Inspection on 03/07/08 for Donec

This inspection was carried out on 3rd July 2008.

CSCI found this care home to be providing an Good 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

Donec 04/07/07

Donec 15/11/06

Donec 20/12/05

Donec 06/09/05

Donec 17/01/05

Donec 02/06/04

Donec 29/01/04

Donec 14/11/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Donec Headley Road Grayshott Hindhead Surrey GU26 6DP Lead Inspector Christine Bowman Unannounced Inspection 3rd July 2008 11:00 Donec DS0000011876.V367394.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 Donec DS0000011876.V367394.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. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Donec Address Headley Road Grayshott Hindhead Surrey GU26 6DP 01428 605525 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) donec@efitzroy.org.uk www.efitzroy.org.uk Elizabeth Fitzroy Support Mrs Karen Elizabeth Bond Care Home 14 Category(ies) of Learning disability (0) registration, with number of places Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 14. Date of last inspection 4th July 2007 Brief Description of the Service: Donec, is managed by Elizabeth Fitzroy Support, and is registered to provide a service for fourteen adults with a learning disability or physical disability. The home has links with local General Practitioners, the Community Nursing Team and local community. Donec is a large three-storey house on the outskirts of Grayshott, a small village on the Surrey and Hampshire border. There is no lift available and is therefore appropriate only for service users with good mobility. Service users are able to access local facilities and are encouraged to maintain their independence. Visitors are welcome and service users families are encouraged to play an active part in their relatives life. Information provided by the manager confirms the fees are currently £606.48 to £1199.78 per week and service users are responsible for paying for their own toiletries and items of a personal nature. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over six and a half hours and the Registered Manager, Mrs Karen Bond was available throughout the morning and assisted with the inspection process. Other senior staff were available in the afternoon. A tour of the premises was undertaken and some of the residents’ bedrooms, bathrooms and communal areas were viewed. A number of staff and residents were spoken with throughout the day and residents were observed as they prepared and ate their evening meal and relaxed in the living areas and their bedrooms. The key inspection standards for care homes for younger adults were assessed with regard to the outcomes for the residents living at the home. The service user guide was viewed and residents’ files including assessments, care plans, medication administration records and risk assessments were viewed and staff personnel files, including recruitment, induction and training records were sampled. The home’s quality assurance system, complaints and compliments, policies and procedures and maintenance certificates were also sampled. The service had completed an Annual Quality Assurance Assessment (AQAA) and information recorded in this, and on the inspection record since the previous site visit, has been taken into consideration in the writing of this report. Two service users, four staff and one social care professional returned surveys to give their views about the home. Comments from these sources have been included in this report and references to the homes’ own quality assurance assessment have also been made. Thanks are offered to the management and the staff of Donec for their assistance and hospitality on the day of the site visit and to those who completed surveys for their contribution to this report. What the service does well: Person-centred planning promotes the involvement of service users in decision-making about their lives with appropriate support. Care plans were written from the point of view of the resident and included their preferences, likes and dislikes with respect to all aspects of their health and personal care. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 6 A staff member commented, ‘Donec has a really homely feel to it. I love working with all the staff and the service users, who are friendly, which all visitors notice and remark on when they come to Donec. One care manager commented in a survey, ‘what the service does well is that it has a person-centred approach and is creative and pro-active in meeting the needs of the service users. The home is relaxed and homely, yet professional and efficient in all aspects of care’. What has improved since the last inspection? What they could do better: Whilst it may be reasonable to not have a long term plan of refurbishment in place, because the home will be obsolete within a year, it is important to keep the communal areas of the home tidy, in a good state of repair and ensure they are reasonably decorated. Sufficient numbers of suitably qualified, competent and experienced staff must be employed to meet the needs of the service users. The use of temporary staff must not prevent service users from receiving such continuity of care as is reasonable to meet their needs. Persons must not be employed to work in the care home unless a full employment history with a satisfactory written explanation of any gaps in employment has been obtained to ensure they are suitable to work with vulnerable people Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 7 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. Donec DS0000011876.V367394.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 Donec DS0000011876.V367394.