Inspection on 21/01/09 for Derriads

This inspection was carried out on 21st January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Derriads 16/07/08

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 20/03/2009.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Derriads Respite Care Home 70 Derriads Lane Chippenham Wiltshire SN14 0QL Lead Inspector Pauline Lintern Unannounced Inspection 21st January 2009 9:30 Derriads DS0000032436.V374019.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.V374019.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 Older People and 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.V374019.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.V374019.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 16th July 2008 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. 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.V374019.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 1 star. This means the people who use this service experience adequate quality outcomes. Our unannounced inspection took place over one day in January 2009. At the time of our visit the registered manager, Mr Mark Pearson was on leave; therefore the service manager assisted us throughout the day. We were able to meet the four people who were currently receiving a service, when they returned from their day services. One person was spending their first overnight stay at the home, and told us they were looking forward to it. We sent Mr Pearson an Annual Quality Assurance Assessment (AQAA) to complete. This was their own assessment of how well they are performing and it gave us information about their future plans. Information from the AQAA is detailed within this report. We sent out surveys to people who use the service and health care professionals. One health care professional responded. We reviewed the information that we had received about the home since the last inspection. 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. On the 15/01/2009, our pharmacy inspector visited the service to look at the arrangements for managing medication. We had the opportunity to talk to two staff members to gain their views on the service provided at Derriads. We also met with a new member of staff on her first day at the home. 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: The home provides new people with information they require to enable them to decide if they wish to stay at the home or not. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 6 Staff members were observed interacting positively with the people staying at the home. The arrangements for managing medication are good. What has improved since the last inspection? What they could do better: The home must ensure that any person staying at the home, who may be at risk of pressure sores is risk assessed and monitored. Guidelines must be included within their care plan. Where people may have specific sensory needs, the home should explore available aids and equipment, which may enhance the person’s quality of life. Person centred planning needs to be further developed. Staff may benefit from training in this area, in the future. Care needs to be taken to ensure that all care planning documentation is kept under review. Activities, which take place outside or inside the home should be recorded and Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 7 evaluated. This will provide the staff with what activities were successful and what was not so popular for individuals. There still appears to be a high level of agency staff used, to cover sickness and annual leave, this is not ideal. The home is currently recruiting for more staff members. 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. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 2 Quality in this outcome area is good. Information is available to prospective new people and their relatives, to enable them to decide if they wish to use the service or not. To ensure the home can meet a persons needs a full assessment is completed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which are available in alternative formats. Both documents provide the reader with information about the service and staff. Information is included on the Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 10 procedure for making a complaint, if required. At the last inspection, a requirement was made relating to providing information on arrangements for returning home, or remaining at Derriads, if a person using the service becomes ill. The Statement of Purpose now provides a reference to the protocols in place, should this situation arise. Prospective new people to the service, have the opportunity to visit the service prior to their stay. This may include joining others for a meal, or having an overnight stay. The home identify, whether they are able to meet a persons needs following a Community Care Assessment and having gathered information from the person themselves or their representative. Information received forms the persons care plan. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 6, 7 and 9 Quality in this outcome area is adequate. Care plans are in place, but do not always reflect the needs of the person. Risk assessments are in place, and have been reviewed. However, some potential risks have not been assessed, which could place people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of the inspection process, we sampled the care plans of two people. Evidence showed that one persons support plan had been reviewed, with the Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 12 involvement of their relative and key worker. The second plan sampled stated that the plan should be reviewed in November 2008, however we could not find any evidence of this happening. The support plans include details of how to meet the persons needs. This includes communication, mobility, medication, physical needs and personal care needs. The service manager reported that they are in the process of introducing a one page profile for each person who receives a service. This will involve making the care plans more streamlined and person centred. Managers are currently receiving training in Person Centred Planning. The service manager confirmed that this training will be filtered down to the staff team, sometime in the future. At the previous inspection a requirement was made, which related to ensuring that people had an up to date epilepsy profile in place, if it was needed. It was noted that people now have an epilepsy profile and an interaction plan in place. The Community Nurse and a staff member had completed this. Risk assessments