Inspection on 12/06/06 for Five Ways

This inspection was carried out on 12th June 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Five Ways 19/06/09

Five Ways 20/06/07

Five Ways 02/12/05

Five Ways 15/07/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Five Ways Kingsdown Park East Tankerton Whitstable Kent CT5 2DT Lead Inspector Jenny McGookin Unannounced Inspection 12th June 2006 10:00 Five Ways DS0000047387.V297545.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 Five Ways DS0000047387.V297545.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. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Five Ways Address Kingsdown Park East Tankerton Whitstable Kent CT5 2DT 01227 277861 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) Adelaide Limited Mrs Paula Jane David Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December 2005 Brief Description of the Service: Five Ways is registered to provide residential care for three adults with learning disabilities. The home caters for people of either sex, within the age range of 18-65 years. The property is a spacious two-storey detached house in a quiet residential street in Tankerton. It is not wheelchair accessible and is not adapted for people with physical disabilities. It has four spacious single bedrooms (one of which is for staff use), each with its own wash hand basin facilities. There are four communal WCs, three baths (one of which is also a Jacuzzi, though it is not currently in use) and two showers - all of which are conveniently located on the ground and first floors. The kitchen is on the ground floor along with the lounge, dining room, conservatory and a den (which is scheduled to be converted into a sensory room). The property has an enclosed garden to the rear, which has a patio area, and a swimming pool. The front of the property has been attractively landscaped. There is off road parking for two to three vehicles, and unrestricted kerb-side parking. There are bus routes at either end of the road. The home is within walking distance of shops and the sea front and is 5-10 minutes walk from Whitstable High Street, with all the transport and community resources that implies. The current fees for the service at the time of the visit were £2,253.00 per week. Information on the home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is Adelaidecare@hotmail.co.uk Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to review findings on the last year’s inspections (December and July 2005) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on those occasions. The inspection process took just over six hours, and involved meeting with the proprietor (who is also the registered manager); the shift leader and a visiting music therapist. One resident was on holiday with a family member and the second resident was already too unsettled to interact meaningfully when the inspector arrived and remained so throughout the day. The inspection involved a review of the premises and a range of records. One resident’s files were selected for care tracking. What the service does well: What has improved since the last inspection? What they could do better: Developmental workers should be asked to contribute to documented reporting systems to ensure an inclusive approach to care planning. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 6 Some personnel records were not available for inspection, as access arrangements had not been made in the absence of the main key holder. This will require addressing, so as not to frustrate the inspection processes. The management of one resident’s personal finances off site will require scrutiny by the funding authority to ensure probity is being exercised by all parties involved in his care. This is not to be interpreted as a reflection on the home’s own operational probity. 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. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 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 Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 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): 1, 2, 3, 4, 5 1. Prospective service users do not have all the information they need to make as informed a choice as they are able, about where to live. 2. There is a systematic preadmission assessment process, which identifies needs, preferences and interests 3, 4. Adelaide Care Ltd. has a careful admission process, designed to enable the prospective resident to sample the facilities, company and environment provided by the home, before their admission is confirmed. 5. Each resident’s placement is subject to a documented contract. This document is not, however, currently available in a format more suitable for the residents Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Public Information The Statement of Purpose, Service User Guide and contract have each been revised since the last inspection, and copies were supplied for inspection. Each document usefully details a range of elements of the services and facilities provided by this home. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 9 When assessed against the elements of the National Minimum Standard, however, each document was judged in need of further attention to obtain full compliance. This effectively means that funding authorities, relatives and other representatives do not have all the information they could have to make informed placements and this must be addressed. The detail has been reported back to the home separately. The Statement of Purpose and Service User Guide each needs, moreover, to show an issue date so that the reader can judge its currency (matter raised at the last inspection and found to be still outstanding). The intention in each case is to provide a text to meet these residents’ severe learning difficulties. What follows on in each case, however, is a sequence of statements about key elements of the home and services, each word of which is literally matched by an underlying symbol, and illustrated in each case by a photograph or diagram or symbol. This creates very intense documents, made more problematical by a number of grammatical and spelling errors. And the approach is not consistently applied, sometimes addressing the reader in terms of “we” and “you”, at other times