Wiltshire County Council has an agreement that some personnnel information can be kept at County Hall, eg CRB checks, references and medical declaration. We have agreed that we would inspect these at County Hall. However, some staff files we looked at had a CRB certificate and references, one had a copy of a driving licence and a birth certificate. One file had the person’s name missing, as well as their next of kin details, and some files had no photographic ID. The manager said he was unsure what was to be kept at County Hall, so had decided to just “keep copies of everything”. This lack of clarity was concerning in light of the recent discussions with Wiltshire County Council regarding storage of information. The registered person has been asked to write to CSCI with full details of the personnel information which is stored by them at County Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 25 Hall. The manager must make sure that all staff files contain the appropriate information, including photographic ID. The home’s manager should be issued with a list of personnel information which he is to keep in the home. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 26 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 Residents do not always benefit from a well run home. The manager of the home failed to demonstrate his knowledge of what he needs to do to in order to make sure people are safe. Service users cannot be sure that their views underpin the monitoring and review of care practice. Lack of manual handling training for some staff means that service users are potentially at risk, although there are good health and safety checks carried out. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home’s manager, Mr Mark Pearson has been managing Derriads for two years, and has been registered with CSCI since the last inspection. He previously worked with children & young adults with autism, Aspergers Syndrome & challenging behaviours. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 27 During our conversation with Mr Pearson, we discussed the contents of one of the staff files we had looked at. This file contained details of the person’s driving licence and birth certificate. Neither of these is required to be kept on file, although previous legislation said it did. The manager said he was not aware that the Care Homes Regulations 2001 had been amended. When asked what version of this document was kept in the home, he was unclear about the difference between the National Minimum Standards (NMS) and the Regulations, and showed a downloaded copy of the NMS with the Regulations attached. This contained a previous unamended version of the Care Homes Regulations 2001. It was of concern to note that he had not kept abreast of the changes to the Regulations affecting his particular service. It is recommended that the most recent copy of these amended Regulations is kept in the service. As a result of this inspection it has also been noted that Mr Pearson has had two requirements repeated. He has failed to ensure that risk assessments had been reviewed and updated regularly and has failed to ensure that all service users have a current epilepsy profile in place. He failed to ensure that a record was kept of all the complaints made to the home. He has allowed untrained staff to support service users, leaving them potentially at risk, so that we had to write an urgent letter outlining our concerns to him and his employers. He has not ensured that staff or service user meetings have been held regularly. Wiltshire County Council conducts regular internal audits, and a senior manager visits the home every month to meet with service users and check on various records. Reports of these visits must now be sent to CSCI. The most recent internal audit highlighted some of the areas which needed attention, as identified in this report. There were some good health & safety records in place. The fridge and freezer temperatures are recorded daily and there are various weekly, monthly and annual checks done to make sure the home is safe. The home’s hoists, tracking systems and other equipment are serviced on a regular contractual basis. The home’s fire risk assessment was up to date, and most staff had done fire training, although some have still to be done. Fire drills had been carried out. Some staff had done no manual handling training, although some service users need support with hoists. This included long standing staff as well as newer ones. This means that service users are potentially at risk of falls. The manager has been asked to ensure that all staff have manual handling training. Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 x 1 X 2 X X 2 X Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 29 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 2 Standard YA6 YA9 Regulation 15 (2) (b) 13 (4) (c) Requirement All care plans should have clear evidence of reviews and what changes have been made, if any. All risk assessments must be reviewed and updated as necessary. This is the second time this requirement has been made. All staff must have evidence of training in food hygiene. Timescale for action 16/09/08 16/09/08 3 4 YA17 YA19 18 (1) (c) (i) 12 (1) (a) 15 (2) (b) 16/09/08 All service users who need one 16/09/08 must have an up to date epilepsy profile. This is the second time this requirement has been made. There must be explicit instructions for staff regarding service users who become ill while having respite care. Clear details about arrangements for returning home or staying in Derriads must be available. There must be one person on duty at all times who is trained in administering rectal Diazepam and Midazolam. 5 YA19 12 (1) (a) 16/09/08 6 YA20 18 (1) (c) (i) 16/09/08 Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 30 7 8 9 10 11 YA20 YA22 YA23 YA30 YA32 18 (1) (c) (i) 22 Schedule 4 (11) 13 (6) 13 (3) 18 (1) (c) (i) 18 (1) (a) All staff must have evidence on file of medication administration training. A log of all complaints made to the service must be kept. All staff must have training in Safeguarding Adults All staff must have infection control training. There must be written evidence in the home that all agency staff have had their CRB checks and relevant training. This can be done by Wiltshire County Council or in writing from the agency. If Derriads staff find that this is not the case, they must report the matter to their manager. The registered person at Wiltshire County Council must write to CSCI with full details of the personnel information which is stored by them at County Hall. The manager must make sure that all staff files contain the appropriate information, including photographic ID. A copy of the report written by the provider during their monthly visits must be sent to CSCI until further notice. All staff must have manual handling training 16/09/08 16/09/08 16/09/08 16/09/08 16/09/08 12 YA34 19 Schedule 2 19 Schedule 2 26 16/09/08 13 YA34 16/09/08 14 YA39 16/09/08 15 YA42 18 (1) (c) (i) 16/09/08 Derriads DS0000032436.V361821.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 YA1 Good Practice Recommendations The Statement of Purpose should be amended to include details of what happens when a service user becomes ill, and should be amended to include reference to the newly appointed Responsible Individual nominated by Wiltshire County Council. Service users support plans should be more tailored to the individual service user, and be more person-centred. All service users should have up to date community care reviews, and that the home should have a copy of these reviews. This will make sure that staff are aware of any changes in the people’s needs and how to care for them. Risk assessments should clearly state the name of Derriads respite care service not any other service. They should also have one format used consistently. Regular service user meetings should be held, and records kept of these meetings. The services of an independent advocacy worker should be considered in order to seek the views of service users. The plans for the extension to the bathroom should be carefully considered so that there is enough communal space for service users to be comfortable and safe. The home’s manager should be issued with a list of personnel information which he is to keep in the home. A copy of the most recent Care Homes Regulations should be kept in the home. 2 3 YA6 YA6 4 5 YA9 YA22 6 7 8 YA24 YA34 YA37 Derriads DS0000032436.V361821.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Derriads DS0000032436.V361821.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!