Inspection on 21/12/05 for Elcot Close (5)

This inspection was carried out on 21st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elcot Close (5) 28/06/06

Elcot Close (5) 15/07/05

Elcot Close (5) 10/02/05

Elcot Close (5) 12/10/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Elcot Close (5) Marlborough Wiltshire SN8 2BB Lead Inspector Bernard McDonald Unannounced Inspection 21st December 2005 08:00 Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 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 Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 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. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elcot Close (5) Address Marlborough Wiltshire SN8 2BB 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) 01672 516320 White Horse Care Trust Mrs Christine Messenger Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (2) of places Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 5 No more than two service users admitted as younger adults with a learning disability may be accommodated after attaining their 65th birthday. 15th July 2005 Date of last inspection Brief Description of the Service: 5 Elcot Close is a spacious detached well-maintained property situated on the outskirts of Marlborough town centre The home is registered to provide residential care for up to five people who have a learning disability. It is managed by the White Horse Care Trust and is one of a number of care homes run by them. The house, which is in a quiet cul-de-sac, has a pleasant enclosed garden to the rear of the property and an open planned garden at the front. The home provides single bedroom accommodation for three service users and a shared room for two. The home has its own transport so service users can access the wider community and attend a range of health care provision. Typically the home provides a minimum 2 staff on duty during the day. At busy times extra staff may be deployed. There is no awake staff at night. Instead support staff take in turns to sleep in so as to be available to respond to any night time needs as they arise. Additionally there is an on call system in operation so extra help can be summonsed in an emergency. The home encourages and enables service users to maintain their independence. The philosophy of care is in line with the principles of John O’Brien’s five accomplishments. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed in a total of four hours. Before the inspection commenced the inspector received a number of comment cards from the relatives of service users, which indicated they were satisfied with the care provided at the home. The inspector had the opportunity to view all areas of the home, meet with all service users and examine all care plans. The inspector interviewed service users in private and in small groups to obtain their views on the service they receive. In addition the inspector met with two support staff that were on duty. There was one requirement outstanding from the previous inspection. Preliminary findings of the inspection were fed back to one member of staff at the end of the inspection. What the service does well: This is a small care home where service users expressed satisfaction with the care they receive. Observations made during the inspection demonstrated a good rapport between staff and service users. Care plans were comprehensive and demonstrated how service users needs were being met at the home. Systems for reviewing service users care needs were well managed and service users confirmed they had been involved in their care reviews. There was evidence to demonstrate service users are involved in the running of the home and are able to learn and develop independent living skills. In particular service users are encouraged to participate in the planning and preparation meals and also assist with some domestic tasks for which three service users receive payment. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 7 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 Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5. The home ensures service users needs are assessed prior to admission and that service users are made aware of the terms and conditions of their stay. EVIDENCE: There have been no admissions to the home since the last inspection. The inspector examined the contracts of all service users. Following a requirement made at the last inspection service users have signed the abridged version of the contract. Discussion with staff confirmed the contents of the contract had been discussed with all service users. One service user commented “it was done at my IP”, (individual planning meeting). Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9, 10. Care plans are clear and service user focussed. The handling of confidential information is well managed. The failure of the home to complete risk assessment reviews puts service users at risk. EVIDENCE: Examination of all care plans demonstrated how service users needs are being met at the home. The service users care plans were comprehensive and identified clear goals and the outcomes to be achieved. Discussion with service users confirmed they had attended their review meetings. The home is operating a key worker system and service users were aware who their key worker was. As part of the role of key worker a three monthly review report is completed to monitor the progress service users have made in meeting goals and to ensure the goals remain achievable. The inspector was concerned to find no progress had been made in reviewing service users risk assessments. The most recent review of risks for one service Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 10 user was completed in August 2004, while another service users risk assessments were reviewed in November 2003. The absence of any reviews means the home cannot ensure risk assessments remain appropriate or ensure the safety of service users. It was a requirement at the last inspection that risk assessment must be reviewed. The Commission has agreed to extend the timescale for meeting this requirement, however failure to complete the reviews within the revised timescale will result in the Commission taking enforcement action. Discussion with staff demonstrated a clear understanding of the principles of confidentiality. One member of staff commented that, “ nothing leaves the building and not to discuss service users outside.” One member of staff was aware of the policy relating to sharing information with other agencies. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 16, 17. The home is striving to ensure that service users rights are respected. Service users are provided with opportunities to develop independent living skills and are offered a healthy diet. EVIDENCE: Discussion with three service users confirmed they are involved in helping with domestic tasks around the home for which they get paid at the minimum hourly rate. One service user stated, “ they had just been given a pay rise” another service user stated “they enjoyed hoovering” while another service user, stated, “they liked dusting”. Staff confirmed one service user is supported to attend a Sunday service and other service users are asked if they want to go but have declined. Observations made during the inspection demonstrated there was an obvious rapport between service users and staff. Service users spoke positively about their key workers and their experience of living at the home. One service user commented that they “liked it here” another service user stated, “ I really like the staff.” All bedroom doors have been fitted with suitable locks, though in Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 12 practice these are never used by service users, as they prefer to leave their rooms open. Discussion with service users confirmed they help to plan and prepare meals. Staff confirmed the menu is normally planned a week in advance following consultation with service users. Three service users have a more active role in preparing one meal of their choice each week. The service users confirmed they enjoyed this task and liked to cook. Two service users stated the meals were “good”. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. The home is failing to ensure medication is accurately recorded when it is administered to service users. EVIDENCE: It is the policy of the home that no staff administers medication without having completed a drug competency course. This practice was confirmed by one member of staff recently appointed at the home who stated they were not allowed to administer medication. Examination of the record of medication administered to service users would indicate a need for staff to update their medication training. The inspector found a number of records had not been signed and was therefore unable to determine whether their medication had been given. This deficit was brought to the attention of staff on duty to ensure immediate action is taken to ensure service users receive medication as prescribed by their G.P. and an accurate record is kept. Medication is held secure in the home and separate records were kept to demonstrate medication received at the home and returned to the pharmacy. Service users consent to medication being administered by staff has been obtained. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The home is making every effort to ensure service users views are listened to and they are protected from abuse. EVIDENCE: Discussion with service users confirmed they were happy living at the home and felt safe. The home has continued to record minor “niggles” between service users that have not resulted in a complaint. This practice ensures service users views or concerns no matter how small are being recorded. The inspector received three comment cards from the relatives of service user. Two comment cards indicated they were aware of the complaints procedure and one indicated they were not. Discussion with service users confirmed they would speak to the manager or one of the staff if they had any concerns or complaints. No complaints have been received since the last inspection. Discussion with staff demonstrated an awareness of what action they would take to report any concerns regarding the welfare of service users. Policies on the local vulnerable adults procedures were in place. The home was holding money on behalf of service users. Examination of records demonstrated this money was being accurately recorded and receipts were being kept for money that had been spent. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. The home is providing a comfortable and homely environment. EVIDENCE: The inspector viewed all areas of the home including service users bedrooms and communal living areas. The home was clean, tidy and generally well maintained. A contract is in place to promptly respond to minor repairs. The home is accessible to all service users. The Trust plans to extend the home to provide an additional bedroom and bathroom on the ground floor. It is planned that the work will commence in the New Year. The home is situated on the edge of Marlborough and is in keeping with similar properties in the area. The home has it’s own transport to enable service users access the local and wider community. All service users spoken to at the inspection expressed satisfaction about their bedroom and the overall standard of accommodation. One service user commented, “it was nice” another service users said they had “everything they needed”. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35. The home is striving to ensure that service users are supported by a competent staff team. EVIDENCE: Examination of the rota shows there is a minimum of two staff on duty throughout the waking day. In addition one member of staff provides sleeping in cover. Discussion with staff demonstrated an awareness of the needs of service users. A staff training plan is in place that covers the principles of care for adults with learning disabilities, person centred planning, communication skills, dementia care and abuse awareness. Progress is also being made in National Vocational Training (NVQ). One member of staff has completed NVQ 2 and one person has completed NVQ 3. The remaining staff team is working towards the award. One member of staff recently appointed confirmed they would be completing the Learning Disability Award Framework training (LDAF) prior to commencing their NVQ. A structured induction programme is in place. One member of staff confirmed their training needs are discussed in supervision and felt that the Trust provided a lot of training for staff. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42. Overall the home is ensuring service users health and welfare is promoted. EVIDENCE: In the absence of the manager the quality assurance systems were not inspected, as staff were not aware of where the information was held. Examination of fire safety records demonstrated tests in fire alarms emergency lighting and safety equipment were taking place as good practice states. The last recorded fire safety drill was held 12.12.05. Discussion with the most recently appointed member of staff confirmed they were aware of the fire safety procedures. Discussion with service users confirmed they were also aware of what action they should take if the fire alarm sounds. A fire risk assessment is in place but this needs to be reviewed to ensure service users continued safety in the event of a fire. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 18 The home has completed health and safety risk assessments, which had recently been reviewed. To ensure the safety of service users who may be at risk of scalding from hot surfaces or hot water, radiators have been guarded and hot water regulated close to 43c. Staff confirmed they had received training in manual handling, first aid and infection control. Portable appliance testing was up-to-date. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 1 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elcot Close (5) Score X X 1 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000028533.V269914.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation Requirement Timescale for action 13(4)(a)(b) The registered person must (c) ensure risk assessments are reviewed a minimum of once a year or earlier if the needs of risk to service users changes. This was a requirement at the last inspection. The timescale for compliance was 01/09/05. Failure to meet the requirement within the revised timescale will result in the Commission taking enforcement action. The registered person must ensure all medication is recorded when it is administered to service users. 01/02/06 2 YA20 13(2) 22/12/05 Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 21 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 YA42 Good Practice Recommendations The registered person should ensure the fire safety risk assessment is reviewed annually. Elcot Close (5) DS0000028533.V269914.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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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