as “they” or “the service users” “the staff”. If it is accepted that some of the residents would be better able to communicate verbally, and others would be better able to use Makaton and /or PECS symbols (Picture Exchange Communication System) etc., there needs to be a range of separate formats available to cater for this spectrum of need. Admission process. Neither resident had any choice about their transfer from previous placements, as these decisions were led by the funding authorities in each case. However, Adelaide Care Ltd has an admissions process, based on multi disciplinary assessments and meetings, and which is inclusive of the resident’s responses (and their representatives) at key stages. This process includes visits, overnight stays, joining in with meals and a trial stay of one month, which the inspector understands can be extended. There was anecdotal information to indicate that each of the current resident’s admissions had been managed effectively and that that they had settled remarkably well. One previous admission was, however, unsuccessful this would underpin the need for a measured, pre-emptive approach to the preadmissions process, before confirming placements. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 6. The preadmission assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs. 7. Observed interactions between staff and the resident were respectful during this inspection. The home still needs, however, to demonstrate its control over the care plan reviews – matter raised at the last two inspections. 8. The current residents have a number of opportunities to influence their daily routines and the running of the home, and their level of involvement is a matter of personal choice. 9. There are risk assessments to cover the residents as individuals, their activities and their environment (inside and outside the home), to maximise their capacity to be independent. 10. The arrangements for the storage and disclosure of confidential information are generally satisfactory. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 11 EVIDENCE: In a number of key respects the findings from the last two inspections were confirmed by this inspection. There is in each case a range of preadmission assessments on file, which were in the first instance drawn up by the funding authorities, then updated by the home’s own. The format of the home’s care plan, which follows on, is designed to address the health and social care needs of the resident, particularly when underpinned by documents such as a “Likes and Dislikes” document. It is written in the 1st person to keep the resident’s perspective central to the process. But it was still not yet available in an accessible format to meet the special communication needs of the residents. Risk assessments are properly linked to the care planning process (daily living routines, behaviour management, safety in the community, finances etc). Unfortunately, one resident was off site with relatives, and there was no opportunity to observe the other resident being supported by staff to modify his behaviour on this occasion, and he remained unsettled throughout the day. The visiting music therapist was also unable to obtain any meaningful interaction with him on this occasion. The last inspection (December 2005) was better able to report on the extent to which the residents are being supported to make day-to-day decisions and choices. With one exception (complaints policy), there was still no evidence of policies being reproduced in accessible formats, and there are as yet no plans to involve the residents in the development of policies, staff recruitment or service development. There was good evidence of daily reports being summarised 4-6 weekly, with a view to informing the care planning process. The inspector was advised that since the last inspection, the home is assuming a lead responsibility on formal reviews of care plan objectives, where it previously appeared to be overly reliant on the Care Managers to provide documentary evidence of these processes. However, there were as yet no records to evidence this – it was accepted that one formal review had yet to be set up. The home’s arrangements for keeping confidential information secure against unauthorized access was judged generally satisfactory. Since the last inspection, a dedicated office had been established on the first floor and all cabinets and office facilities are all properly secured. However, in the absence of the main key-holder (who was on annual leave at the time of this inspection visit), some records were not available. Contingency arrangements will need to be made, so as not to frustrate the inspection process. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 11, 16. Staff enable residents to maintain and develop social, emotional, communication and independent living skills. The daily routines promote choice and independence. 12. Staff support residents to undertake training and to take part in fulfilling activities. 13, 14. This home has a dedicated Leisure Activities Co-ordinator and offers a range of activities inside and outside the home. Links with the community are good, and support and enrich the residents’ social and educational opportunities. Activities are recorded. 15. There are open visiting arrangements, and the home is well placed for access to local community resources. Staff support residents to maintain links with families. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 13 EVIDENCE: Abilities, activities and personal preferences are established as part of the preadmission assessment process, and confirmed by care plans and day-to-day consultation or interpretation (where one resident does not have verbal skills) thereon. Adelaide Care Ltd has access to its own Community Outreach Worker, Education Development Worker, activities co-ordinator and music therapist, to promote identified needs. However, the music therapist is the only one to produce documented accounts of her input. It is strongly recommended that the other developmental workers are tasked to do the same, so that the care planning processes are clearly inclusive. Records confirm that one resident has been continuing to attend Canterbury College for a carpentry course. He attends clubs for arts and crafts sessions, computer courses (at the Umbrella Club), and this includes the use of the Internet) and a range of social events. And he regularly goes out in the community to a gym (some equipment has also been bought in for him to use at the home), museums, cafes and monthly trips to London etc i.e. local mainstream community activities not confined to or identifiable with disabilities. He is said to be able to manage pocket money, with support. Staff also support him with cooking sessions. At the last inspection (December 2005) an intensive programme of work was being set up for the second, more recent resident, using the specialist services of an independent organisation, but this initiative had been frustrated by cost factors, and will require a fresh start. However, there had been some Makaton training for all the staff, including the residents’ activities co-ordinator. There was anecdotal information about the extent to which he is able to participate in ball games, and his progress with making eye contact. In each case the home maintains records of the residents’ activities and there are scrap books of photographs to illustrate them – and these was examined this inspection visit in respect of both residents. There are open visiting arrangements, which have previously been confirmed by feedback from one relative. One resident is supported to manage a weekly phone card, and the inspector was told that he had learned to dial some numbers for himself since the last inspection. There are two cordless handsets, which can be taken into bedrooms for privacy as well as the office phone. Dietary needs and preferences are established as part of the preadmission assessment process, and confirmed by the care plan and day-to-day Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 14 consultation. Each resident has a menu book / diary, which is used to record what is eaten for each meal, as required. And one resident’s weight gain (which was raised for attention by feedback from his family) is being monitored. The dining area is a light spacious area, which provides a congenial setting for meals but the residents can choose to eat elsewhere. This standard was not further pursued on this occasion, as one resident was off site and the other was too unsettled to observe. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 18, 19, 20. The residents receive an appropriate level of support with their personal, emotional and healthcare needs. Personal care is offered in a way protect their privacy and dignity and promote their independence. 19, 20. The health needs of the residents are well met with evidence of access to a range of healthcare services. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The preadmission and care planning processes assess the extent to which each resident can manage their own personal care, and their choice and control is actively promoted by staff. All the bedrooms are single occupancy and bedroom doors have double-acting locks to guarantee their availability and privacy, while enabling staff to access the rooms in an emergency. There are enough toilet and personal care facilities (baths, showers, wash hand basins) – and these have been completely refurbished to a high standard since Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 16 the last inspection, although the Jacuzzi facility continues to be unavailable to the residents. Staff are available on a 24 hour basis to assist residents. The care planning process routinely addresses a range of standard healthcare needs e.g. GP, optician. The home also accesses care managers, district nurses as appropriate. The home has dispensed with its own medication administration arrangement and record system, in favour of the monitored dosage system (MDS) from Boots The Chemist, which also provides training and its own medication administration record (MAR) sheets. Recording standards were judged satisfactory, although the question of allergies needs to be more routinely addressed in each case. The home has also obtained a copy of the Royal Pharmaceutical Society Guidance to ensure its practice is compliant with best practice, underpinned by training (including specialist training e.g. insulin management for 60 of the staff, with District Nurses providing back up). Storage / access arrangements were judged more systematic than as previously reported. The home keeps its medication in lockable wall-mounted facilities (one per resident), and there is also a dedicated fridge and a contract in place for the storage and collection of SHARPS. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 22. The home has a complaints procedure, and some work has been done on its format to meet the special needs of the residents. 23. Residents are generally safeguarded against abuse. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints file, which usefully details its guiding principles in its preface, and describes the arrangements, procedures and timeframes for each stage. However, like other key public information documents (see section on Choice of Home), the text a sequence of statements, each word of which is literally matched by an underlying symbol. This makes it a very intense document to read, made more problematical by a number of grammatical and spelling errors. And the approach is not consistently applied, sometimes addressing the reader in terms of “we” and “you”, at other times as “they” or “the service users” “the staff”. If it is accepted that some of the residents would be better able to communicate verbally, and others would be better able to use Makaton and /or PECS symbols (Picture Exchange Communication System) etc., there needs to be a range of separate formats available to cater for this spectrum of need. As reported at the last inspection (December 2005) there was only one complaint on file, and this was not judged a realistic reflection of communal Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 18 living. One resident has special communication needs, which will need to be catered for. The challenge for this home will, therefore, be to interpret expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can properly judge compliance with this standard. Staff induction covers a range of relevant adult protection policies: challenging behaviour; incident and accident recording; complaints; whistle-blowing; abuse and adult protection. In discussions with staff, they have invariably confirmed their commitment to challenge and report any instances of abuse, should it occur. The rapport between staff and the current resident appeared appropriately familiar and respectful. Feedback from the other resident has previously confirmed that he felt he was in safe hands, and that he would raise any issues with staff. Less clear, on this occasion, was the extent to which the home is overseeing / accounting for his expenditure and the manager was asked to submit a view on this. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 24, 28. The standard of the property is good. The furniture is domestic in style, and comfortable. Residents have a choice of communal areas, and there are homely touches throughout. Further investment is planned to make the home environment more safe and to install a sensory area, to enhance the resident’s lifestyle. 27. Each bedroom has a wash basin cubicles, and there are sufficient communal bath and WC facilities to guarantee their availability and privacy. 29. The home is not wheelchair accessible and although it has ample useable floor space throughout, it is not adapted for people with physical disabilities. 30. The home is well maintained, clean and free of offensive odours. Consideration must be given to providing an alternative route for access to the ground floor WC/bathroom. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 20 EVIDENCE: The layout of this home is generally suitable for its registered purpose. All areas of the home were inspected and found to be homely, comfortable and clean. The furniture tends to be domestic in style and there were homely touches throughout. The rear garden, although monopolised by the swimming pool and patio, provide pleasant discrete focal points and congenial areas to walk or sit in. The home has a “No Smoking” policy. Communal Areas These are all on the ground floor. There is a spacious formal lounge at the front of the home, which has restricted access, for formal meetings and accompanied residents. At its far end is a split level “den” (which has been converted into a sensory area) forming a discrete room. There is a second lounge linked to the dining area, for everyday use. The dining room is at the centre of the home and is linked on one side to the kitchen and at another side to the second lounge, conservatory and rear garden. All the chairs (dining, lounge and conservatory) belong to suites and are therefore uniform in style – a range of chairs (e.g. some with arms, or set at different heights) would give residents more choice. Because of identified trip / accident hazards, in the den area in particular, where there is a split level well, all edges have been covered and padded. The kitchen is light, airy, clean and well maintained. Communal Bathrooms / WCs There are WC facilities on both floors, and a choice of bath and shower facilities - all of which are reasonably accessible to bedrooms and communal areas; and these had all undergone substantial refurbishment since the last inspection. There is also a Jacuzzi, but residents do not have access to this. Bedrooms All the bedrooms are spacious and single occupancy. All the bedrooms were inspected and found to be well maintained. In terms of their furniture and fittings, they were generally compliant with the provisions of the National Minimum Standards, and every bedroom also has a TV point. No matters were raised for attention on this occasion. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 32. The registered person has ensured that staff have the competencies to meet the residents’ needs, and has made a commitment to ensure that the remaining 40 of the team have undertaken or obtained NVQ accreditation. 33. The home has an effective staff team, with sufficient numbers and complementary skills to support residents’ assessed needs. 34. The registered person operates a thorough recruitment procedure. 35. The registered person ensures there is a staff training and development programme. 36. Staff receive the support and supervision they need to carry out their job. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The waking / working day has been interpreted as 7am till 10pm, and visitors should expect to find between 2-4 staff on duty. This arrangement was in fact confirmed by this unannounced site visit. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 22 The deputy is on site for 3/7 days each week (though he was on annual leave at the time of this visit) and there are two shift leaders who cover the other days, with the manager in regular attendance each week. At night there are invariably two sleeping staff on site, on call. There are no dedicated ancillary staff (e.g. cooks or cleaners). These tasks are covered by the staff responsible for direct care, and one of the current residents is supported to carry out some domestic chores. Every Friday there is also a Leisure Activities Co-ordinator. The manager is detailing her own on-site hours on staffing rotas, as required; and “shift planners” are used to record ancillary hours (cooking and cleaning) separately, where staff duties are split between direct care tasks and ancillary work so that anyone authorised to inspect the records can readily evaluate the staffing arrangements. Staffing rotas will need to include a cross reference to shift planners to ensure this link is made. The personnel files were not available for inspection on this occasion as the main key-holder was on annual leaved. The manager was advised that contingency arrangements will need to be made, so as not to frustrate the inspection process in future, given all site visits are likely to be unannounced. However, the last inspection December 2005) found a sound level of compliance with the National Minimum Standards in respect of recruitment, induction and training (which includes TOPSS training), and copies of resultant certificates. Staff have at each inspection confirmed having had a range of training opportunities, such as food safety, fire safety, manual handling, First Aid, and challenging behaviour. See also section on “Lifestyle” for details on specialist input to meet one residents’ special needs. Both staff who met with the inspector on this occasion confirmed feedback at previous inspections and records, that they had formal supervision from their line manager, which generally exceeds the National Minimum Standards. The line management was said to be accessible and supportive. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 37. The registered manager has a range of relevant qualifications and experience to run the home. 38. The management approach is open, positive and inclusive. 39. Effective quality assurance and quality monitoring systems are in place to measure the home’s effectiveness. 40. The home’s written policies and procedures comply with accredited standards 41. Records required by regulation for the protection of residents and for the effective running of the home are properly maintained. 42. The registered manager ensures as far as is reasonably practicable the health, safety and welfare of residents and staff. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager has a range of relevant qualifications (City & Guilds, BTEC Diploma, Higher National Diploma, Tavistock Urban Community Studies, Diploma in Social Worker (CETSW), BA Hons International Social Work) plus 17 years experience working with adults, children and their families. The inspector was advised that she has not had any further training since the last inspection (December 2005). This is a home, which has already been able to demonstrate good progress with its inclusive approach to its first resident. He is clearly benefiting from access to a range of fulfilling activities as well as to mainstream community resources not immediately identifiable with or confined to his special needs. Some investments had been made to meet the needs of the second resident, but others have been frustrated, and he was very unsettled at the time of this inspection, so the inspector was unable to evaluate the effectiveness of the placement. The home has a policy and procedure for Quality Assurance, which is usefully prefaced by statements about its guiding principles and includes questionnaires for use with residents (though there is still as yet no picture or symbol assisted version), referring agencies, care managers and relatives. Initial feedback comments were judged encouraging, though there is now a need to repeat the exercises, to ensure their currency. As reported at the last inspection, the registered manager has ensured that key policies and procedures are in line with accredited models – examples include, the home’s own code of conduct (which has been checked against the General Social Care Council model) and its own medication policy (which has been checked against the Royal Pharmaceutical Council model) and its own policy on adult protection (which has been checked against the Department of Health “No Secrets” document and the local Kent and Medway protocols). This is judged a robust approach. Property maintenance records were judged generally in good order and maintained in the best interests of the residents. The gas safety certificate, which was only slightly overdue at the last inspection, had been duly updated. The home has the required public liability insurance cover. At the first inspection weekly petty cash accounts and financial records were judged fully accountable and properly supported by receipts. Less clear on this occasion was the extent to which the home was overseeing and accounting for one resident’s expenditure. This is not to be interpreted as a reflection on the home’s own operational probity. Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 2 Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4& Schedule 1 Requirement The registered person must ensure the Statement of Purpose is fully compliant with the National Minimum Standard and regulations. Original timeframe – 31/03/06 The registered person must ensure the Service User Guide is fully compliant with the National Minimum Standard and regulations. Original timeframe – 31/03/06 The registered person must ensure the Contract is fully compliant with the National Minimum Standard and regulations. Original timeframe – 31/03/06 The management of one resident’s personal finances off site will require scrutiny by the funding authority to ensure probity is being exercised by all parties involved in his care. Timescale for action 31/07/06 2. YA1 5 31/07/06 3. YA5 5(b)(c) 31/07/06 4. YA43 17(2) & Schedule 4 30/06/06 Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 27 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. 4. 5. Refer to Standard YA1 YA5 YA7 YA11 YA21 Good Practice Recommendations The registered person must ensure the Service User Guide is available in a range of formats to meet the individual residents’ special communication needs. The registered person must ensure the Contract is available in a range of formats to meet the individual residents’ special communication needs. The home needs to demonstrate that it takes more control over the formal care plan reviews. Developmental workers should be asked to contribute to documented reporting systems to ensure an inclusive approach to care planning. The policy on the management of the death of any service user needs to include: - the duty to retain records after any death for three years after the date of the last entry, and - medication for seven days in case there is a coroner’s enquiry. One reference to the Commission’s old title needs to be updated. Complaints. The challenge for this home will be to interpret expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can judge compliance with this standard. Staffing rotas will need to include a cross reference to shift planners to ensure this link is made, by anyone authorised to inspect the staffing arrangements. there is now a need to repeat the quality assurance exercises, to ensure their currency. There should be contingency arrangements to cover the absence of the main key-holder, so as not to frustrate the inspector’s right of access or compromise Data Protection principles. 6. YA22 7. 8. 9. YA33 YA39 YA41 Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Five Ways DS0000047387.V297545.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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