Inspection on 11/09/07 for Elliott House

This inspection was carried out on 11th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elliott House 18/09/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Pennine Camphill

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

CARE HOME ADULTS 18-65 Elliott House Rotherham Road Great Houghton Barnsley South Yorkshire S72 0EG Lead Inspector Mrs Sue Stephens Unannounced Inspection 11 September 2007 11:10 DS0000066960.V337766.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 DS0000066960.V337766.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. DS0000066960.V337766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elliott House Address Rotherham Road Great Houghton Barnsley South Yorkshire S72 0EG 01226 756319 01226 759972 elliotthousemilbury@tiscali.co.uk www.milburycare.com Milbury Care Services Limited 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) Mrs Rachel Chovil McGarry Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6), of places Physical disability (2) DS0000066960.V337766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user over the age of 65 years may be accommodated. 18th September 2006 Date of last inspection Brief Description of the Service: Elliott House is a care home for people with learning disabilities. Milbury Care Services Ltd provides the care and accommodation. The home provides care for people with complex emotional and physical needs. The house is purpose built, and stands in its own grounds with garden, patio area and car parking. The home has six single bedrooms, each have en-suite facilities. The home is on one level and can accommodate people who use wheelchairs. There is a spacious lounge, kitchen/dining area and an activities room. Two bedrooms have kitchen facilities and space for additional furniture. The bedrooms and shared spaces exceed the National Minimum Standards for room sizes. There are good amenities, for example shops, pubs, a church and leisure facilities close to the home. There is a shopping centre a short drive from the home, and there is public transport into Barnsley town. The manager provided the information about the homes fees and charges on 11 September 2007. Fees range from £1565 to £1724 per week. Additional charges include travel costs, hairdressing, social activities, additional meals and holidays. Prospective residents and their families can get information about Elliott House by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. DS0000066960.V337766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced; it took place between 11:10 am and 16:45 pm on 11 September 2007. The inspector sought the views of people who live at the home, and spent some time observing their care and support. She spoke to two members of staff. Rachel McGarry, the registered manager, assisted with the inspection. During the visit the inspector looked at the environment, and made observations on the staffs’ manner and attitude towards people. She checked samples of documents that related to peoples’ care and safety. These included three assessments and care plans, medication records, and staff recruitment files. The inspector looked at other information before visiting the home, this included evidence from the last key inspection, and the homes Annual Quality Assurance Assessment (AQAA). This is information the commission ask services to provide once a year to show how the provider thinks the home is performing. The manager had completed the AQAA and had provided information about the service Three relatives and four visiting professionals (involved in the home) responded to the Commission for Social Care Inspection surveys. This was a key inspection and the inspector checked all the key standards. The inspector would like to thank the people who live at the home, the manager and staff for their warm welcome and help towards this inspection. The inspector also thanks the relatives and professionals who responded to the surveys . What the service does well: It was evident that although the home was experiencing problems with their staffing levels the manager and staff were committed and wanted to give people good quality care and support. People lived in a nice, spacious clean home. And relatives and visiting professionals said this is what was good about Elliott House. One relative described Elliott House as like “home from home”. DS0000066960.V337766.R01.S.doc Version 5.2 Page 6 Relatives also said staff were caring, friendly and attentive. Visiting professionals said staff were keen to understand peoples needs. People had an assessment before they decided to come to live at Elliott House and this helped form peoples care plans. This means staff have information about how to support people in a safe way. The information people get about what Elliott House can provide, and its charges, is very clear and easy to understand. Staff spoke to people in a dignified manner and understood their ways of communicating. People looked clean and presentable. They had good support from staff to do this. People had trained staff to support them with their medication. The staff followed safe procedures. Staff had training so they knew how to follow safe practice procedures such as fire safety. And the organisation carried out safety checks to make sure the environment was safe. What has improved since the last inspection? What they could do better: DS0000066960.V337766.R01.S.doc Version 5.2 Page 7 There are four main urgent areas that the home needs to improve to make sure people have good care and are safe from harm. Make sure that there are enough staff available so that people have enough support to meet their needs and: • • • • Keep people safe from harm from others Manage behaviours Attend health care