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): Standards 1,2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides sufficient information in suitable formats to enable prospective residents, their relatives/friends/representatives to decide if the home will meet their needs and a thorough assessment is carried out to ensure the home is able to meet those needs. EVIDENCE: The Statement of Purpose and the Service User Guide provided sufficient information for residents, prospective residents, their relatives and representatives to make a decision about the ability of the service to meet their needs. The service user guide was written in a person-centred way and included drawings and symbols to promote the understanding of current and prospective residents with learning disabilities. One service user, who completed a survey, confirmed they had been asked if they wanted to move into this home. Another service user stated they had visited before they moved in and that the advocacy service had helped them to make a decision. Since the previous site visit two new service users had moved into the home because their home, which was owned by the same provider, had closed. In addition to having a learning disability, the two new residents also had physical disabilities and were wheel-chair users. Full assessments of need had been carried out and families and care management had been involved. The Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 10 manager stated that the transition had been carried out sensitively and the service users already living at Donec had been consulted, before it was finally agreed they could move in. The AQAA recorded, ‘both service users had visited the service on several occasions with the support from advocacy and they also had over night stays’. Most of the other service users had lived at the home for many years and some for most of their lives The admissions process was described clearly in the service user guide and included visits to the home to be introduced to the other residents and the staff and short stays to sample life there. A comprehensive assessment procedure and documentation were available to support this process covering all aspects of the service user’s health, social and personal care needs. Information with respect to equality and diversity was collected to enable an individual approach to the service user’s care needs. Assessment documentation viewed on service users’ files included personal details including religious and cultural needs, communication needs, health and personal care needs and the likes, dislikes and preferences of the service user from which a person-centred plan of care had been drawn up. Donec DS0000011876.V367394.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): Standards 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Person-centred planning promotes the involvement of service users in decision-making about their lives with appropriate support and independence is promoted through the balancing of the risk factors involved. Shortfalls in staffing levels limit opportunities for decision-making. EVIDENCE: The organisation had recently reviewed their care planning process and were reviewing all the service users and introducing them to the new plans. The documentation was comprehensive and written in a way, which made it accessible to the service users. Everything was written in a person-centred way indicating ownership by the service users of the information written about them. Two service user files were sampled and each contained a personal profile under headings including, ‘About Me’, my personality and relationships, communication, leisure, community living skills, and ‘looking after myself’. Specialist requirements were included and one service users’ plan indicated that a special vehicle had been ordered to enable them to be transported in Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 12 their wheel-chair and that interim measures included the use of a taxi and one–to–one support to enable them visit the library to access the computors. Service users had allocated key workers to offer consistency and continuity. The manager stated that care management were involved in annual reviews and that relatives also contributed and care plans had been up-dated accordingly. One care manager commented in a survey, ‘what the service does well is that it has a person-centred approach and is creative and pro-active in meeting the needs of the service users. The home is relaxed and homely, yet professional and efficient with all aspects of care’. Files sampled included communication profiles with special instructions to ensure that the staff were aware of how each individual expressed themselves. One resident used objects of reference to make their wishes known. Care plans recorded where service users’ choices had been identified to inform the staff. Advocacy schemes were well used at the home and the manager stated that the two new service users had received this support in deciding to move to the home, and that the current service users would be provided with advocacy to support them through the future changes. Service users had their own bank accounts, and collected their benefits on their house-keeping day. They paid the rent at the bank and, the manager stated, and the money left over was their personal allowance. The service users had to buy their own toiletries from this allowance and were given support to budget for holidays. One service user wrote in a survey, ‘I can sometimes make decisions about what I do each day,’ and another commented, ‘I can do what I want during the day and in the evening, but not at the weekend. I like to go to bed no earlier than 9.30 in the night.’ A service user’s support plan recorded that they, ‘could choose what they wanted to eat for breakfast and lunch and butter bread and make lunch, with assistance.’ A member of staff commented that the service users used to have more opportunities to go out regularly in the evenings – to the pub or local clubs and activities. Due to staffing levels, this never happens now and I have been told by the service users that they miss this’. Risk assessments included in the residents’ care plans gave instructions to the staff on how to avoid hazards whist ensuring the residends remained as independent as they were able. A moving and handling risk assessment in one service user’s file gave detailed guidelines to the staff, was written from the point of view of the service user, and illustrated with diagrams to show exactly how they should carry out these tasks for the safety and comfort of the client. Three of the four care staff, who completed surveys, confirmed they were always given up to date information about the needs of the people they support and one that they usually were. One thought they always had the right support, experience and knowledge to meet the different needs of the people who use the services with respect to equality and diversity three thought they usually did. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents take part in appropriate activities that take account of their needs and preferences, they are supported to maintain personal relationships and to be part of the local community. Residents’ rights are recognised and they are offered a healthy diet that reflects their individual tastes and dietary needs. EVIDENCE: On the day of the site visit some of the service users were attending day services in the community, one was working in a local store, one was on an appointment with their General Practitioner and others were enjoying a home day, getting up later, relaxing, and completing their weekly chores such as laundry and cleaning their bedrooms. One service user, who had been allocated one-to-one support, no longer attended ‘On Track’, the organisation’s day centre, because they wanted to go to the local library to access the computers there. The AQAA recorded that, ‘at Donec there are currently two service users who attend voluntary employment. One works at the local café one day per week and the other works at a nearby charity shop. A gentleman Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 14 at Donec has paid employment and works two days per week. Most service users attend a day service where college courses are offered for such things as IT and woodwork’. A copy of the service users’ support plans were included in their care plan, showing how much time was allocated to supporting individuals within the community. One service user was a member of the local Working Men’s Club, which they had attended for a number of years, where they were accompanied by a volunteer and enjoyed playing snooker. This service user also liked to go sailing on a nearby lake and got there by taxi. Another service user enjoyed bowling, hydrotherapy, having the television on and long baths. The service users, whose files were sampled had a section entitled ‘Community Living Skills,’ which included the ability to travel and use public transport, road safety awareness, money and shopping, telling the time and time-keeping, cooking skills, kitchen safety, household chores, use of telephone and healthy eating. Independence was promoted within the home and the section of the care plan entitled, ‘Looking After Myself’ showed how individuals were empowered to complete self-help tasks. One resident stated, ‘I am supported by staff to keep my room clean’. All the bedrooms were single occupancy and the manager stated that the service users had keys for their bedrooms and a front door key. One service user liked to complete chores around the home such as wiping the tablemats and clearing the table after dinner. Service users were observed preparing their evening meal supported by the staff in the home’s large kitchen. ‘Families and friends can visit at any time, which is convenient to the service user’, the manager stated, and some residents had special relationships, which were respected. The manager wrote in the AQAA, ‘the service users’ privacy and dignity are respected at all times and this is demonstrated by the way people who use the service are spoken to, supported and listened to’. This was verified throughout the site visit. Service users’ aspirations were fully explored at Donec and one service user, who had died very recently, had always wanted to go to Florida to see Micky Mouse. This goal had been fulfilled. ‘Some other service users will be taking a holiday on the Isle of Wight next week’, the manager stated, and holidays in Devon and to Disneyland Paris had been booked. Service users’ preferences with respect to food was recorded in their care plans and one resident especially liked chips and sausages, marmite sandwiches and bananas. Staff personnel files sampled confirmed that food hygiene certificates had been obtained for the safe handling of food. There was plenty of choice with respect to food and some residents were preparing their own choice of evening meal with support. The manager stated since the chef had left it had been difficult to recruit and this had resulted in increased Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 15 participation in the preparation of food by the service users where appropriate. Donec DS0000011876.V367394.