Inspection on 28/06/07 for Dramsdon

This inspection was carried out on 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Dramsdon 13/03/06

Dramsdon 11/08/05

Dramsdon 22/02/05

Dramsdon 27/08/04

Dramsdon 18/03/04

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 08/07/2008.

CARE HOME ADULTS 18-65 Dramsdon Rivar Road Shalbourne Marlborough Wiltshire SN8 3QE Lead Inspector Roy Gregory Key Unannounced Inspection 28th June 2007 09:30 Dramsdon DS0000028600.V335500.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 Dramsdon DS0000028600.V335500.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. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dramsdon Address Rivar Road Shalbourne Marlborough Wiltshire SN8 3QE 01672 870565 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) White Horse Care Trust Mrs Elizabeth Lavis Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than five service users with a learning disability at any one time. 13th March 2006 Date of last inspection Brief Description of the Service: Dramsdon is provided by the White Horse Care Trust, which has several care homes throughout Wiltshire and beyond. The home is located in a small village where there is a pub and one shop, on the Wiltshire/Berkshire border. It is a spacious bungalow set in secluded gardens. The service provides care and single room accommodation for five people under the age of 65 who have a learning disability. Some of the people who live at Dramsdon have complex needs. A small support staff team is headed by Liz Lavis, registered manager. Cooking and cleaning are undertaken by the support staff, as well as care duties. One staff member remains in the home overnight “sleeping in” in case of emergency, backed up by on-call arrangements. The home provides a sevenseater car, so people are enabled to go out regularly. Weekly fees payable for people currently living at Dramsdon range between £1118 and £1262. New admissions are not anticipated in the foreseeable future, but there is good information available for any prospective users, including a pictorial service user guide. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place between 9:30a.m. and 5:30 p.m. on Thursday 28th June 2007. The registered manager, Liz Lavis was available for most of the day. There were also conversations with support staff who were on duty during the day. On arrival the inspector found breakfast was underway. Later in the day, preparations for the evening meal were seen. All areas of the home were seen, including the bedrooms with staff assistance. There were observations of staff interactions with all the people who live in the home. The inspector looked at how medication was used and how the home links up with health professionals and other community resources. The care plans and records for two people were examined in detail. Other documents seen included staff records, for information about training, supervision and recruitment; and health and safety records, to see how risks to people were assessed and managed. Following the visit, telephone contact was made with the near relatives of two of the people who live at the home. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the experiences of people using the service. What the service does well: People’s support plans made sure their needs were understood. None of the people at the home had verbal communication skills. All support plans included a communication profile. A plan for one person contained excellent pictorial guidance to the signing that they used. Relatives spoken to confirmed they were invited to care reviews, and able to talk about care needs at any other time. Care plans emphasised a person-centred approach, to include respect for diverse needs. The people living in the home had been together for many years. Staff had a good understanding of the relationships between them. Relatives that the inspector spoke to said the home had always communicated well with them and been open to suggestions and comment. They were very pleased with the standard of care provided. One said, “They let me know anything. I go up when I can. I love the atmosphere.” Another said, “I can ring any time. It’s like a normal home, or as near as you can get. All opinions are valued. They inform me of anything happening”. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 6 For activities outside the home, there was a seven-seat car to take people out and about. Use was made of very local resources, such as a pub and village events, and people also went further, to places of interest and events. All people in the home went together on annual activity holidays run by a specialist trust, with the support of home staff. Records showed that staff were attentive to health needs, communicating promptly with GPs and specialist health resources when necessary. They had received and acted on nutritional guidance. The pharmacist inspector carried out a detailed inspection of medication use in the home in March 2007 and rated practice as “excellent”. Comments from relatives included, “I cannot praise the home enough” and “Y has the best care he could have”. The home was decorated to a high standard throughout and was very clean everywhere. All the bedrooms reflected the personalities and interests of their occupants. The large sitting room was a homely, “adult” space. There were attractive gardens to front and rear and there was much evidence of regular use of the outdoor space. Patio furniture outside the dining room meant people could eat outdoors if they wished. A relative said, “X loves the gardens and their own room and the house”. Records showed all staff were consistently involved in training. Staff were clearly familiar with the content of support plans. All interactions seen between staff and people being supported were sensitive and patient. Risk assessments seen were of good quality, with an emphasis on helping people to have a range of experiences. What has improved since the last inspection? What they could do better: As at the previous