appointments Access social and leisure opportunities Make sure staff are trained and competent before they work without supervision and guidance Check the home better and look at people’s quality of care and their experiences. Deliver the care and services the home promises people in their contracts and terms and conditions. Following the inspection the responsible individual, Mr Paul Constable, agreed to come to the Commission for Social Care Inspection offices in Sheffield to talk about the staffing concerns. The home provided the inspector with daily staffing levels for two weeks following the visit to demonstrate that they had taken action to improve safer staffing levels. In addition to this the home needs to improve the following areas to make sure people get better care and support: People need to have the care and support they have identified in their assessments and care plans. People need to be able to follow their preferred daily routines. And have better opportunities to access education, social, leisure and community activities. Care plans need to be better so that they include what is important to people. Such as their likes, dislikes and preferences. And the plans need to be better to help people understand the information about them. People need to have a care plan about their medication so that staff support them in a safe and consistent way. DS0000066960.V337766.R01.S.doc Version 5.2 Page 8 The manager needs better support and resources to manage the home better. She needs to spend more time managing the home. Staff could encourage people to look at cooking and healthy eating magazines. This will give staff and people better ideas about more interesting meals. People should be able to access Health Action Plans. This will help give them more control over their health care. There is more information about this on www.doh.gov.uk/ Some relatives need more information about how to complain if they need to. Staff need to help people keep their wheelchairs clean. Staff need training about peoples special needs. The manager needs to access more training to help her manage the home 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. The summary of this inspection report can be made available in other formats on request. DS0000066960.V337766.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 DS0000066960.V337766.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 and 5. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People have their needs assessed before they move in. This helps make sure it is the right place for them to meet their needs and aspirations. However, People do not receive the service promised by Milbury Care in their contract. EVIDENCE: People had their needs assessed before they came to live at Elliott House. The manager and staff liaised with professionals and families to find out about peoples needs. The manager and staff also spent time with people, before they came to the home, to find out more about them. Elliott House used the organisations corporate assessment tool to look at people’s needs. The manager had started to review some existing people’s needs using the new tool. This was a very in-depth look at what support people might need. This was good practice, however the assessment did not identify peoples likes, dislikes and preferences. And it did not have symbols or pictures to help people understand what the assessment was about. The home could improve DS0000066960.V337766.R01.S.doc Version 5.2 Page 11 these so that people have their care assessed using a more person centred approach. Elliott House gives each person, and their families or advocates, a Statement of Purpose and Service User Guide. These give people information about their fees, the home, and the kind of service they will receive. The information in the contract, service users guide and statement of purpose was excellent. It had clear and plain language and pictures and symbols to help people understand it. (The Service User Guide forms part of people’s contract, terms and conditions). ‘ The inspector found that the home was trying to manage on low staffing levels. And this had happened for some time. Because of this people did not receive the care and support identified in their assessments, or as promised in the Statement of Purpose and Service user Guide. This inspection found that the service was not meeting these agreements. Further information about this is explained in the relevant parts of this report. People had good information about their terms and conditions and fees. This has improved since the last inspection. DS0000066960.V337766.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 adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People do not always receive the care and support that is identified and set out in their care plans. Low staffing levels have affected people’s opportunities to make choices and decisions in their daily lives. EVIDENCE: The manager said she was in the process of reviewing people’s care plans in line with the organisations new care-plan format. . This included an assessment of people’s needs and plans of care and support based on those needs. And the plans included risk assessments based on giving people the opportunity to take reasonable risks. The care plans held good information about people’s needs. This has improved since the last inspection, and people’s records were stored in a secure place. DS0000066960.V337766.R01.S.doc Version 5.2 Page 13 However, these were not in a format that would help and encourage people to be involved in their plans. For example, the typed writing was very small, and there were no pictures, photos or symbols to help people recognise what their plan was about. Because the home was operating on low staffing levels, staff, at