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): Standards 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal, health, physical and emotional needs are met according to their preferences and wishes and safe procedures promote their access to medication. EVIDENCE: Service users’ personal support preferences were recorded in their care plans. The home had forged good links with the local Community Learning Disability team and was working closely with them to ensure that the new build for Donec would be suitable for everyone’s needs both now and in the future. The AQAA recorded that, ‘we are making sure the environment is suitable for people who have been diagnosed with Dementia or for service users who are registered blind. This will mean that they will give advice on colours, flooring and other details.’ Records were kept in the service users’ files of specialist involvement including physiotherapists, community nurses, General Practitioners, chiropodists, dentists, opticians and the community mental health nurse. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 17 Staff personnel records confirmed that the staff responsible for the administration of medication had accessed medication training. ‘Some of the service users who currently live at Donec are able to self medicate’, the AQAA recorded, ‘this is done with the support of a risk assessment and continual monitoring. Safe procedures were in place for the receiving, disposal and the administration of drugs for the safety of the service users. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home endeavours to ensure that the communication needs of the residents are met to enable them to make their feelings, wishes and views know so they may be acted upon. Complaints are welcomed and systems are in place to protect the service users from the possibility of abuse, neglect and self-harm. EVIDENCE: The home had a clear complaints policy and procedure and a pictorial version for the residents, which were displayed on a notice board to inform residents, their relatives, friends and representative of the process should they wish to use it. The AQAA recorded, ‘all concerns from service users are listened to and acted upon. This is sometimes facilitated via advocacy or the key worker. Each service user is explained to that they have the right to complain at a level and pace that they will understand. It is also explained that their key worker, advocate, care manager or someone else of their choice, will support them with this where necessary’. Since the previous site visit the home had received six complaints and the AQAA recorded that they had been responded to and resolved within twentyeight days. The Commission for Social Care Inspection had received no complaints on behalf of this service. The two residents, who completed surveys, confirmed knew who to speak to if they were not happy and how to make a complaint. The four staff, who completed surveys were all aware of the procedure to follow should a resident, their relative or representative Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 19 have concerns about the home. A compliment recorded stated, ‘May I say I could never thank you enough for all the wonderful work you and your staff perform.’ The home held a copy of the local authority ‘Safeguarding Adults Policy and Procedure’ to inform the staff of the referral process and the local authority contact details should they need to make a referral. The staff training matrix showed that the majority of staff had received the Protection of Vulnerable Adults training within the last two years. Certificates held on staff personnel files verified this. The staff recruitment process safeguarded residents and records confirmed that the staff, whose files were viewed, had been through rigorous recruitment checks including Criminal Record Bureau (CRB) and the Protection of Vulnerable Adults list checks prior to the offer of employment to safeguard the service users. The four staff, who completed surveys also confirmed the employer carried out checks such as CRB and references, before they started work. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, homely and safe environment, which meets their needs and is clean and hygienic. EVIDENCE: A partial tour of the premises was undertaken and the communal living spaces, bathrooms and three residents bedrooms were viewed with their permission. The manager stated that the home had originally been built at the beginning of the twentieth century and had been extended on at least two occasions to provide the current accommodation. The communal living area consisted of a large living room, which was both a sitting and a dining room. There was comfortable seating and a large screen television at one end of the large room and a dining table with chairs at the other end. There was suitable domestic lighting and plenty of natural light from the windows over-looking the garden. In this room there was a large television, a music centre, videos, Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 21 compact discs, games and musical instruments for the service users’ entertainment. Leading from this room was an activity room. There had also been a separate dining room, but the use of the room had changed because an accessible ground floor room with sufficient space to accommodate a wheelchair user had been needed. The change of the use of the room had been gradual and the manager stated, the service users had been consulted and their responses had been recorded in the minutes of the residents’ meetings. However a staff member thought otherwise and wrote on their survey, ‘the recent loss of the dining room upset the service users. I accept the new service users needed to move home, but the wishes of the existing service users were completely overruled. This, in my opinion, does not follow the rule that it is the