inspection, no shortfalls were identified in how the home complies with regulations. Three recommendations have been made. There was some excellent work on helping people to develop and maintain social and practical skills, but the evaluation of such work was not consistent. A detailed evaluation of what had actually been tried and what worked well would guard against the same goals simply being repeated year on year. Many kitchen units showed signs of general wear and tear, with missing trim and dropped doors. This meant cleaning surfaces to a satisfactory standard Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 7 was becoming difficult, so the kitchen should be upgraded before this becomes more of a problem. There was scope for archiving some material from personal records, so that only relevant information is kept to hand. It would be helpful to have a “front sheet” containing the most basic personal information. 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. Dramsdon DS0000028600.V335500.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 Dramsdon DS0000028600.V335500.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 & 2. Quality in this outcome area is good. Procedures and information are in place to ensure that any admission would be based on professional assessment and exchange of information. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at Dramsdon have been together as a group for many years. Staff and management recognise that this represents a support to each individual, so people’s needs are met partly by helping them stay together. No change is expected, so the prospect of admission of any other person is remote. Were a vacancy to arise, the provider Trust has an admissions policy and procedure that would be followed. This would involve assessment of the possible impact of a new placement on the people living in the home, as well as the person considering moving there. There was a pictorial “service users’ guide” that explained in simple terms the nature of service people can expect to receive. There was a detailed “statement of purpose”, which was up to date and contained all the information required. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is excellent. People’s assessed needs are reflected in care and support plans, which are reviewed and changed as necessary. People are supported in making choices in their everyday lives. Risks are identified, and assessed in a way that encourages safe participation in a range of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a support plan for each person. These used standard sections to give guidance on how to support people to meet their personal, physical and social needs. The plans looked at in detail were very individual, being clearly based on accumulated knowledge and regular reviews. They showed preferences about things like food, rising and bed times and how personal care should be provided. None of the people at the home had verbal communication skills. All support plans included a communication profile, which showed evidence of review at least annually. A plan for one person contained excellent pictorial guidance to the signing that they used. Staff spoke of a sign that had recently been Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 11 developed with the person to extend their degree of choice at mealtimes. This had been added into the support plan guidance. The person’s support plan included a goal agreed in May 2007: “Improve communication skills – maintain existing signs, offer more choices e.g. tea/coffee, reinforce the sugar sign.” People were assigned “key workers”, sometimes two. Their role was to oversee people’s needs for items such as clothing and toiletries, and to make sure care plans remained appropriate to people’s needs. Key workers were responsible for reviewing individual plans every two months. Plans showed they were also reviewed fully every year. Key workers and the manager took part in these reviews. Care managers were invited but did not always attend. Staff kept daily care notes about all the people in the home. These notes were concise and factual. They showed the physical and personal care that had been given, what food the person had eaten, any activities undertaken and the person’s response. The quality of information assisted in review of how well support plans worked to meet people’s changing needs. Different parts of support plans would refer to risk assessments where necessary. For example, a person liked to use a garden trampoline. The risk assessment showed the benefit and enjoyment from the activity. Ways of supporting safe use had been decided, by recognising and reducing the risks. All risk assessments seen were of good quality, with an emphasis on helping people to have a range of experiences. Observations of care confirmed that staff assisted people to make decisions by offering and facilitating choices. People went to different parts of the home and garden as they chose. Staff maintained awareness of where people were and how much support they needed at any time. They showed they were familiar with people’s preferred routines. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 – 17. Quality in this outcome area is excellent. People have opportunities to be part of the community and to take part in developmental and leisure activities appropriate to their needs. Their rights are respected and they are supported to maintain family and other important relationships. People are offered a healthy diet and enjoy their food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activity records were being kept for all people. The two records looked at in detail showed some activity was recorded every day. Activities within the house included use of audio-visual equipment in own rooms and in the sitting room, playing games and using the garden, which itself is well equipped. People also go out of the home a lot. There was some use of local day resources, although the future of these was in some doubt. On the day of the visit, attendance had been cancelled for one person, as was increasingly happening. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 13 For activities outside the home, there was a seven-seat car to take people out and about. A number of “social drives” were recorded. Other outings were to specific events or places of interest, or to undertake shopping. Use was made of very local resources, such as a pub and village events. Resource centre, outreach work and family contact were also recorded, to give an overall picture that people benefited from plentiful engagement and stimulation, appropriate to their age, gender and levels of understanding. When the home’s car had been unavailable for a time, it had been possible to borrow one from another home in the Trust. As this did not suit one of the residents, another car was also hired for two weeks. All people in the home went together on annual activity holidays run by a specialist trust, with the support of home staff. Liz Lavis said these had been very successful, including for those that preferred watching to full participation, as the accommodation, staffing levels and ethos all fitted well with the needs of people in the home. Two people had also been supported to have a selfcatering walking holiday in Dorset. People’s individual plans included activity goals. One person’s was signed by their key worker, care manager and the deputy manager. It included as an aim: “To prevent boredom and under-stimulation”. The means identified were to continue a focus on developing communication skills, to increase external activities, to increase use of a massage bed, to offer a choice of walks and to provide some cooking experience with a particular member of staff. Most goals were repeats of the previous year’s, with “progress” reviewed as “ongoing”. Such work can need a long time to show real change, but the plan would have benefited from more evaluation of what had actually been tried and what worked well. This contrasted with another person’s activity plan, which showed a much better standard of evaluation. The White Horse Care Trust has a written commitment to developing “person centred approaches” in the care provided. The home has a charter for implementation, which staff have signed up to. One development from this was that people had questioned whether all the male residents were happy to be shaved every day. At the time of the visit, two men had grown beards. This appeared to be a very satisfactory outcome for them. Staff showed patience and understanding in all their interactions with people. When the inspector arrived at the home, breakfast was still in progress and staff ensured meeting people’s needs at the table remained their priority. Friendships between the people in the home have existed and been maintained over many years. Staff spoke a lot about this. They showed sensitivity in helping people be together when they wished, and to enjoy private space at other times. Visits and other contacts with family members were facilitated. One relative told the inspector, “They let me know anything. I go up when I can. I love the atmosphere.” Another said, “I can ring any time. It’s like a normal home, or as near as you can get. All opinions are valued. They inform Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 14 me of anything happening”. One person had no significant contacts outside the home. There was a record of attempts to find an advocate for them. It was recognised that friendships made through day services needed to be sustained if possible. For meals there was a six-weekly menu in operation. Kept with this were recipes for staff to follow. Staff said they were able to use their respective strengths in the kitchen, for example, one was acknowledged as a skilled baker whilst another produced hearty soups. Staff had received some training from a dietician in March, 2007. Individual care plans contained nutritional guidance and, for one person, advice from a speech and language therapist on managing a swallowing difficulty. Staff were clearly familiar with the content of plans. Ways had been developed to support a blind person to make some choices by touch. The kitchen was essentially out of bounds to residents for health and safety reasons, but was configured such that contact was maintained with the living area next to it. Some people were able to assist with tasks such as taking used plates back to the kitchen after a meal. Residents and staff ate together in a homely dining room. This had patio doors to an outside eating area that was available in good weather. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is excellent. People received personal support in ways that they preferred and needed. Their physical and emotional health needs were being met. The arrangements for managing and recording medication ensured people were protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has long experience of meeting the personal care needs of all the people living there, in line with their preferences. This was reflected in good quality support plans that would enable a new member of staff to understand and to give the care people want and need. All examples of care support that were seen were careful and person-centred. All people were registered with a local surgery, which is also a rural pharmacy practice. Individual records confirmed that a GP visited people six-monthly for medication reviews. All visits to or from GPs and dentists were recorded in detail. They showed staff were proactive in recognising and acting on any concerns about health. Additionally, some people were in regular contact with consultants. One person’s records showed an ongoing exchange of information between a psychologist, speech and language therapist, and home staff, which Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 16 demonstrated “joined up care”. The latest stage reached in this ongoing work was reflected in recent changes to the person’s care and support plan. Monthly weight records were kept for all people, as