times, could not meet people’s needs as identified in their plans. For example, when they needed support to go to a health-care appointment or to follow their preferred routines and activities. Some people who live at Elliott House often have complex needs and behaviours. The care plans did not identify in sufficient detail how this affects or limits people’s freedom of choice. For example, if someone wishes to smoke and where they want to smoke. Staff were aware of the kind of decisions people liked to make. And they were aware of how to encourage people to do this. For example what people wanted to do during the day, what they liked to eat and who they preferred to spend time with. Elliott House also held a monthly meeting where people could discuss what they wanted from the home. However, at times, people were not able to follow their own choices and decisions because there were not enough staff available to support them. For example, this affected people who like to go out or do a lot of different activities during the day. DS0000066960.V337766.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): 12, 13, 15, 16 and 17. People who use the service experience poor quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People do not get regular and consistent support to follow their preferred daily routines, access the community and develop their independence and skills. EVIDENCE: The inspector observed the routines and daily lives of people who live in the home. On the day, staff were operating on low levels and the manager was included in the staffing numbers. Two people did go out to the shops; however, other people did not have a structured day. The inspector saw, at intervals through out the day, that some people were left without staff attention and support to do activities. Staff said they were aware of this and the inspector saw staff trying hard to meet some people’s demands DS0000066960.V337766.R01.S.doc Version 5.2 Page 15 for attention. In turn this resulted in other people being left alone for periods of time without attention or activity, for example in their bedrooms. This was not acceptable, and could be a reason why some people feel they have to demand so much attention from staff. Staff said that they could not plan activities while staffing levels were like this, and opportunities to go out into the community were limited. They said there was only one driver and this affected how often some people could go out. One staff said “It’s hard with the staffing levels, there is nothing structured”. They said one person likes to go swimming but only one member of staff took them. The home’s Service User Guide tells people the service will do the following: • • • Try to help you do things outside of the home Or help you do other things in the day We have 14 other staff so that we can have four people in the home during the day People did not get this service on a reasonable and regular basis. More than four people stayed at home during the day and there were no additional staff to help them follow their preferred daily routines and activities. People had very limited opportunities to develop their skills and independence. Inadequate staff levels meant staff were unable to meet peoples diverse needs, for example, the amount of attention they needed or support from more than one member. There was fresh food and snacks available for people. Staff said people could have drinks whenever they wanted; but most people needed support from staff to get drinks and snacks, so needed their attention. Staff prepared people’s meals; they said they asked them what they wanted to eat on a daily basis. Staff had made a record of what people had eaten. This has improved since the last inspection. Staff follow a set menu but said they could change this if people wanted something different. Although the menu was adequate and gave people choice and variety, it was not very exciting for the age group of people at the home. Staff confirmed most people liked their food and would try different things. DS0000066960.V337766.R01.S.doc Version 5.2 Page 16 The inspector noted two people enjoyed looking through magazines. She advised the manager to think about buying cookery and healthy eating magazines. This would help staff think about more interesting meals and help people become more involved by looking at pictures and recipes they might like to try. This would also create an activity for people and help include them in the running of the home. DS0000066960.V337766.R01.S.doc Version 5.2 Page 17 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 judgment using a range of evidence, including a visit to this service. People do not get sufficient support to maintain or promote their personal and health care needs. EVIDENCE: People looked clean and well dressed. However, the inspector was concerned (from observations seen on the visit) that at times people only get basic personal care and support because of the amount of times staff try to cope on low staff levels. The inspector noted that staff were busy with people who have complex needs and behaviours and this left people who did not demand so much without staff attention. The inspector noted staff did respond to people who needed assistance with personal care as quickly as possible. And they remained friendly and spoke to people with dignity. DS0000066960.V337766.R01.S.doc Version 5.2 Page 18 People received care from staff levels that were below their contract agreement, this reduced their opportunities to develop their independence and help themselves more with personal care tasks. It gave people less control over their lives. A relative replied in the survey that staff have the right skills to look after people properly and staff usually keep them informed about