Inspection on 09/06/08 for Drayton Wood

This inspection was carried out on 9th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Drayton Wood 08/06/09

Drayton Wood 14/06/07

Drayton Wood 21/06/06

Drayton Wood 04/01/06

Drayton Wood 26/07/05

Drayton Wood 18/01/05

Drayton Wood 24/05/04

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

CARE HOME ADULTS 18-65 Drayton Wood Drayton High Road Drayton Norwich Norfolk NR8 6BL Lead Inspector Mrs Judith Last Unannounced Inspection 9th June 2008 02:40 Drayton Wood DS0000027499.V366156.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 Drayton Wood DS0000027499.V366156.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. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drayton Wood Address Drayton High Road Drayton Norwich Norfolk NR8 6BL 01603 409451 01603 426568 bennellcare@tiscali.co.uk 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) Benell Care Services Limited Ms Sonja Serruys Care Home 36 Category(ies) of Learning disability (36) registration, with number of places Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. In total thirty six (36) people of either sex, who have a learning disability, may be accommodated. Nine (9) people, of either sex, with a learning disability may be accommodated in Drayton Wood main house. Six (6) people, of either sex, with a learning disability may be accommodated in Cedar Lodge. Seven (7) people, of either sex, with a learning disability may be accommodated in Holly Lodge. Seven (7) people, of either sex, with a learning disability may be accommodated in Honeysuckle Lodge. person accommodated in Honeysuckle Lodge will be no more than 25 years. Seven (7) people, of either sex, with a learning disability may be accommodated in Spruce Lodge. 14th June 2007 6. Date of last inspection Brief Description of the Service: The home is registered to provide services to adults with learning disabilities who are between the ages of 18 and 65 years. Drayton Wood is set in seven acres of landscaped gardens and forty acres of woodland. In the grounds there are pens for pygmy goats and chickens and there is an aviary. At the present time there are, on the site, five houses accommodating service users. Drayton Wood is the original building and dates back to Victorian times. There are four much more recent purpose-built houses known as Holly Lodge, Cedar Lodge, Honeysuckle Lodge and Spruce Lodge. Although the five units are registered as one, they function almost independently of each other with separate staff teams and service users with different needs. The main house, Drayton Wood, provides accommodation for up to nine service users. There is one shared bedroom that is used for couples wishing to share, and seven single bedrooms. Seven of the eight rooms have en-suite facilities. There is a large lounge and dining area and a dedicated busy colourful day care centre. Honeysuckle Lodge and Holly Lodge provide accommodation to 7 people, in single rooms with en-suite facilities. Cedar Lodge accommodates 6 people. Each home has its own kitchen and dining facilities, and living rooms. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 5 One further unit for 7 people, Spruce Lodge, has been completed since our last inspection. It is registered to provide accommodation for up to 7 people in single rooms with en-suite baths or showers. There is a shaft lift to help people access the first floor. The home is located within easy access to the City of Norwich and other nearby towns and villages. Drayton Wood was awarded the Investors in People Award in December 2004 and this has been renewed in December 2007. This is given for commitment to staff training. Fees are from, £458.00 to £1003.86 per week, dependent upon needs and dependency, with additional charges for hairdressing, chiropody, transport and personal spending. The manager says that the inspection report is made available to people who ask for it. It is left in the reception area of the main home but sometimes goes missing from there. In the past she has written to relatives to tell them how they could access the inspection report. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 6 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. We spent six hours in the home. Before making our visit we reviewed all the information we have about the home and looked at detailed information that the manager was asked to send to us. We also wrote to people before we visited to ask what they think about the service. We had written comments from four staff members, nine people living at the home and two relatives. During our visit the main method of inspection used was called “case tracking”. This system is used to see what records say about people’s needs, and to find out from observation and discussion what happens in the daily lives of people living at the home and the outcomes they experience. We also looked around a part of the home, talked to four staff and nine people living there. We watched and listened to what was going on so we could see how people were being supported. We used this information and the rules we have, to see how well people were being supported in their daily lives. What the service does well: Staff work very hard to support people with activities that they enjoy and to make sure that people are included in society regardless of their disabilities. This includes using local facilities like shops and pubs and supporting people who want to apply for jobs. They have also made sure that people who want to can vote. This means that people have a fulfilling lifestyle and that staff help to promote their rights. People live in homes that are generally well maintained and most of them have their own bath or shower rooms. People told us that they like this and also that they like having keys for their rooms so that they can keep things private. The staff work hard to make sure that the home is clean and safe for people living there. Staff say they know what to do if someone raises a concern. They know who they should report these things to. Everyone we spoke to told us they know what to do if they have any concerns about their care or the way they are treated. This means that they know how they can get things put right. One person living at the home wrote to us that: “I feel that the staff are marvellous” Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 7 The manager works hard to make sure that the staff are well trained to give them the knowledge and skills they need to help support people properly. Where people’s support plans set out the kinds of things they need prompts, support or praise for, the records that staff keep show that this is given. This means we can see that staff are giving people the support that they need to reach their potential and to learn