service users’ home and we only do things that they give permission for’. The large kitchen, which provided sufficient space for service users to be supported to prepare their meals, had benefited from some updating and improvement since the previous site visit. At the previous site visit, a requirement was made, that a plan of refurbishment and decoration for the home should be in place to ensure that the home is kept in a good state of repair and that it is reasonably decorated. The kitchen, which had been in need of attention, because some doors and drawer fronts had been missing from the cabinets, was much improved. Although the décor of the home in general continued to be rather shabby, there were no health and safety concerns and the service users’ bedrooms viewed were pleasantly decorated, well equipped with electrical equipment for their entertainment and had been personalised. The AQAA recorded, ‘Service users bedrooms all reflect the person’s personality and they have chosen the décor with the support of their key worker where appropriate’. There were lots of posters on the doors of bedrooms and on walls, which were bright and cheerful and gave some insight into the service users interests. The plans of the new home due to be built in the grounds over the next year, showed how the environment would eventually be vastly improved. The service users will be living in smaller units, or attached cottages and much work was in the process of being carried out with the service users to prepare them for living in their new homes. The home was surrounded by a large, mature garden with appropriate seating and a bar-b-cue. The laundry room was appropriately equipped with an industrial washing machine, which, the manager stated, ‘meets all the health and safety regulations’. There was an infection control policy and there was evidence of good practise in the use of liquid soap dispensers and paper towels. Infection prevention and control training was not included on the staff training matrix as a separate item, but was included in Health and Safety training, which was updated on a five year cycle. A resident commented in the survey they completed Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 22 that they, ‘thought the home was always fresh and clean. Another service user commented, ‘I am supported by staff to keep my room clean and staff clean daily around the house.’ A care manager, who completed a survey commented, ‘ the home could improve and that they were aware of the on-going plans for re-development to create smaller environments and more updated homes’. Donec DS0000011876.V367394.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): Standards 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Safe recruitment practices, appropriate induction and mandatory and specialist training prepare the staff for the supportive role and to meet the service users’ individual needs. However, the home does not always have sufficient staff to meet the needs of the service users. EVIDENCE: The AQAA recorded that less than 50 of the staff had achieved or were working towards a National Vocational Qualification (NVQ) at level 2 or above. Although a substantial number of care shifts had been filled by agency staff over the three months before the AQAA was completed, no qualifications were recorded for them. The manager was aware of the need for improvement in this area. She stated that it had been difficult to recruit staff locally partly because the home was rather isolated and not covered by a bus route. Two of the four staff, who completed surveys thought there, were usually enough staff to meet the individual needs of all the people who use the service, and the other two that there sometimes were. One staff member commented, ‘staffing levels rely on agency support workers. Elizabeth Fitzroy Support seem reluctant to advertise for more permanent staff (possibly because service users will be moving to supported living houses once they are built and they are due Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 24 to be finished next year, I believe.) Another staff member stated there were not enough permanent staff to cover sickness and holidays. Another comment from a staff member was that, ‘occasionally agency workers are not of a good enough standard to work at Donec’. The staff member had told management of this and the manager responded that on two or three occasions she had told the agency not to send particular staff again, however, she stated, ‘the agency usually only send staff, who have built up a relationship with the service users over a period of time. She also stated that she was in the process of building a team of bank staff for the home.’ The staff, observed working at the home on the day of the site visit, were enthusiastic, approachable and committed to supporting the service users. Interactions were respectful and communication good, the staff were attentive and provided support in an unobtrusive and empowering way. A service user commented in a survey, ‘the staff always treat me well and listen and act on what I say,’ and another stated, ‘I get on well with staff and the other service users’. The recruitment procedure, described by the manager, was confirmed in the records of two newly recruited staff, and the four staff, who completed surveys, confirmed their employer carried out checks, such as CRB and references, before they started work. A good audit trail was kept; interview questions recorded and eligibility to work in the United Kingdom had been explored. Applicants had not, however been required to give a full employment history, with gaps in employment explained, to ensure that only suitable people are considered for