their family member’s health care. Care plans identified people’s health care needs. Professional visitors replied that staff usually seek advice and act upon it, and that staff usually meet people’s health care needs. One professional said, “the care team do ask questions and follow my advice that I give them”, and another said, “staff seem keen to understand the principles of managing peoples specific health care needs”. One professional raised a concern that, “at times clinics have been cancelled due to transport difficulties”. The manager and staff confirmed this was correct because of the current staffing level problems. A professional also said, “staff do not always have the relevant information needed”. The inspector fed this back to the manager during the visit and asked that she make sure staff have the right information when they take people to clinics and appointments. The plans of care did not include Health Action Plans. Health action Plans help people take more control over their health care needs. There is government guidance about this on the Department of Health Website: www.doh.gov.uk/ Medication systems were in order. Records were easy to understand and up to date, storage was clean and appropriate for the medication in stock, and staff had training. Staff understood the medication procedures well and they considered people’s consent each time they offered people their medication. Medication storage and records have improved since the last inspection. People did not have a care plan about their medication. This means staff may not always follow consistent care and approaches for people needing support to take their medication. DS0000066960.V337766.R01.S.doc Version 5.2 Page 19 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 adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Safeguarding systems are in place but the low staffing levels put people at risk of harm and abuse. EVIDENCE: The home had their complaints procedure on display in the entrance hall, this explained what people should do if they wanted to raise a complaint or concern. People could approach staff and the home held a weekly meeting where people could raise issues if they needed. One relative replied in the survey they knew how to complain and had information about how to do this, while another said they had not had any information or advice. The home had adult protection procedures available for staff to follow if they needed them. Staff had access to the organisation training resource on practices to safeguard adults (adult protection). The manager said that she had also nominated staff to attend the Barnsley Local Authority safeguarding training; this will give staff good information and an understanding about local procedures. One survey stated that some people can be “disruptive and frightening” and staff were aware that they needed to protect some vulnerable people. DS0000066960.V337766.R01.S.doc Version 5.2 Page 20 During the visit the inspector noted that someone spent a considerable time in their own room. Two members of staff explained that when they were short of staff it was safer for them to stay in their own room because they were at risk of harm from other people if they used the shared rooms without staff supervision. This was not acceptable, and showed that the low staffing levels put people at risk of harm. The inspector issued the home with an immediate requirement. This means that the providers are required to take immediate action to make sure people are protected and safe from harm. The inspector checked a sample of people’s finance records. In the main these were in good order. However, where the manager had identified missing receipts she had not recorded this on the records. This means it is more difficult for audits to pick up patterns and frequencies of missing receipts. The inspector advised the manager about this during the visit. It was also difficult to tell on one receipt whether staff had used a persons money to pay for staff travel. The manager said that was not the homes policy but would check with staff to make sure this did not happen. DS0000066960.V337766.R01.S.doc Version 5.2 Page 21 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 judgment using a range of evidence, including a visit to this service. People live in a comfortable environment that meets their needs. EVIDENCE: The home was bright, clean and welcoming. It had homely touches in the shared rooms and people had personalised bedrooms. The hygiene standards in the kitchen and someone’s bedroom have improved since the last inspection. Relatives said “the place feels like home” and “the premises are very smart and clean; and a professional visitor said, “The environment is always clean, bright and welcoming”. DS0000066960.V337766.R01.S.doc Version 5.2 Page 22 The laundry facilities were suitable to meet people’s needs and the home was free from offensive odours. One wheelchair had accumulated dirt and food on it. This was not hygienic and it did not respect people’s dignity and appearance. DS0000066960.V337766.