and practice new skills. What has improved since the last inspection? What they could do better: We still have concerns about the way medicines are managed and have set out two things that need to happen by law. One of these we told the manager about the last time we went. The systems for checking and recording medicines kept in the home for people need to be improved. If they are not, then the management team cannot be sure people have had the tablets or medicines they have been prescribed, and cannot be sure that medicines have been given safely. They need to look at the checks staff make when they are preparing and signing for tablets, so that they do not forget things that have been prescribed, Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 8 or can put it right immediately if they have missed something out. This is so people get the treatment they need to keep them well. The manager needs to make sure information about fees is set out clearly in the guides given to people or their representatives who are helping them make decisions about moving into the home and whether it is the right one for them. The manager knows there are some other things that she needs to look at and has done something about some of these already – for example, how she looks at the quality of the service and takes people’s views (including those of staff) into account. Since the inspection visit took place the manager has provided us with information to show that she is addressing the requirements we have made in this report. 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. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 9 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 Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 10 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): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs EVIDENCE: There are service users guides for each of the separate homes on this site. They are available in simplified picture formats for people living at the home and there are separate records on file for people who have been admitted recently, that show the format used and the date on which this was explained to the person. Where possible this record is also signed by the person concerned as well as by the staff member. This shows efforts are made to ensure that people have the information they need about the home and what it can offer. Seven out of nine people who completed their comment cards say that they had enough information to decide about moving there and one additional person says that their mother had the information. Placing authorities have the information about fees and what these will cover and this is also set out in contracts. However, it is not in the full format of the service users guide where regulations say people thinking about using the service (or their representatives) should be able to find it. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 11 We checked the records for five people who have moved in since our last visit. These all contained assessments of their needs completed with the necessary information and had been signed by both the manager and the person whose assessment it was (where people are able to sign). Where people have needed to move in a hurry, care managers have completed assessments. A staff member told us that they had found the assessments to properly reflect people’s needs so that they knew the service would be able to meet them. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives, and for the most part, play an active role in planning the care and support they receive. EVIDENCE: We looked at support plans for five people. These are compiled from assessments and generated from a computer programme known as “Residata”. They cover a range of issues and the support people need – for example in relation to personal care, health care, mobility, communication and managing finances. Under each heading there are objectives for care and the support staff need to offer, as well as any associated risks and what staff are to do to minimise these. This means there is clear information about how people’s needs are to be met. The practice of updating and reviewing support plans is variable with dates on some print outs not showing they have been reviewed or updated in the last six months as set out in standards. For example, in one person’s record part of the information did not show it had been updated since June 2007, and Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 13 another part since November 2007. One staff member told us that there has been a problem with the network link for printing this information and keeping it up to date. A review sheet is kept in one house and dates on these did show that people’s support plans were looked at regularly to make sure they were up to date and show people’s current needs. However, again they did not match the print out dates. This means support plans do not always show whether they are a proper reflection of people’s current needs. In some cases the support plans have been signed by service users, but this is not consistent so doesn’t always show how they are involved. However, people we spoke to told us that staff talked to them about what they wanted to do and how staff could help. Eight out of nine of the people who wrote to us say that staff always listen to and act on what they say. They say staff look after them well. We heard staff encouraging people and prompting with activities. This interaction was consistent with the support plans we saw which showed where people needed praise or prompting. This means that staff show they understand people’s needs and help them develop and practice skills. Each support plan contained information about the support needed with managing finances and how people needed to be supported with budgeting, or withdrawing money from the bank. Staff do this for one person who has a busy programme of activities and is out most of the weekend. We spoke to the person about this. They told us that they were quite happy for staff to do this on their behalf. Support plans also show the involvement of family, befrienders or advocates (and reflect difficulties securing input from the latter). They do not all include photographs of people to make it easier for new staff to understand and relate information about people’s needs to the people living in the home. People’s routines are set out and guidance for staff shows where these might have to be more structured due to other obligations – for example where one person needing prompting to be ready for the transport to day care. All four staff who wrote to us say the way that the way information about people’s needs is communicated, usually or always works well. We asked staff on duty about this and they felt that they had the information they needed where things changed. One person did reflect that sometimes it was difficult to catch up where staff had been on leave or days off, but that information was available. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are supported to live a fulfilling lifestyle and to develop their skills. People’s social, recreational and educational needs are taken into account. EVIDENCE: Everyone living at the home who wrote to us told us that they choose what they are going to do throughout the daytime and can decide what to do at weekends. People we spoke to say that they get to decide what they want to do. One of the people we met does not have verbal communication – although they were able to understand and respond to what staff said when asked to get their shoes if they wanted to go out. A staff member told us that “objects of reference” (specific items that might help the person make choices about activities) are used. This means that staff try to find ways of communicating that the person will be able to use and to understand. One staff member told Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 15 us that staff have had some training in signing in the past. Regrettably the staff member trained as a communication coordinator has left. Support plans reflect people’s spiritual beliefs. Three out of four staff who wrote to us say that they always have enough training and information to help meet people’s diverse needs – for example in relation to faith, culture, sexual orientation. Some people have weekly activity programmes that allow for them to have time at home, away from structured day services. They told us that they would do some cooking, cleaning and shopping. One staff member told us that someone liked to carry out some chores the night before so that they could “trade this” for the staff support doing other things on their day off. This means that people are able to make choices about their activities and programmes. One person’s file showed that they had been referred to an occupational therapist to develop and learn independent travel skills. Records show some difficulties with this and that it would be resumed after the dark winter nights. However, we could not see that staff had chased this, or that the decision had been made at review that it was no longer appropriate. This means that the person may not be reaching their full potential at present. The file for one person we saw shows they have attended a cookery class. People told us they have opportunities to do some cooking in their homes. We saw letters from prospective employers on files showing that staff tried to help people find employment if that is what they want to do. When we have visited before, people have showed us certificates for college courses they have attended. Records show that people go out to local facilities and when we visited one person told us they were going shopping. We heard them planning what to buy with a staff member. Our past visits have shown us that some people go out unaccompanied to the local shops. One person told us that they go into Norwich. Records also show other people going out on trips such as to the coast, out for lunch, theatre visits and social clubs. This means people are able to benefit from facilities in the community. Support plans contain confirmation from the local council that people are on the electoral register and where they have applied for postal votes with staff support. This means people’s right to citizenship (the right to vote) is promoted. One group of people told us that they have planned a holiday to Blackpool and they were looking forward to this. Another told us that they were saving for their holiday and staff were helping them budget for this. One person says they are going to Spain. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 16 Two people spoke to us about their hobbies and said that they like to knit. One person says they like to embroider as well. Both told us they had the things they need to do this. One person likes horse riding and collects ornaments of horses. One person, who has not been at the home long, was very pleased to tell us that they now have a piece of garden and are growing vegetables. They showed us this and seedlings in their greenhouse. These things tell us that people have the opportunity to keep up their hobbies and interests and to learn new skills. The home has supported people with relationships in the past and continues to do so. The organisation also has a policy on personal and sexual relationships and these are supported where they are not exploitative and where people have capacity to consent. The manager has information relating to sexuality and relationships for people with learning disabilities and can use this to refer to or pass on to staff when it is needed. She says they plan to continue promoting equality and diversity by delivering training for staff specifically geared for people with learning difficulties –promoting their “Rights, Responsibilities and Risks – Living Safer Sexual Lives”. People told us that they see their families. One person says they go at weekends and records show this contact. One person told us that some of their family had visited them at their home and also that other family members would telephone. Some people have telephones in their rooms and clearly value this because they can take calls from friends and relatives in private. One person wrote to us that: I have got friends here People we spoke to say they have keys for their rooms. One person left this in the door and said they might use it sometimes. One person we saw used theirs. Two people confirmed they had keys for the front door of their home. We know from comments we had at our last visit that people who are able to manage keys are offered these. People told us they like this because they can keep things private if they want to, and can come and go as they please. Support plans show whether people wish staff to open their mail and assist with this. While we were visiting, one person who had signed agreement for this, had unopened post taken to them to open and have the staff member assist with its content if necessary. During the evening meal in one house we heard staff talking to people living at the home rather than each other. There was a lot of laughing and chatter on both sides and people told us that they got on well with the staff. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 17 People’s responsibilities for keeping their rooms tidy and clean are set out in guides to the service. People told us that they do their housework. We heard one staff member prompting someone about finishing the task and praising the person for what had been achieved. People we spoke to were proud of their rooms and how they kept them clean. Four people asked to show us what they had done. The rules on smoking are set down. Risks associated with the consumption of alcohol are taken into account, particularly in relation to medication. Records show that people do have the opportunity to drink responsibly when on outings. One person says they like to go out for a beer. As at previous inspections, people have the opportunity to plan menus. Staff told us that they sat round the table and got together with people to discuss this. Three people we spoke to confirmed this. This means that people get the chance to decide what they are going to eat. People we spoke to told us that the food was good and they liked it. One person wrote to us that: The food is nice Support plans show when people might have difficulties with weight gain or loss, and weights are recorded. This means that staff can support someone appropriately where there are problems that might affect people’s health. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care that people receive is based on their individual needs but with potential compromise to people’s privacy when staff are helping them. The management of medication needs attention to show that people are protected from errors. EVIDENCE: People’s personal care needs are set out in support plans. Where they have en-suite facilities they clearly value these. Several people told us that they really like having their own bathroom (or shower room). Plans set out where prompting, encouragement or assistance is needed and also where supervision is necessary for someone’s safety, for example because of epilepsy. We were concerned that one “accident” report for staff, referred to an occasion where a person living at the home had hit them with a cushion while they were “assisting [x] in the shower room”. This implied that the person’s privacy could have been infringed while they were being supported, because another person living at the home had been able to get into the shower room. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 19 Support plans reflect people’s self esteem needs and one identifies that the person responds positively to praise about their appearance. Daily records show this happens and record the person’s response. This reflects that people are encouraged to take a pride in their appearance. There are records that show when appointments such as for chiropody have taken place, and health related correspondence is on file showing appointments with other professionals. Each person now has a “health plan” folder and work is in progress to complete these so that they provide a full picture of people’s health care needs and how these are to be met. They also show the people involved so that staff can support people with the right contacts for appointments. Staff say they have training in administering medication. We saw workbooks supplied by the local pharmacy to help them understand what they should be doing. The manager also says that staff have had training in the ordering, receipt and disposal of medicines to help with an audit process so senior staff can be sure people have had the medicines they are prescribed. However, we have concerns about the adequacy of this process in helping to protect people from error. We looked as medicines in detail in one of the units, where records and supplies had been in use for just under three weeks. We saw that there are no balances carried forward recorded, to help with the audit process for medication that is only needed from time to time. One person’s medicines showed a discrepancy of two tablets that were surplus based on the records. This means that the person could not have had all the doses prescribed and recorded as given. The person needs the medication to help control epilepsy and if it is not given properly they are at risk of having more seizures. The reverse of one medication administration record has been annotated for 3rd June saying that one drug was not given as it was “forgotten”. This meant the person did not have the medication that their doctor considers they need to keep them well. One person has been prescribed a medicine to help thin their blood. There is information for staff to refer to. We saw that an appointment for blood testing had been arranged so that the doctor could adjust the dosage if necessary. The chart for recording administration had been written clearly with dosages and numbers of tablets to be given so that staff had the right instructions to follow. However, as with other medicines, there was no balance carried forward recorded on the chart. This means that checks and audits would not be able to show the correct dosages were being given over time. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and could be sure these would be dealt with. There are measures in place to help protect people from abuse. EVIDENCE: All of the people who wrote to us, and everyone we spoke to, say they know who to talk to if they have any concerns about their care. They say that they do not have any complaints and are very happy about the way that staff support them. Support plans show that the service users guide is explained to people and part of this is about how people would complain if they needed to. The manager’s records show two complaints since the last inspection, both of which were dealt with promptly and thoroughly. All of the staff who completed comment cards told us that they know what to do if someone raises concerns about their care. Staff told us that they have training in how to protect vulnerable people and say that they would report any concerns to their managers. They showed us telephone numbers that were freely available to them and say that they can call any time. This means there are measures in place to protect people and to take their concerns seriously. Recruitment records show that staff are checked before they start work, to make sure that they are not listed as unsuitable to work with vulnerable people. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 21 The people we spoke to say that they feel safe at the home. Several people told us it was much better than where they used to live. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and safe environment that suits their needs. EVIDENCE: We did not look around all the different houses on the site but we were invited to see the rooms of some of the people we spoke to. We looked briefly at the reception, staircase and landings in the older part of the service. The sofas in the hallway have been replaced since our last visit and so are in much better condition. The outside of the building remains in need of attention to woodwork - above the ground floor office in particular. We saw the outside of four other units. People had access to gardens and garden furniture and we saw that people were using these to enjoy the fine weather. Some people were playing ball in their garden. We saw rooms in two other houses that were in good condition, well maintained and well decorated. Three people showed us their rooms and the facilities. They are very happy with these and say that they like living at the Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 23 home. People visit one another if they have friends in other houses on the site. One of the houses we visited had a shaft lift to help people who find stairs difficult. Two people told us this was better than what they had in their previous home. Records show that fire detection and fire fighting equipment is tested and maintained regularly. Some of the flowerbeds in the grounds are overgrown. However, people say that they enjoy being able to walk around and the grounds are large and spacious for this. Two people are supported with their own vegetable gardens. A relative suggested to us that they would welcome the development of a sensory garden in the courtyard between buildings, with raised beds and seats so people had additional stimulation. We saw that the individual homes and communal areas of the main home were clean. We have seen previously that there are systems in place to make sure that hygiene and food safety is promoted. The information the manager sent to us says that staff have training in infection control and 84 of the staff have been trained in food safety. A chart we saw shows that the management team have looked at training to make sure that they arrange updates when these are needed. This means that staff have the underpinning knowledge to help minimise the risk of hazards from food safety, and to control infection. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 24 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 and 36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff working at the home are well trained and have a good understanding of how to support people who live there. EVIDENCE: We looked at staff training files to see the range of training that was on offer. The manager has acted to update her lists now the training officer has left - as it was difficult to see when time limited training was due to expire. We saw that this has been planned out and that the training needed as it was reaching expiry date, had been arranged. This means that staff can keep their knowledge up to date and so support people more effectively and safely. The manager gave us up to date information when we visited about the numbers of staff. There are 36 care staff working in the six homes on the site. Of these, the manager says 11 people already have National Vocational Qualifications. A further 8 people are already on the course and two are awaiting registration, based on information from the manager and administrator. This will give well over half of the staff the underpinning knowledge to help support people properly. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 25 Staff we asked about training said it was good. All of the four staff who wrote to us said they were given training that was relevant, helped them to understand people’s needs, and kept them up to date with new ways of working. We saw evidence in a letter that the home that it has been awarded Investors in People (Dec 2007) again, for its commitment to training staff so that they are skilled and competent to support people properly. Staff keep their own induction training information so it was not always easy to see this was delivered in a timely manner. However, we did see induction files for two people. One person is repeating some of what had been done before because of the training officer having left. Work is being undertaken to address the delivery of induction. However, everyone writing to us said it mostly covered (and in one case that it covered well) what they needed to know to do the job. The manager says induction also covers equality and diversity issues so that staff are aware how people might be discriminated against and to help support them in their work with people who have disabilities. We looked at recruitment files for three staff who have been appointed recently. These showed that checks are made to show applicants have not been banned from working with vulnerable people. There are references, proof of identity and photographs to help with these checks and show that recruitment takes into account the safety of people living in the home. Staff say that they can approach their managers to talk about their work or what they are finding difficult. All four people who wrote to us say that they meet with their managers to talk about their work, half say this happens regularly. One person says it happens often, and one says sometimes. Staff we spoke to say they have supervision. One staff member told us they tried to provide supervision about once every two months, depending on leave, but was not able to provide records to support this. Because of this, we asked another two members of staff in the same house whether they received supervision and were told they did - and that this was about once every two months. Each house has its own staff meetings. We saw records in one house showing they happened every two months and in one case provided for a frank exchange of views, showing that staff are able to raise issues that concern them. However, all staff completing written comments who responded to the question about what could be done better, say that communication could be improved Comments included: Communication could always be improved Communication could always be improved so that staff are fully aware of changes in residents needs and health. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 26 Communication within the other houses. Communicate as a company and not individual homes. The manager says in information that she sent before our visit, that they could do better in keeping communication lines open between staff and management. We discussed this issue with her and she says that she will be looking at what they can do to address it. People living at the home told us they were very happy with the staff. One person wrote to us that: I feel that the staff are marvellous and do their job correctly. Not only that, I dont want any of them to leave. Im happy with everyone here, they have been kind and helpful to me. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is accessible to people living and working there, although there has been some slippage in showing how people’s views are taken into account in its development. People’s health, safety and welfare is promoted. EVIDENCE: The manager is qualified and experienced in her post. She undertakes periodic training to help her with her role and we could see this on the training matrix. The structure of the home provides for each unit to have a team leader, and the manager has a deputy to take responsibility for the day-to-day running of the service in her absence and to coordinate the operation of the other houses. This means that there are clearly defined routes for people to resolve issues, and clear lines of accountability. Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 28 People living at the home know who the manager is and where she is based if they need to contact her. One relative wrote to us: “I think Drayton Wood is a great example of how a care home should be run.” There is current insurance cover for employer’s liability. There are residents’ meetings in individual units although these are not always recorded. In one place, records showed they happened about once every two months and people’s suggestions and views were written down. This confirms what the manager told us in information she had sent. In another, there were no records since August last year, although we were told that people met informally and discussed things around the meal table. People living there told us that they talked to the staff about things they wanted to do. They told us they liked their home. Team leaders are expected to audit the quality of services provided in their own units. However, in the examples we saw, the information was not complete for each house. There had been no resulting actions drawn up to address any shortfalls that might impact on the service people receive. . The manager claims in information that she sent to us, that the quality of the service is monitored in questionnaires that are carried out in April and a development plan for improvement is made from these. There was no evidence available in the home to support this. The manager contacted us after the inspection to say this was an oversight that she is now arranging this survey for July, as it is overdue. She says she will analyse the results after that. We have not made a requirement because she has said she will take the action needed to show how people’s views are taken into account in improving the service. Some information the manager sent to us was not fully completed. The manager says this is because she filled in the wrong form so there was nothing about people’s “individual needs and choices” (section 2 of this report). There was also no information about the gender, age and ethnicity of people living in the home. The manager contacted us after the inspection to say that she has now reviewed the information. The manager says she will make sure that she fills in our form to tell us everything she needs to, when we next ask for the information. Because she has acknowledged the shortfalls and has already done something about it, we have not made a requirement. Although the formal process for looking at the quality of the service was not up to date and fully complete, the people we spoke to and those who wrote to us told us that staff listened to them and acted on what they said. This means that people feel their views are taken into account. We looked at a sample of health and safety records in individual units, and at staff training. There is a health and safety policy for the organisation and staff Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 29 have training in this and first aid. These areas help to help promote people’s safety and welfare. The fire alarm system for the home is certificated (displayed in the main home) and records in other units show it is serviced regularly. Call points and emergency lights are tested regularly, based on records we saw. Fire extinguishers are serviced annually. (Records for this in one part of the home are not all up to date as they have not been entered in the record log since November 2006, but there are stickers on the extinguishers themselves showing they were tested in May.) This means that equipment needed in the event of a fire should work properly and give people time to get out safely. We saw information in services about the cleaning products they use and how these are to be used safely. There are risk assessments for activities carried out by staff and those that people living at the home might participate in. This means that staff have clear guidance about how to keep this activities as safe as possible. Overall, there are measures in place to help ensure the homes are as safe as possible for people who live and work there. Drayton Wood DS0000027499.V366156.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. 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 2 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 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 OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 3 x 2 x x 3 x Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement Information about the range of fees must be included in the full format of service users guides so that representatives of people thinking about moving there, have all the information they need to help make the decision. Outstanding requirement Systems for recording medication must provide for a clear audit trail. This is to ensure errors can be easily and promptly identified to protect service users from misuse. Previous timescale of 31/07/07 has not been met. Staff must be competent to follow safe and proper procedures for checking medicines so that medicines are not “forgotten”. The system needs to provide for prompt identification of errors or omissions so that they can be addressed promptly. This is so people are better protected from error and to ensure they get the treatment Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 32 Timescale for action 31/07/08 2. YA20 13(2) 30/06/08 3. YA20 13(2) 30/06/08 they have been prescribed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Action should be taken to resolve issues with dating support plan information to more clearly show when this has been reviewed and updated with people, as added evidence they reflect people’s current needs. The practice of including photographs on support plans should be extended to all the units on the site. This is so new staff find it easier to identify whose information they are looking at and to provide a useful reference to people who might want to look at their own support plans. Where specialist input has been put on hold for any reason, staff should assist people to follow it up so that any progress or training opportunities people might benefit from, are not missed. The management team should look at the way communication works so that they can address why staff feel this could be better. 2. YA6 3. YA12 4. YA39 Drayton Wood DS0000027499.V366156.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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