changes may indicate cause for concern. “OK Healthchecks” were completed annually for each person and where appropriate, epilepsy profiles were in place. One person had been referred for community nurse attention to a possible pressure area concern. The immediate worry had been allayed, but the nurse had left pressure area care information and this was readily available to all staff. For the same person, skin care directions had also been received from their aroma therapist, and acted on. For another person, a home visit had been arranged with a specialist learning disability nurse to progress plans on how best to meet particular needs. The pharmacist inspector carried out a detailed inspection of medications practice in March 2007, following two errors that had been notified by the home. The errors were found to be the result of distractions, and were at variance with otherwise sound procedures and practice. The pharmacist inspector considered practice to be “excellent”. Her recommendation that “The written medication administration record should be signed and checked by two members of staff before being used”, as an additional safety measure for good practice, had been complied with. Medication training was prominent in the home’s training records, which showed clearly when individual staff members were due to have their competency re-assessed. A person’s external certificate in safe handling of medications was seen, as were examples of the White Horse Care Trust’s own competency certificate. There were good records of the receipt, administration and disposal of drugs. Support plans contained excellent guidance about use of any medicines prescribed for use “as needed”. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had recorded three complaints since the previous inspection. None of these related to care needs of people living there. The complaints record showed appropriate responses had been made and the Trust head office had been kept informed. Also on record was a compliment about the quality of care interactions, received from representatives of another care provider. The two relatives who were contacted were aware of the Trust’s provision for receipt of complaints, but were confident anyway that any concerns addressed directly to the home would be responded to adequately. The manager was aware of changes that had been made in 2006 to the local inter-agency safeguarding procedures, but had not received copies of the updated “No Secrets” booklets that give brief guidance to the procedures for staff. She undertook to obtain these. Abuse awareness was a standard component of induction and renewable training for all staff. Information on the Mental Capacity Act was available within the home. Behaviour guidelines formed part of support plans for three people. These were based on accumulated experience and external professional guidance. They were clear, and subject to regular reviews. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 18 Staff received training in physical intervention, in which the emphasis was on de-escalation and individual planning to avoid difficulties arising. People’s personal money accounts were checked during regular provider’s unannounced monitoring visits. Personal cash was kept safely in separate wallets. Log sheets and numbered receipts were kept for all personal expenditure. On trips and holidays, people’s meals and fuel usage were paid for by the service, on the basis that such needs would have to be met at home. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 & 30. Quality in this outcome area is excellent. Dramsdon provides a homely environment, maintained and kept clean to a high standard. Individual bedrooms reflect people’s needs and lifestyles. They have access to pleasant and usable shared spaces. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was decorated to a high standard throughout. The maintenance book showed there was swift attention to any noted shortfalls. Servicing of the heating boiler and checks on electrical safety were all up to date. All the bedrooms reflected the personalities and interests of their occupants. The provision of pictures in a blind person’s room showed respect to them and their visitors. “Maintaining a safe environment” was an element in the person’s support plan that ensured familiar pathways were unobstructed and also gave important information about preferred temperatures. The building is owned by a housing association. Some safety glass was due to be provided by them in the hall area, during August 2007. Another upgrade that was becoming urgent was replacement kitchen units. These showed a lot Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 20 of signs of general wear and tear, with missing trim and dropped doors. This had reached a point where cleaning surfaces to a satisfactory standard was becoming difficult. There were good records of health and safety, and infection control monitoring by regular audits. Staff kept to a policy of not taking laundry to and from the utility room, which necessitated going through the kitchen, when food preparation was in progress. There were high standards of cleaning throughout the house, including in toilets and bathrooms. Protective clothing was available in appropriate places. People are well provided with communal space. The large sitting room is a homely, “adult” space. There are attractive gardens to front and rear and there was much evidence of regular use of the outdoor space. Patio furniture outside the dining room meant people could eat outdoors if they wished. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is good. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota provided for three staff on duty through most of the day and evening, increased to four on one day a week to enable support to day resource attendance. Recruitment to a full staff complement was proving difficult, perhaps owing to the relative isolation of the home. However, consistent staffing was enabled by use of White Horse Care Trust “bank” staff, and overtime volunteered by members of the staff team. At night, there was a sleeping-in member of staff. There was a lone working policy to cover this arrangement, and senior staff were made available on call. Two members of staff had been recruited since the previous inspection. For each the recruitment records showed an application form had been completed, three written references had been obtained, and checks with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) list had Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 22 been completed before people began working. They had a three-month probationary period appraisal. The manager had experience of arranging an extension of this period if there were issues needing to be resolved. Newly recruited staff went immediately onto the care trust’s own induction and LDAF (Learning Disability Awards Framework) induction, the latter leading on to NVQ training (National Vocational Qualification) in care. A recently recruited person said they valued their induction, which included learning about food hygiene and abuse awareness. Six out of ten permanent staff had achieved NVQ in care level 2, or were working towards it. Staff did not take on key working responsibilities until they had gained significant experience. Similarly, administration of medicines was introduced as a duty later on, and training for that involved being observed at least ten times before being adjudged competent. There was a training and development plan. All staff received compulsory training in first aid, manual handling, food hygiene, fire procedures, epilepsy awareness and abuse awareness. It was clear when individuals needed to renew these training elements, and records showed when different courses had been undertaken, with copies of certificates where these had been awarded. Records showed all staff were consistently involved in training. Records of staff team meetings showed they were used in part to ensure staff were familiar with changes to care plans and with the current issues for all people in the home. In the office there was a programme for supervision of all support staff, a task shared by the manager and deputy manager. This ensured staff members received regular individual supervision six times per year. This demonstrated compliance with a recommendation made at the previous full inspection in February 2006. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 23 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, 41 & 42. Quality in this outcome area is good. The manager provides leadership and direction so people benefit from a well run home. Quality assurance systems include obtaining the views of service users’ supporters to monitor and improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. Record keeping could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Liz Lavis, the manager, expected to achieve NVQ level 4, and the Registered Managers Award, within a year. She had recently obtained a certificate in equality and diversity. She was supported in management tasks by a deputy manager and by delegation of areas of responsibility to others. The manager and deputy were further supported by area peer group meetings organised by the trust. All staff seemed to be familiar with the various systems on which the Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 24 home relies for smooth running. The computer was being upgraded by the trust. The White Horse Care Trust undertook an annual survey of supporters of people who live in their homes, and of staff, to monitor satisfaction with their services and thus to influence business planning. The results of annual surveys were analysed in a professional way and were readily available in the home. The 2006 survey had included only one response in respect of Dramsdon. That respondent had indicated overall satisfaction. The two relatives the inspector spoke to considered the home and the trust were interested in their opinions at any time. Unannounced monthly monitoring visits by the trust included checks on fire precautions monitoring and other aspects of health and safety. An audit in May 2007 found some manual handling assessments had not been completed. These had now been done, showing the effectiveness of the monitoring. Two staff members shared delegated responsibility for overseeing health and safety management in the home. They had received training for the role in 2006, including training in risk assessment. Some environmental risk assessments were seen. They were of good quality and staff had been required to sign that they had read them. There was a record of wheelchair servicing. Information concerning people living in the home was not always presented in the most helpful way. There was scope for archiving some material, so that only relevant information is kept to hand. Contact information for accessing next of kin was invariably tucked away. It would be helpful to have a “front sheet” containing the most basic personal information. This could also double as a “grab sheet” in the event of anyone having to go into hospital. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 25 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 3 25 4 26 X 27 X 28 4 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 3 X 3 X 2 3 X Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA12 YA24 YA41 Good Practice Recommendations Evaluation of activity goals should always demonstrate how they have been approached and what aspects have been successful or difficult to achieve. The kitchen should be fitted with modern units and surfaces to ensure it can be cleaned to a satisfactory standard. Service users’ personal records should be slimmed down by archiving non-current information, and the most important basic information should be readily available at the front of each person’s record. Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Dramsdon DS0000028600.V335500.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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