Inspection on 10/05/06 for Fell Close (4)

This inspection was carried out on 10th May 2006.

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

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

Other inspections for this house

Fell Close (4) 17/04/07

Fell Close (4) 11/10/05

Fell Close (4) 28/09/04

Fell Close (4) 13/04/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Fell Close (4) 4 Fell Close Scarborough North Yorkshire YO12 6ST Lead Inspector Mr M. A. Tomlinson Unannounced Inspection 10 and 16th May 2006 09:20 th Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 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 Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 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. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fell Close (4) Address 4 Fell Close Scarborough North Yorkshire YO12 6ST 01751 474740 01723 364310 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) www.wilfward.org.uk The Wilf Ward Family Trust Mr Lionel Aubrey Bede Linley Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 4 residents with Learning Disabilities some or all of whom may have Physical Disabilities 11th October 2005 Date of last inspection Brief Description of the Service: Fell Close is a dormer style bungalow situated in a residential district of the town. It is conveniently located for the main community amenities such as shops, churches and the public transport network. A former private dwelling it provides accommodation for a maximum of four residents. There are gardens to the front and rear accessible to residents. Dedicated car parking is available to the front of the property. Three of the four bedrooms are located on the ground floor. All bedrooms are for single occupancy. No bedroom has an ensuite facility. Sufficient communal facilities are provided. There are a number of communal areas including sitting and dining rooms. The staff provide care to residents with severe learning difficulties some of whom may have associated physical disabilities. Appropriate aids have been provided and adaptations made. There is not a passenger lift to the upper floor. The staff seek to provide a holistic care regime offering personal care, help, advice and guidance with daily living skills and activities, a catering service, a laundry service and cleaning and domestic duties. All care and services are offered in conjunction with, rather than for, residents. Social activities are arranged inhouse and at external locations. All residents are registered with local medical practitioners who can arrange access to more specialised services should the need arise. The staff team and residents have direct access to the Community Learning Disability Team. Fell Close is owned by the local health authority. The Wilf Ward Family Trust (referred to in the report as ‘the Trust’), a registered charity, provides the care and services. The Trust does not have ‘set fees’ or a ‘scale of charges’ for the service users but assesses the fee prior to a service user’s admission into the home based on their needs, their specific requirements and any other additional requirements as agreed with the placing Authority. The placing authority also undertakes a financial assessment of the prospective service user and takes this into account when agreeing the charges with the Trust. All of the service users and/or their representatives have access to the CSCI inspection reports either in the care home, the Trust’s Headquarters or via the Internet. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken as an integral part of the Commission for Social Care Inspection’s ‘ongoing’ inspection process of the home. The visit was unannounced although on the inspector’s arrival on 10th May 2006 the service users were in the process of being taken out for the day by the staff as workmen were replacing the flooring on the ground floor of the care home. The opportunity was taken, however, to speak with available staff, examine the service users’ care records and undertake an inspection of the premises. At the time of this visit the registered manager was attending an external management meeting. A further visit was therefore made on 16th 2006. The visit covered the ‘key’ National Minimum Standards and the requirements and recommendations made during the previous inspection. The visit took approximately nine hours to complete and included telephone discussions with relatives of the service users and a representative of the social services care management team. Discussions were also held with the home’s staff and management, the locality manager and a representative of the Trust’s Human Resource section. Reliance was placed on observation of the service users as they had very limited verbal communication skills. A number of statutory records, including the service users’ care records, policies and procedures were examined. On the completion of the inspection feedback was provided for the registered manager and the deputy manager. Only four recommendations were made on this occasion and no requirements. What the service does well: What has improved since the last inspection? Following the previous inspection the following improvements have been made in the home: Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 6 • The level of day staffing has been increased. This has consequently enabled the staff to spend an increased amount of quality time with the service users. It has also enabled the staff to develop a more flexible and comprehensive programme of activities for the service users. The introduction of a deputy manager has enabled the registered manager to spend more time on dedicated management tasks. A review of the medication administration procedure has improved the safety of the process and has lessened the chance of error. The complaints procedure has been revised and now complies with the regulations to the Care Standards Act 2000. The manager has implemented the quality assurance procedure that has entailed sending questionnaires to the relatives of the service users. Fire drills have been regularly held, at the frequency recommended by the Fire and Rescue Department, taking into account the disabilities of the service users. Refurbishment of the premises has included replacing the ground floor carpeting with laminate flooring and the relocation of the dining room and kitchen. These actions were taken on grounds of safety and hygiene. A revision of the service users’ care records have ensured that they more meaningful for the staff and personalise each service user. • • • • • • • All of the requirements made during the previous inspection had been addressed. 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. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 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 Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 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 and 5 Whilst the Trust has a proven admission and assessment procedure, there was, however, insufficient evidence in the case of Fell Close to fully assess this particular outcome area as no service users have been admitted for sixteen years. EVIDENCE: The current service users had been accommodated in the home for approximately sixteen years having been originally accommodated in a longstay hospital (Claypenny). The original assessments on the service users and the associated admission process had consequently been archived by the Trust and were not available for inspection. One of the four original service users had been recently transferred to another of the Trust’s care homes (The Grayling) as it had been considered more suitable to meet his physical needs. According to the registered manager this transfer was undertaken with a full assessment of the service user, in conjunction with the placing authority and with considerable sensitivity to lessen the anxiety for the service user concerned. This process will be examined during the next inspection of The Grayling. The manager stated that there is no immediate plan to replace this service user at Fell Close. Whilst there had been no recent admissions at Fell Close, the Trust has a proven assessment and admission process that will, according to the manager, be adhered to should another service user be admitted. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 9 The care records provided evidence that the service users had been regularly assessed by the home as well as several external agencies such as the Learning Disability Service and the service users’ day placements. It was evident that these assessments had been used as the basis for the service users care plans. These assessments clearly identified both improvement and deterioration in the service users’ needs, abilities and behaviour. The Trust had no formal contracts with the Service Users. Each service user was, however, provided with an individual contract for care implemented by the placing authority. A copy of the statement of the service users’ terms of conditions of residence was included with the care records. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 “Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service” The service users’ care records provide sufficiently detailed information in order for the staff to address the service users’ assessed needs. Regardless of their disabilities, the service users are provided with a range of opportunities to develop their personal skills thereby maximising their potential. EVIDENCE: All of the service users had a personal care plan implemented by the home. These were in addition to any care plan developed by their placing authority. It was evident that considerable changes had been implemented to the service users’ care records since the previous inspection. The personal care records, which included the care plans, were detailed and comprehensive. They clearly identified the primary needs, as well as the abilities, of the service users along with the actions to be taken to the staff in order to address those needs. The care records also included documentary evidence of reviews, a risk assessment of each service user (see Standard 42) and documentary evidence of their social activities in the form of photographs and other artefacts. Supporting records were written in the ‘first person’ by the staff on behalf of the respective Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 11 service user. The staffs’ rationale for this was that it personalised the information and encouraged new staff in particular to see the service users as individuals and not solely as service users with disabilities. The staff presented as having pride in the care records and felt that they were more meaningful and accurate than they had previously been. The staff stated that they would encourage the service users to look at their care records particularly the photographs. The care plans were cross-referenced to other records such as the reviews. There was evidence that the service users were consulted, albeit in a limited way, about their needs and wishes. This, according to the staff, was one of the main responsibilities of the service users’ key workers. A discussion was held with the staff regarding their ability to communicate with the service users. Advice on this was also included in the respective care record. All of the service users had limited communication skills of varying degrees. For example one could hold a reasonable conversation and would answer ‘direct questions’ but another could only speak very few words and could not form sentences. It was apparent that the more experienced staff had developed a range of communication techniques for use with the service users. These included ‘flash cards’, pictorial representation (Makaton or derivative) and understanding of the service users’ body language, behaviour and verbal sounds. There was evidence in the records that support had been provided by the Learning Disability Service for the staff to address this problem. From observation it was evident that the staff generally understood the service users when they indicated a need or required support. It was also observed that the more able service user assisted the less so. It was evident that the staff encouraged the service users to make choices and decisions for themselves but were also realistic in their assessment as to the service users’ ability to make ‘considered decisions’. The decisions made by the most dependent service users were often in the form of facial expressions (i.e. happiness) at, for example, the prospect of some activity. According to the staff, the service users had been consulted on the daily routines in the home particularly if change was involved. The relatives of the service users confirmed this, to an extent. It was evident, however, that the more able service user was generally aware as to what was happening in the home that would affect them. It was also observed that this service user willingly assisted the staff with domestic tasks such as the laundry. There was also documentary evidence, supported through discussions with the staff that even the most disabled service users were enabled to assist the staff. Examples were provided of this. It was observed that the service users were encouraged to retain an element of independence that was in keeping with their abilities and needs. The staff, for example, did not ‘fuss’ over the service users but enabled them to have their own space and do their own thing’. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The service users are provided with an opportunity to participate in a range of social and educational activities, which provides them with a good level of stimulation. EVIDENCE: Through discussions with the staff, and the relatives of the service users, and an examination of the home’s records, it was evident that considerable emphasis is placed by the staff on the service users’ personal development. It was also evident that the staff had taken into account the service users changing needs in particular those related to age. All of the service users have an organised day placement each week. Their assessment of need and their wishes had been taken into account when agreeing to their activities at their day placements. These included swimming, bird watching, literacy skills and the use of a sensory room. In reality the home primarily focussed on the development of the service users’ social skills. This was mainly achieved through regular contact with the public and good access to community facilities. For example, one service user enjoyed going to the local pub for a Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 13 drink (beer). The staff said that they encouraged him to pay for his own drinks as part of his social skills training. Another service user’s main enjoyment was being driven in the home’s vehicle. This was reflected in their care and activity plan and was confirmed as being implemented at least once each day. Confirmation was provided that there is good interaction with service users from other care homes operated by the Trust. The staff confirmed that the service users are encouraged to remain in contact with their relatives. The relatives of service users also confirmed this. This contact was incorporated into the service users’ care plans and activities programme. All of the service users had relatives who regularly visit and/or telephone them. It was observed that the staff spoke to the service users in a mature manner and gave them the required level of respect. Where the staff needed to be directive towards a service user, it was done in a firm but respectful manner. The staff and manager confirmed that punitive measures were not used to deal with the service users’ behavioural problems but reliance was placed on the use of discussion, persuasion and ‘diversionary techniques’. The staff said that they were in the process, with the assistance of the Learning Disability Service, of developing a programme for one of the service users who displays unacceptable social behaviour. There was a planned menu but according to the staff there was a flexible and informal approach to the meals so they could take into account the service users wishes and food preferences on any particular day. It was evident that the mealtimes are also flexible to take into account the service users wishes. For example, one service user had just got up at the start of the inspection and was having breakfast on their own in the dining room. The records also indicated that on occasion’s service users would get up late in the morning. With the recorded support and advice of a G.P. and a dietician, one service user was endeavouring to lose weight for health reasons. This was reflected in their care plan. It was evident that the service users enjoyed their meals and would occasionally have them out in the community. The staff monitored the service users’ dietary intake and the records confirmed that the service users had access to a dietician. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 14 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): 18, 19 and 20. “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The service users are provided with good support from the staff and health and social care professionals thereby ensuring that their healthcare needs are met. The medication administration system ensures that the service users receive the correct medication at the correct time thereby addressing their medication requirements. EVIDENCE: Whilst it was difficult, or even impossible, to ascertain that the service users were satisfied with the service provided by the staff, it was evident that they had established a good relationship with the staff and looked content and relaxed in their environment. It was observed that the staff were patient and considerate when providing support or personal care for the service users. The relatives of the service users also confirmed this. The staff used the service users’ care plans as a working tool through which they could provide good standards of care. The care records confirmed that there was good input and support provided for the service users by health and social care professionals. It was also evident from the records, and confirmed by the staff and the service users’ relatives, that the staff closely monitored the service users’ health needs and that prompt and appropriate action was taken when Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 15 necessary to address them. One relative stated that they were directly involved in the discussions relating to a possible operation for his daughter. The home continued to use a monitored dosage system for the administration of the service users’ medication. The ‘blister packs’ plus other prescribed medication was secured in a dedicated medication cabinet. The nominated responsible member of staff on duty carried the key to the cabinet. The staff rota for administration of medication was available for examination. The staff confirmed that they had received training on the safe handling of medication from the local pharmacist. The staff records verified this. A support worker explained the medication system, which corresponded to the Trust’s approved procedure. Records were maintained of received, administered and returned medication. The administration records were complete and up to date. Following the comments made during the previous inspection the administration procedure had been reviewed. Two staff now administered the medication and both signed the medication record in confirmation. Rectal Diazepam was retained for the use of one service user. It transpired that this medication had never been used although it had been renewed at regular intervals. It was also evident that only three staff had received training in its use. The registered manager agreed to review the need to stock this medication and the need for staff training in its use. With the exception of one service user who uses an inhaler, the service users had been assessed as not being capable of safely self-administering their medication. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 16 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 and 23 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The internal and external support provided for the service users should ensure that any problem or concern is quickly identified and acted upon. EVIDENCE: The Trust had an appropriate complaints procedure that had been made available to the service users, their families and others directly involved with the home. The complaints procedure was also provided in pictorial form. In the specific case of Fell Close only one of the service users had the ability to make a complaint albeit with assistance. The other two service users primarily relied on others to make complaints on their behalf. It was apparent from the records and discussion with the staff and the relatives of the service users that this was a realistic option. The relatives said that they felt able to make their concerns known although they generally could not envisage using the formal complaints procedure. The Trust also had good Adult Protection procedures that endeavoured to take into account the source of an allegation (e.g. service user, their family or third party). Information on abuse and its consequences was contained in the care records for quick reference by the staff. The staff records confirmed that the staff had been provided with training on the subject. Since the previous inspection an allegation of abuse of a service user had been the subject of a joint investigation by the local Social Services Department, the CSCI, the police and the home’s management. This had been made following the staff ‘Whistle Blowing’ procedures. The Adult Protection procedures were adhered to Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 17 including a referral under the Protection of Vulnerable Adults procedure. The Adult Protection process was confirmed through discussions with the Trust’s Human Resource department, the home’s manager and the Social Services department. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 18 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, 25, 26, 27, 28, 29 and 30. “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service.” The premises provide the service users with a homely and pleasant environment in which to live. The design of the property and the lack of a passenger lift does not enable those service users with mobility problems to have access to the upper floor. EVIDENCE: As previously mentioned in this report, considerable refurbishment had taken place in the home. This included replacing the ground floor carpeting with laminate flooring and exchanging the location of the dining room and the kitchen. These modifications had been made with the agreement of the Primary Care Trust and on the recommendation of this commission (See previous inspection reports). According to the registered manager, the rationale for the for changes was that the laminate flooring was more hygienic and safer for the use of the service users who had mobility problems and that the kitchen needed to be relocated also for reasons of safety and hygiene. The inspector felt that the laminate flooring looked rather ‘stark’ and possibly detracted from the domesticity of the home. The manager countered this by stating that in his opinion the new flooring was in keeping with modern Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 19 furnishing and it was more appropriate for the needs of the service users and in particular those who had mobility problems and used a wheelchair. The premises were decorated and maintained to a good standard with the service users’ bedrooms in particular presenting as being homely and cheerful. It was evident that the service users were able to furnish their bedrooms with their personal belongings and consequently the rooms tended to reflect the personality and gender of the occupant. One concern raised by the manager was the current lack of lounge space especially for four service users some of whom use wheelchairs. The home does not have a passenger lift and consequently only one service user is able to safely use the stairs. For the safety of the other two service users a ‘safety gate’ had been fitted to the base of the stairs. This had been risk assessed and recorded. There were adequate numbers of toilets and bathrooms with a ‘specialist’ bath being located on the ground floor. The manager is intending to have ‘overhead tracking’ fitted from a bedroom on the ground floor to the bathroom in order to assist the most disabled service user and further promote their dignity. The office was located on the upper floor and had been reorganised to make it more usable for the manager and the staff. The outside of the property was decorated to a good standard. There were car parking spaces to the front of the building although several staff left their cars at the end of the cul-de-sac so not obstruct the neighbours’ drives. The front and rear entrances to the care home were accessed via wheelchair ramps that had handrails on either side. The rear garden was accessible to the service users and provided appropriate facilities that could be used in good weather. The home has its own Multi Person Vehicle (MPV) that was appropriately fitted out for use by the service users including those who use a wheelchair. The manager stated that they are hoping to get a second vehicle to provide greater flexibility for taking service users out. On the day of the site visit the home was very clean, hygienic and totally free of any unpleasant odours. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 20 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, 33, 34, 35 and 36. “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The service users are supported by a competent and well trained staff team. The day staffing level ensures that the service users’ needs can be met promptly and effectively. EVIDENCE: As previously stated in this report, following the last inspection the day staffing level in the home had been reviewed and subsequently increased in order to meet the diverse needs of the service users. The outcome of this being that there was a minimum of three staff on duty during the day plus the manager or deputy manager. This was reflected in the home’s staffing rota and confirmed by the staff. According to the staff the increased staffing enabled them to spend more time with the service users on one-to-one basis and had also improved the service users’ activity programme. The staff team was a reasonable representation in terms of experience and gender. From observation of the staff it was evident that they had established a good relationship with the service users. They demonstrated a commendable understanding of the service users needs and were realistic insofar as promoting choice and independence for the service users. The staff spoken to acknowledged the difficulty in communicating with two of the service users and confirmed that for new staff it took time and patience to do so. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 21 Communication with the service users took various forms and included a combination of verbal and facial expression, body language and the use of pictures. From observation of the staff on duty it was apparent that they were able to communicate with the service users and understand their needs and wishes. The staff were provided with training in communication during their induction process. The staff confirmed that they had been provided with an opportunity to undertake a range of training courses in statutory and professional subjects. They provided examples of these. The staff stated that considerable emphasis was placed on staff training. New staff underwent a comprehensive induction and foundation training package leading to enrolment for the National Vocational Qualification (NVQ). Of the fifteen permanent staff, three had achieved a NVQ at level 2 and the deputy manager at level 3. The deputy manager was taking the Registered Manager’s Award. Five staff were currently undergoing the induction programme and on the completion of this were intending to obtain a NVQ. Several staff had taken the Learning Disability Award Framework (LDAF). The registered manager and the organisation’s Training Officer maintained a training record for the staff. The home was on course to achieve the recommended ratio of 50 qualified staff. Whilst there was no specific training in service users’ equality and diversity it was, however, implicit within the induction and foundation training programme. With the written agreement of the CSCI, the organisation’s Human Resource (HR) Section held the staff records. Basic information on the staff was also available in the home. Six staff records were examined. They provided confirmation that all prospective staff underwent a robust recruitment, selection and vetting procedure. The HR officer advised that on occasions the ‘POVA First’ procedure would be used and that in such circumstances the member of staff concerned would be closely supervised whilst undertaking the induction training programme. The rationale for this was that some CRB checks could take a matter of weeks to complete and given the local employment situation it was not practical to ask this person to delay taking up a post. The registered manager and the staff also confirmed this. All of the staff records examined contained a copy of the staff member’s contract of employment. The staff confirmed that they were provided with regular supervision that culminated in an annual appraisal. The deputy manager provided recorded evidence of this. Several of the staff spoken to confirmed that they were provided with good support from the manager and said that they felt able to discuss with him or the deputy manager any concerns or problems that they may have. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 22 The staff presented as being enthusiastic and as working as a team. It was apparent from discussions with them that they had a good understanding of the service users’ needs in particular those elements such as the promotion of independence and choice that go to provide the service users with a good quality of life. It was also evident that they had considerable pride in their and the service users’ achievements. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Sound management at all levels appropriately supports the staff and service users. The organisation’s quality assurance monitoring process should ensure that the service users’ are not discriminated against in relation to their disabilities. EVIDENCE: Since the previous inspection the registered manager had completed the Registered Manager’s Award (RMA). The manager is consequently qualified to the required standard having also a nursing qualification that equates to a National Vocational Qualification at level 4 in care. The registered manager had considerable experience in operating the home having been initially registered some sixteen years ago. He demonstrated a sound understanding of the service users’ needs. The staff records provided evidence that he had continued to undertake a programme of training. He demonstrated a democratic style of management, which included an ethos to encourage and empower the staff to take an active part in the running of the home and take Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 24 responsibilities and tasks commensurate with their experience and status. This was confirmed by one of the more senior support workers who stated that she received a good level of support and leadership from the manager. As previously mentioned in the report the day staffing level had been increased. A ‘spin off’ of this was that a deputy manager had been established thereby providing the manager with more dedicated time to address managerial tasks such as attending management meetings and ensuring that the home’s policies, procedures and records are adhered to and maintained up to date. The Trust had a sound Quality Assurance Monitoring procedure that ‘linked’ all levels of the organisation. The members of staff as well as the manager of the home had to submit monthly ‘objectives or aims’ to the their line management to ensure that progress and achievement was adequately monitored. This process also incorporated elements of equality and diversity with regards to meeting the needs of the service users. The records available in the home and the Trust’s headquarters confirmed this. Since the previous inspection the manager had sent out a questionnaire to the relatives of the service users. The responses to the questionnaire were examined. Overall the relatives of the service users were very complementary regarding the service provided by the home and in particular the attitude and helpfulness of the staff. Where a minor criticism had been made it had been promptly addressed. For example, one relative wanted to be kept informed of the respective service user’s health including minor ailments and the staff had been instructed to do this. It was evident from the records, the servicing certificates for the gas and electrical systems and the staff records that appropriate action had been taken by the registered manager to ensure that the premises were safe for the service users and the staff. Risk assessments were in place although the manager acknowledged that these needed reviewing following the refurbishment of the premises in particular the re-locating of the kitchen and dining room. The accident and fire records were examined. Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 N/A 3 X 4 X 5 3 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 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA20 YA29 YA32 Good Practice Recommendations The possible use of Rectal Diazepam should be reviewed. Consideration should be given to installing a passenger lift thereby enabling all service users access to the upper floor. The registered providers are reminded of the need for 50 of the care/support staff to achieve a National Vocational Qualification in care to at least level 2. On completion of the refurbishment programme the home’s risk assessments should be reviewed. 4. YA42 Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. Extracts may not be used or reproduced without the express permission of CSCI Fell Close (4) DS0000007835.V293034.R01.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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