employment with vulnerable adults. All the staff who completed surveys also thought the induction covered everything they needed to know to do the job when they started very well. The staff induction programme was based on the Common Induction Standards and was a specially adapted version to support staff working with people with learning disabilities and was externally acredited. The staff training matrix showed that mandatory training including health and safety, moving and handling, fire safety, first aid, food hygiene, the protection of vulnerable adults and care and control of medicine, had been accessed by the majority of the staff in a timely manner. Other training which had been undertaken by some staff to support the needs of the service users included, epilepsy and diazpan, positive communication, person-centred approaches, report writing, dementia and palliative care. Palliative care had been specially requested because a service user, who had lived at the home most of their life, had contracted a life-threatening illness, from which they had recently died at the home with community support. Other specialist training available to the staff, such as challenging behaviour and intensive interaction, had been attended by a small number of staff. The four staff member, who completed surveys confirmed the training given is relevant to their role, helps them understand and meet the individual needs of the service users, and keeps them up to date with new ways of working. The manager wrote in the Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 25 AQAA that, ‘after induction, staff are supported to complete their NVQ and a criteria is followed to ensure that everyone is treated fairly and that all can access this qualification. Donec currently has two trained assessors’. Donec DS0000011876.V367394.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): Standards 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well managed home which is run in their best interests. Their health, safety and welfare is promoted and protected. EVIDENCE: The manager had many years of experience of working in and managing homes for younger adults. She was suitably qualified, having gained a National Vocational Qualification at level 4 in Care and the Registered Managers Award. She also had previously held a social work qualification and was an NVQ assessor. Meetings were held regularly to enable service users views to be heard and the manager stated that service users take an active part in their yearly reviews, which were also attended by care managers and relatives. Key Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 27 workers offered continuity and consistence to the service users and supported them to express their feelings and views and enabled them to be involved in decision making about all aspects of the running of the home. The Annual Quality Assurance Assessment (AQAA) completed by the manager and sent to the Commission for Social Care Inspection recorded that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body. Certificates were available to confirm this. Policies and procedures and codes of practice in relation to Health and Safety had not all been reviewed in a timely manner to ensure the staff were kept up-to-date with current legislation and practice. However, the staff training matrix confirmed that training in manual handling, health and safety, food hygiene, first aid and fire training had been regularly updated to inform the staff. Records were kept of accidents and other serious incidences and the home informed the Commission for Social Care Inspection appropriately about such events. A maintenance person was employed to deal with the ongoing programme of maintenance and repair and to ensure the environment was safe for the service users. The staff, who completed surveys, thought the home was good at providing training, with good support and development meetings. They thought that the quality of care was good, that the staff team were happy and friendly and provided adequate support to the service users. They also thought the atmosphere at the home was ‘homely’. One staff member thought there was nothing the home could do better, ‘as far as I’m concerned the service is brilliant as it is’. Another carer thought that listening to the staff more could improve the service Donec DS0000011876.V367394.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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA32 YA33 Regulation Requirement Timescale for action 24/09/08 2. YA34 18(1)(a)(b) Sufficient numbers of suitably qualified, competent and experienced staff must be employed to meet the needs of the service users. The use of temporary staff must not prevent service users from receiving such continuity of care as is reasonable to meet their needs. Schedule 2 Persons must not be employed (6) to work in the care home unless a full employment history with a satisfactory written explanation of any gaps in employment has been obtained to ensure they are suitable to work with vulnerable people. 27/08/08 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. Donec Refer to Standard YA24 Good Practice Recommendations Whilst it may be reasonable to not have a long term plan DS0000011876.V367394.R01.S.doc Version 5.2 Page 30 of refurbishment in place, because the home will be obsolete within a year, it is important to keep the communal areas of the home tidy, in a good state of repair and ensure they are reasonably decorated. Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Donec DS0000011876.V367394.R01.S.doc Version 5.2 Page 32 - 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. 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