have been completed, which relate to profile and interaction plan. However, one person did not have a seizure chart within their epilepsy management plan. The service manager confirmed that there is now always a person, on duty who is trained in administering rectal Diazepam and Midazolam. It was noted that one persons assessment had identified that they were prone to pressure sores. We could not find any reference to this within their support plan. We asked that clear guidelines and a risk assessment be put in place to ensure the health needs of the person are being met. Within a support plan it states, that a person has a sensory loss. We could not evidence that this had been fully explored and documented. We said that the care plan should provide further detail on the loss and what this could mean for the person. We asked the service manager to explore the use of sensory aids, which may be of benefit to the person. People living at the home are supported to make decisions about the way they live their lives, where possible. No one staying at Derriads currently has an advocate. Within the AQAA it states that the home are planning to introduce residents meetings, introduced by an independent advocate. Within one persons support plan it states I want to go out in the van for drives, when I am on respite at Chippenham. Another persons support plan states, I do not like to be pressured into doing things. I do them in my own time, if I choose to. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 13 One support plan informs about me, how I communicate. It then records how the person will communicate their needs to staff members. Risk assessments are completed and kept under review. Assessments include areas such as eating/drinking, accessing the garden, epilepsy, hot drinks, showering and medication. All risk assessments are now in the same format. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 15 NMS 12, 13, 15, 16 and 17 Quality in this outcome area is good. People have the opportunity to access social and leisure activities, however these are not always recorded. Links with families and friends are encouraged if appropriate. Menus vary, to ensure the dietary needs of the people staying at the home are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Many people who stay at Derriads continue to attend their day services, or normal outside activities, with support, if they choose to do so. Records show that some people using the service, attend Middlefield Centre; where they attend intensive interaction groups, participate in activities such as walking and day trips. They also attend sensory chill out sessions. Within care plans, there was little or no evidence of activities arranged by the home. One persons activity record stated that they had walked around the garden in August 2008. There were no further entries. However, within the support plan it records that the person had visited a fast food outlet and they had coped with the activity very well. We felt that if this activity had been such a success, why had it not been accessed again. Another persons activity record had no entries on it. We asked the service manager to ensure that a record is kept of any activities that people have participated in. This should include activities, which take place inside the home, in addition to activities within the community. There should be an evaluation of how successful an activity has been, or not. One member of staff we met with reported that when people return from their day services, they often just want to chill out in front of the television, rather than got out. People who visit Derriads are encouraged and supported to maintain links with their friends and families. However, this can depend on individual circumstances. People who stay at Derriads are able to entertain their friends and family in the privacy of their rooms if they wish to do so. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 16 One support plan states that although the person is unable to communicate verbally, they will let staff know what they want by making various sounds or by their body language. Another persons plan states I like my own space, I will indicate when I want to go to bed by sitting on my bed. Within the AQAA it states, we continue to ask service users what they want from the service. We offer good meals, interact well with the service users & offer outings/amenities chosen by service users. We keep records of meals & ensure there is good, wholesome food on offer. Some individuals have specific dietary needs and these are recorded & catered for. Each individual service user is known for their own preferences. Leisure activities are catered for with this in mind. Meals are varied and take into account the needs of the people staying currently staying at the home. One person needs a lowfibre diet and this was detailed within their support plan. Staff training records demonstrate that staff have received basic food hygiend training. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 18, 19 and 20 Quality in this outcome area is good. Support plans detail how a person, wishes to have their personal care delivered. Bathing facilities have improved. People using the service have access to health care professionals as and when they are needed. People using the service are protected by the home’s procedures for the safe handling of medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Support plans provide guidance to the reader on how to meet the personal care needs of each individual. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 18 One file we sampled records that the person does not like to have a bath, but prefers showers. Daily notes demonstrate that this request is respected. One persons support plan states, Talking to me throughout my personal care helps me to relax. I like you to tell me what you are about to do. Since our last inspection the bathroom has been refurbished and enlarged, which provides a safer environment for people to manoevour around in. The bathroom and toilets were found to be clean and hygienic when we visited the service. The home has various adapatations and equipment to support people with their physical needs. Staff members receive training in manual handling procedures. People are supported to attend healthcare appointments. This includes visits to hospital, general practitioners, chiropodists, dentists and the community nurse. Within our surveys we asked, do staff have the right skills and experience to support individulals social and healthcare needs? One healthcare professional commented, sometimes, there is a need for