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People who use the service experience poor quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People have not received a good service because Milbury Care Services Limited has failed to maintain safe and suitable staffing levels. EVIDENCE: Relatives and professional visitors said about the staff team: “We are happy (name) is in good hands” “Staff are always friendly and approachable” “Always willing to give assistance” “The staff are very welcoming and the place feels like home from home” “Very caring and kind” “They make us very welcome when we visit” Six staff out of a team of 14 had achieved a National Vocational Qualification in care at level 2 or above. And a further 2 staff were working towards the DS0000066960.V337766.R01.S.doc Version 5.2 Page 24 qualification. NVQ trained staff helps make sure people receive safe and consistent care. This has improved since the last inspection. The inspector found that the home had been running on unreasonably low staffing levels. The home’s Annual Quality Assurance Assessment failed to identify this. And the manager or provider had not notified the Commission for Social Care Inspection when staff levels were so low it affected people’s welfare. For example when people missed health care appointments, or could not follow their preferred daily routines. People’s contracts and the Service User Guide promises people they will have support from 4 members of staff during waking hours. However at times the home had only two members of staff on duty. Staff also told the inspector that this happened quite often, and there were occasions when the low staffing levels included new untrained staff. This is not safe practice and puts people’s safety, welfare, and rights to freedom and choices at risk. The manager and staff confirmed the home had seen a high staff turn over. One staff said they believed staff left because some “can’t handle what they do”; and used an example about someone needing two staff to handle their behaviour, therefore on low staffing levels the shift was very hard. Staff said when the home is short of staff they follow a procedure to try to get extra staff. This included contacting bank staff and asking other Milbury homes. They said they were never successful when they contacted other homes. Staff were confused about the on-call system, one staff said they knew where to find the numbers but not what to call them for. Staff told the inspector they felt the organisation was aware of the problem but would not do anything about it. They also said they had received instruction from Milbury Care that they could not use agency staff, and this had made the problem worse. The inspector checked the manager’s supervision and support records. This showed there was an opportunity on each visit to discuss staffing levels with senior managers. The records showed visiting managers had not recorded in this area for a minimum of 3 months. The inspector checked a sample of recruitment records; these were in order and showed that the home follows robust checks to help make sure they recruit the right staff for people. This has improved since the last inspection. Milbury Care Services Limited provides the home with a learning resource for staff that covers the basic mandatory training. Staff use a laptop to access the DS0000066960.V337766.R01.S.doc Version 5.2 Page 25 training. The training covers basic safe working practices and protecting vulnerable adults. The manager is able to monitor which staff have completed the courses and how much time they have spent on the system. New staff have an induction that covers the principles of care. The induction meets the standards set out by the Sector Skills Council. This is good practice because it helps make sure people receive a good standard of care right from the onset of staff starting work at the home. However, staff had not received any training specific to peoples needs. For example they had no training or update training on epilepsy, visual impairment and managing behaviours. This was not good practice because some people at the home have very specific and complex needs. They need to know staff are competent in safe and consistent care approaches. This will give people better opportunities to progress in their lives and develop better independence. DS0000066960.V337766.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42 People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Also taken into account is the action the company have taken in response to staffing concerns raised by CSCI. However it should be noted that areas of staffing and company management/monitoring need to continue to be improved and the improvements sustained. The homes self-monitoring and quality assurance standards have not supported people’s safety and welfare. EVIDENCE: The manager had good experience to enable her to manage the home well. She had not yet achieved the recommended Registered Managers Award qualification. This would help the manager improve her skills and manage DS0000066960.V337766.R01.S.doc Version 5.2 Page 27 some of the homes difficulties better. For example the staffing levels and the organisations support and quality review systems. There was good evidence to show that senior managers from the organisation had visited the home regularly. However, they had failed to pick up or act on the homes serious difficulties that were affecting people’s lives and safety. This included staffing levels, staff retention and the use of the on-call system. The manager was allocated only 20 hours per week to manage the home. This was insufficient; it did not allow the manager enough time to be effective in to cover areas such as: • To oversee peoples support needs • Review and introduce new care plans • Support and supervise staff • Recruit staff • Carry out the administration for the home • Review the homes policies and procedures • And meet the policy requirements of the organisation. A senior manager carried out a service review with the manager on a monthly basis. This looked at the managers and homes performance. The reviews had covered a lot of task-orientated areas. For example it included, ‘the formats of policies need to be accessible’ and ‘evidence of good induction’. Although these are good practice areas, the reviews had focussed on these rather than on people’s real experiences living at the home. The inspector strongly recommends the organisation reviews this to make sure