continued professional development, such as an acknowledgement of the increased complexity of needs e.g. peg feeding, sensory issues, autism, communication needs, positive behaviour management and manual handling. As mentioned earlier in this report files sampled, showed that people now have epilepsy profiles in place. One persons profile records that there, were no changes needed to the existing profile, when it had been reviewed by the community nurse. There is now a protocol in place for if a resident should become ill, while at home, or prior to visiting. Our Pharmacist Inspector looked at arrangements for the handling of medicines. All medicines were stored securely and a controlled drug cupboard was in use, however this needed to be attached to the wall with particular secure bolts. The home keeps clear records of all the medicines brought in with people, used in the home and returned at the end of their stay. Records of controlled drugs are also kept. All care staff have had training from healthcare professionals to enable them to support people with particular needs and a record is kept of this. We saw care plans and profiles for three people and these included care plans for medication, epilepsy profiles and information about their healthcare needs. The Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 19 carers we spoke to were knowledgeable about the medicines that people used and had a good understanding of the medication policy that is in place. Nobody using the home currently self medicates. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 22 and 23 Quality in this outcome are is adequate. Any complaints made directly to the local authority are recorded as having been received, however complaints made directly to the home need to also be recorded. Policies and procedures are in place to ensure that people using the service are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in place to enable people to raise any concerns or complaints, which they may have. Each person receiving a service is given a copy of this document. Within the AQAA it states, there have been 4 complaints received in the last twelve months. It reports that none of the complaints were upheld, and two were waiting for an outcome. A requirement was set at the last inspection Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 21 relating to home not having a record of complaints made. The manager now records any complaints, which have been made directly to the local authority. However, he does not appear to be recording any complaints or concerns made directly to the service. The home should develop a complaints log, which will detail any concerns or complaints received. The log should show actions taken, timescales and outcomes. Within our surveys we asked, has the care home responded appropriately if you or the person using the service have raised concerns about their care? Comments received include, they are driven by a negative culture, cross culture blame exists. Staff members told us that they have seen the No Secrets in Swindon and Wiltshire protocols for responding to allegations of abuse. Staff training records demonstrate that staff attend training in safeguarding adults. There is a whistle blowing policy in place, to protect staff members. The home does hold small amounts of money for some people , on their behalf. We examined the records of two people staying at the home and found that both records balanced with cash held. Receipts are kept of all transactions. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 24 and 30 Quality in this outcome area is good. Derriads provide a homely, safe and comfortable environment for the people who stay there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Derriads is located in a residential area and is in keeping with other properties Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 23 situated nearby. There is a ramp by the front door, to enable easy access. During our site visit, care staff were seen to be carrying out cleaning tasks throughout the home. There were no unpleasant odours and the home appeared clean and tidy throughout. Although the home appeared clean and tidy, it could do with some redecoration to brighten it up. As part of the inspection process, we toured the building. We found bedrooms to be comfortable and well furnished. There is a large lounge, which is currently also being used as a dining room. Staff confirmed that the situation is satisfactory, unless there are four wheelchair users staying, which can restrict the space around the table. Food is currently taken from the kitchen, to the dining area by a wheeled trolley. This is not ideal and it means that staff are having to carry hot food down the hallway. The service manager reported that they have been obtaining quotations to have a conservatory erected, which would then become the dining area. This would also provide a further communal area for people to access. The bathroom was refurbished in October 2008 and now provides a spacious area for people to manoeuvre in. There is a ceiling hoist and an assisted bath available. It was noted that all hand washing areas had anti-bacterial hand wash available. The bathroom and toilets were found to be clean and hygienic. The laundry area houses a washing machine and a drier. One staff member it was sufficient to meet the needs of the people staying there. Staff training records sampled, demonstrated that staff attend training in infection control. All toxic materials are stored securely. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 32, 34, 35 and 36 Quality in this outcome area is good. Competent and trained staff supports people who use this service. Policies and procedures are in place to safeguard people who use this service. However, a checklist showing that safeguarding checks have been satisfactorily received could be kept at the home. Records demonstrate that staff members receive regular supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 25 Staffing levels are flexible to suit the needs of the people currently staying at the home. There is usually three staff on duty during the day. Waking night staff are available if required to meet the needs of the people staying. One member of staff told us, there is always enough staff, last year we used a lot of agency, but now we use more relief staff. At the time of our visit the home had two staff vacancies. One new member of staff was on their first day at Derriads, when we visited. They told us that they had provided two references and had a check with the Criminal Records Bureau (CRB) before being offered a position. At the previous inspection, there was some concern relating to the use of agency staff and the suitability of their training, to meet the needs of the people staying at Derriads. One member of staff told us that there was an occasion when an agency worker, was unable to assist in certain areas such as manual handling, as they had not received the training. They added that this has improved now as they specify the skills needed, when they book the agency worker. There is also a matrix in place, which allows the care staff to look at the qualifications of the agency worker before they request a service. This ensures that the agency worker has the skills required to meet the needs of the people staying at the home. One member of staff reported, we would inform the agency, if we felt the agency worker was not sufficiently trained. One staff member told us all the staff on the relief bank are trained to meet the needs of the people we support. It was noted that there was written confirmation from two agencies stating that all their agency staff have been CRB checked. Within our surveys, we asked if there was anything else that they would like to tell us, comments included, fabulous team working, their approach is fantastic, they have the individuals needs at heart and they are in the job for the service users. New staff receive an induction period, where they are given an induction pack and a work book to complete. This is in line with the Common Induction Standards. Before staff commence their National Vocational Qualification (NVQ), they complete the Learning Disability Qualification (LDQ) to provide them with a sound underpinning knowledge of working with disabled people. Within the AQAA it states, that nine staff members have achieved a NVQ level 2 or above and one staff member is currently working towards the award. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 26 At the previous inspection there was concerns relating to lack of staff training in certain areas, such as safeguarding, medication, infection control, basic food hygiene and emergency medication. Training files sampled indicates that staff now receive training in these areas, along with mandatory training. This includes fire awareness, health and safety, first aid and manual handling. One member of staff confirmed that they are up to date with all of their training. They added the training co-ordinator monitors all of our training needs, I have just applied to attend training in risk assessments. Wiltshire County Councils human resources department assists staff recruitment. All staff have CRB checks and are checked against the Protection of Vulnerable Adults (POVA) register. Two written references and a medical declaration are also required. We suggested that there is a checklist of all CRBs and references received, kept at the home. Staff members we met with, spoke well of the service provision at Derriads. One person told us I have no concerns or worries about the service provision here, everyone is well cared for. We sampled staff supervision records. They showed that staff receives regular one to one support from their line manager. Staff team meetings take place monthly and minutes are kept of the meetings. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 28 NMS 37, 39 and 42 Quality in this outcome area is adequate. There have been some improvements made regarding the management of the home, since the last inspection. Peoples views on the service being provided are obtained, where possible. Policies and procedures are in place to ensure the health, safety and welfare of people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr Pearson is the registered manager of Derriads. He has been registered with CSCI for over two years. He holds the Registered Managers Award and has completed an NVQ level 4 in care. At the previous inspection, there were concerns regarding Mr Pearsons capability to ensure that people using the service remain safe. Since our last visit there appears to be an overall improvement made. Risk assessments are now in place. However, care must be taken to ensure all potential risks are identified and assessed. Record keeping and staff training have also improved. Mr Pearson must ensure that these areas of improvement are monitored to ensure they are not allowed to slip again. Regular senior management audits are carried out monthly and a copy is sent to CSCI. Records of these visits were sampled. Wiltshire County Council also carries out regular internal audits. Satisfaction surveys are sent out to people who use the service, and their representatives, annually. The last questionnaires were sent out in November 2008, the home is currently waiting for the responses to be returned to them. Records demonstrate that regular health and safety checks are completed. There is a Health and Safety policy in place. All equipment, such as hoists and tracking systems are regularly serviced to ensure that they are working correctly. Environmental risk assessments are in place and kept under review. This includes a risk assessment for Legionella and manual handling. The home has a fire risk assessment dated 20/2/09. Regular fire drills take place and staff receive fire awareness training. Small electrical appliances were last checked on 15/12/08. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 29 Regular checks are carried out on the fridge and freezer and the hot water outlets, to ensure they are at a safe temperature. Derriads DS0000032436.V374019.R01.S.doc Version 5.2 Page 30 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 3 40 X 41 X 42 3 43 X 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Derriads Score 3 3 3 X DS0000032436.V374019.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA6 YA9 YA22 Regulation 15 (2) b 13 (4) c 22 Schedule 4 (11) Requirement You must ensure that care plans are kept under review. You must ensure that all identified risks are assessed and kept under review. A record of all complaints made to the service must be kept within the home. This must include actions, timescales and outcomes. Timescale for action 21/03/09 21/02/09 21/03/09 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 1 2 Refer to Standard YA6 YA6 YA13 Good Practice Recommendations Further develop Person Centred Planning, within the service. Explore the use of sensory aids and equipment for who may have a sensory loss. Provide evidence and an evaluation of activities, both internally and externally. DS0000032436.V374019.R01.S.doc Version 5.2 Page 32 Derriads 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.V374019.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!