people’s care, safety and experiences are kept at the centre of the homes aims and objectives at all times. Registered services are required to inform the Commission for Social Care Inspection if any event in the home adversely affects the well-being or safety of people who live there. The home had failed to do this when the staffing levels affected people’s welfare. (See requirement 33). The inspector looked at a sample of health and safety records, for example fire maintenance, and these were in order. Staff accessed training on safe working practices through the organisations learning resource and the manager confirmed in the Annual Quality Assurance Assessment that the home had safe practice procedures in place. The manager said the organisation had recently assessed the homes use of dangerous substances and moving and handling practices. As an outcome staff were nominated to receive up-date moving and handling training. DS0000066960.V337766.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 1 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 1 X X 3 X DS0000066960.V337766.R01.S.doc Version 5.2 Page 29 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. 1 Standard YA23 Regulation 18.1(a) Requirement Immediate requirement Staffing levels must be sufficient to meet people’s needs and safeguard them from harm and abuse 2 YA33 18.1(a) 37.1(e) Staffing levels must not fall below agreed minimum levels. If this occurs and affects people’s daily routines and welfare, staff must inform the Commission for Social Care Inspection The organisation must consult with staff and make sure the procedures for getting staff cover are robust. This must include the on-call system The organisation must not allow untrained staff to work without sufficient supervision and guidance Staffing levels must be sufficient to meet the care and support DS0000066960.V337766.R01.S.doc Version 5.2 Page 30 Timescale for action 12/09/07 31/10/07 needs of people as outlined in their care plans 3 YA39 24.1 The provider must make sure the 30/11/07 quality assurance checks in the home are sufficient to identify areas for improvement The provider must make sure the manager has sufficient support 4 YA5 4.1(b) 5.1(b) 5.1(ba) 16.1 14.1 The organisation must deliver the agreed services, support and staffing levels as promised in peoples contract and terms and conditions 30/11/07 5 YA2 People must receive the care and 30/11/07 support as identified in their assessment of needs People must have opportunities to be involved in social and leisure opportunities. This must meet the agreements outlined in people’s contracts. There must be enough staff to support this 30/11/07 6 YA12 12.1(b) 7 YA19 13.1(b) The home must have sufficient staff on duty to make sure people receive the support to meet their health care needs This must include support to access health care appointments 30/11/07 8 9 YA20 YA35 17.1 (a) Schedule 3 18.1(a) People must have a care plan about their medication needs Staff should receive training that is specific to people’s diverse needs. For example • Visual impairment • Dealing with complex DS0000066960.V337766.R01.S.doc 30/11/07 31/12/07 Version 5.2 Page 31 10 YA37 12.1(a) behaviours Epilepsy The provider must review the managers hours allocated to manage the home and make sure she has enough time to manage the service effectively 30/11/07 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 YA2 Good Practice Recommendations Assessments should include people’s likes, dislikes and preferences so that the home can help people meet their aspirations Assessments should include a format that encourage people to be involved in and understand the information about them For example pictures and symbols. 2 YA6 Care plans should include people’s likes, dislikes and preferences They should include a format that encourages people to be involved in and understand the information about them. For example pictures and symbols. Care plans should include better information about people’s limitations on freedom and choice. 3 YA7 There should be enough staff available to make sure people can make real choices and decisions about what they want to do in their daily lives. There should be better opportunities and better staffing levels to enable people to follow the choices and decisions they make. People should have better opportunities for personal development. DS0000066960.V337766.R01.S.doc Version 5.2 Page 32 4 YA9 5 YA11 6 YA13 People should have better opportunities to participate in community activities. There should be sufficient staff to support people to do this. The service should review people’s opportunities. 7 YA17 The home should provide cooking and healthy eating magazines and recipe books to help people become more involved in choosing their meals and menus. People should have access to Health Action Plans, so that they can take more control over their health care needs. Information is available at www.doh.gov/ 8 YA19 9 10 YA22 YA23 The manager should remind relatives and advocates about how to make complaints. The manager should identify missing receipts on people’s finance records so that audits can check these for frequencies and patterns. Wheelchairs should be cleaned as and when spills occur and they should be included in the homes routine cleaning programme. The manager should commence the Registered Manager’s Award qualification. This will help the manager to manage the more complex issues in the home. The provider visit reports should contain better written detail about the outcomes of the visit. 11 YA30 12 YA37 13 YA39 DS0000066960.V337766.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 DS0000066960.V337766.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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