Inspection on 15/06/06 for Flaxpits House

This inspection was carried out on 15th 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Flaxpits House 31/07/07

Flaxpits House 22/03/07

Flaxpits House 12/01/06

Flaxpits House 29/06/05

Flaxpits House 20/12/04

Flaxpits House 01/07/04

Flaxpits House 10/02/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Flaxpits House 74 Flaxpits Lane Winterbourne South Glos BS36 1LB Lead Inspector Odette Coveney Key Unannounced Inspection 15th June 2006 09:30 Flaxpits House DS0000003383.V300096.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 Flaxpits House DS0000003383.V300096.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. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Flaxpits House Address 74 Flaxpits Lane Winterbourne South Glos BS36 1LB 01454 776191 0117 9709301 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Miss Dionne Marie Brown Care Home 10 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (10), Physical disability (10), of places Physical disability over 65 years of age (10) Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Male and Female 35-64 years and 65 years and over Date of last inspection 12th January 2006 Brief Description of the Service: Flaxpits House is a detached property. There is a large garden to the side and rear of the property, which is fenced for privacy. There are lawns, flowerbeds a summerhouse and a greenhouse. To the front of the property is a large area of hard standing which provides ample parking as well as newly planted plants and shrubs. The property was originally a period house, which has been renovated and extended to provide accommodation on two floors. All of the bedrooms are single occupancy and there is a choice of communal rooms, which all have access to the gardens. The home is close to the centre of Winterbourne, which is served by a bus service to Bristol city centre and is within easy access to the motorway. Flaxpits House is part of the Aspects & Milestones Trust. The home provides residential care for eight adults with learning and physical disabilities. At this inspection it was found that work had been fully completed on an extension to the property, this includes a one-bedded bungalow and an additional two bedrooms and one bathroom. The plans also included making four of the bedrooms en-suite. The registered manger is Dionne Browne, who has been in post since June 2003. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and review the quality of the care provision for the individual’s living in the home. This inspection employed key elements of the national inspection methodology with the objectives of focusing on outcomes for the individual’s. This is evidenced through evaluation of core standards and verification through a surveying and case tracking approach, which included observation of individuals and views of staff. An opportunity was taken to view the home and a number of the records relating to the management of the home and plans of care for three of the individuals were reviewed. Recruitment and selection records of staff were unavailable for inspection. Of the eighteen requirements made at the previous inspection eight had been met, the inspector was unable to assess one of the previous requirements as records were not available for inspection, further information was requested from the manager in order to determine if another requirement made at the previous inspection has been met, this was received on 28th June and the information provided evidenced that the requirement had been met. What the service does well: What has improved since the last inspection? It was required at the last three inspections that each individual had in place a copy of the terms and conditions of their placement. As the manager was not on site at this inspection these documents were unavailable and therefore it is requested that copies of these documents be forward in order to review if these are in place and that they contain the required relevant information. These were received on June 28th and this requirement has been met. Those living and working at Flaxpits House can be assured of their safety in the event of a fire as staff have received sufficient amount of fire instruction and emergency lighting is checked consistently on a monthly basis. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 6 Those living at the home have appropriate items in place to reduce the likelihood of cross contamination and a carpet that was stained has been replaced. When areas of maintenance requirements have been identified work is undertaken with a safe, well maintained environment for those who live at the home. Health and safety at the home has improved as the boiler room has been cleared of clutter. Clients living at the home can be assured that the home is working in line with the regulations and keep the Commission informed of incidents that have affected the well-being of those living at the home. What they could do better: There are a number of requirements and recommendations from the previous inspection, which have not been met, these must be in order to ensure compliance with the legislation and maintain the safety of the individual’s living at the home. Clients would be better supported and empowered to make choices on how they choose to spend their leisure activities if action plans incorporated the use of pictures and photographs. This was recommended at the last inspection. All of the below issues had been required at the last inspection with little evidence to show that these had been met. In order to effectively meet the needs of individual’s care plans must be reviewed on a monthly basis and must include all aspects of individual’s needs. The care plans in place must indicate that all areas of the plan have been evaluated and changes recorded. In order to fully demonstrate that individuals are supported with identified health needs it is required that the home must ensure that clear evidence and information is in place to show that the health care needs of individuals are being met. To ensure that the information held within individual’s care documentation is up to date and relevant it was also recommended that individual’s personal information sheets be reviewed and that consideration is given to the review of the order and contents contained within individual’s care plans. Those living at the home would be safer if staff received medication competency training; this was required at two previous inspections. There are no qualified staff members at the home and therefore staff have not received training by a competent person. It was also required at the last inspection that that stock held medication be better recorded. Records of stock held medication were reviewed and it was found that three staff members were unaware of the purpose of a prescribed medication for one individual. In order to ensure that individual’s are safe the home must ensure that risk assessments are reviewed and updated where required to ensure that the information held is accurate and current and that the assessments encompass Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 7 all areas of individual’s lifestyle. Assessments must include aspect of manual handling. Those living at the home would be assured that their wishes and their choices in the event of their death are acted upon if the home sought methods to obtain these and these wishes were recorded, some progress has been made in this area, however information was not recorded for all. Clients property and valuables would be safer if these were recorded on an up to date inventory and if these were reviewed on a regular basis. It was identified at three previous inspections that the home does not have in place an effective quality audit system based on seeking the views of the clients; this was not reviewed at this inspection and will be a priority at the next inspection. At this inspection a further two requirements were made. It is required that attention is given to the rear garden of the home in order that it is accessible for clients. In order that client’s can be confident that staff have the knowledge and skills to support them it is required that staff undertake a sufficient amount of training. 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. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 8 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 Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 9 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, 5 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Although prospective clients have information to make an informed choice on whether the home is able to meet their needs there are not clear contractual arrangements in place to protect the rights of individual’s. This has been outstanding at previous inspections. EVIDENCE: There had been no admissions to the home for a long period of time, it has been noted on previous occasions that the home had clear admission policies and procedures in place and that admissions to the home are done so following a full care management assessment of need and that admissions are tailored to the wishes and requirements of the individual. Aspects and Milestones Trust have developed pictorial ‘terms and conditions’ of the placement, this contract outlines the rights and responsibilities of intervals. These are entitled ‘licence agreements’. Contractual arrangements were in place between the contracting placing authority and the home. It has been required at the last three inspections that each individual had in place a copy of the terms and conditions of their placement, as the manager was not on site at this and the previous inspection these documents were unavailable and therefore it has been requested that copies of these documents are forwarded to the Commission in order to verify Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 10 that these documents are in place and so that their content can be reviewed to ensure that individual’s living at Flaxpits House are aware of the existence of these agreements. These were received on June 20th June and evidenced that the requirement had been met. These documents are essential for the individuals living at the home in order that they are aware of their rights and have a written and costed statement of the terms and conditions between the home and the individual, which outline the rights, and responsibilities of all parties involved. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 11 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, 9 The quality outcomes in this area are poor. This judgement has been made using available evidence including a visit to this service. It was clearly evident that staff are committed to meeting the needs of residents however, individuals care plans and risk assessments are not reviewed and updated to ensure information held is sufficient. EVIDENCE: Upon discussion with staff it was clear that they have a sound understanding of the needs of individuals and are committed to ensuring that individual rights, wishes and preferred lifestyle is respected. At this visit the care plan documents for three of the clients were reviewed. The inspector saw that residents have in place information which is essential to them in order to live their life in an individualised, person centred way. These recorded individual’s general preferred routines, individual’s strength’s, needs, likes and dislikes and individuals positive reputation. It was noted that some areas of individuals plans such as ‘supporting me when I am out’, ‘keeping me safe’, and ‘how I communicate’ were blank and one individual’s support needs at night had not been reviewed or updated since November 2004. It is Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 12 essential that these documents are reviewed, updated and well maintained in order to ensure that there is clear information in order to direct and guide staff practice ensuring that needs of individuals are being met. It was further noted that pen pictures of individuals were in place with internal guidance that these be reviewed every three months, those reviewed had not been done since July 2005. Another client’s daily support needs had not been reviewed since August 2005, with their essential lifestyle information not having been updated since 2001. It was required at the last inspection that care plans must be updated and reviewed in order to ensure that current and changing needs are captured and recorded. At both this and the last inspection a client fell. Staff responded promptly and effectively in order to assist the person, staff have undertaken manual handling training and evidence of this showed within their practice. Records reviewed of the individuals who fell further showed that their falls happen fairly regularly. A requirement was made at the last inspection that manual handling assessments must be completed in order to record how individuals would be moved in a safe manner in line with the organisations training and polices and procedures, this had not been completed with no further information to show that the safety of this person had been considered therefore enforcement action is being considered in order to effect change and improve record keeping in this area. It has been required at previous inspections that identified risks at the home must be recorded and assessed. A number of risk assessments were reviewed at this visit and those seen included; use of the shower, bathing and support with areas of personal care, however staff told the inspector of one of the clients who attempts to leave the home and the home has increased security due to this yet no assessment is in place to cover this area. This requirement will remain and must be acted upon. At the last inspection it was required that individuals risk assessments be reviewed and updated. It was recommended at the last inspection that consideration should be given to the review of individuals’ care files and that personal information sheets should be updated, this had not been undertaken and will be reviewed at the next inspection. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 13 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, 15. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Individuals lead varied lives and participate in a range of activities, with individual’s rights being respected. EVIDENCE: All of those living at the home were sent pictorial comment cards for them to respond about the service they receive, none were received by the Commission. Three comment cards received from relatives prior to the inspection recorded ‘ staff are always very welcoming and the house is clean and tidy’ ‘staff write and send photographs’ Two comment cards received prior to the inspection from health & social care professionals recorded ‘The staff at Flaxpits always appear polite and very committed to their residents’. One comment card received from a GP prior to the inspection recorded ‘I do not have any concerns about the home’. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 14 From discussion with residents and information seen in individual’s daily records it was clear that residents are supported to participate fully in daytime activities of their choice such as visiting local shopping centres, attending church, hydrotherapy and visiting places of local interest such as Weston-super -Mare, Slimbridge, boat trip’s and visits to a farm. One of the clients has recently returned from a holiday in Portugal. The client was not at home however the staff member who accompanied told of the enjoyment and experiences of the client and of the benefits it had been to them. On the day of the inspection three of the clients were out, another went out later that day and another client was going out for an evening meal and to watch the football. It was recommended at the last inspection that client’s action plans should contain photographs or pictures in order to enable individuals to make choices, no action has been taken in this area to meet this recommendation demonstrating little regard for the recommendation made at the last inspection and of the benefits this would have for those living at the home. Flaxpits House DS0000003383.V300096.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, 21 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s personal care needs were being met; however a review of individual’s healthcare records must be undertaken. Resident’s health care needs were not clearly being met. Residents were not protected by policies and procedures in the safe administration of medication. EVIDENCE: Four requirements were made at the last inspection in respect of this group of standards; all of the areas were reviewed and discussed with staff during this visit. A staff member told the inspector of the processes for administering, recording, storage and disposal of medication. This individual was fully conversant with their role and responsibility and was able to demonstrate a sound understanding in this area. Systems of medication were viewed and were records that are maintained within the home. Some discussion took place with this staff member about the requirement made at the last inspection which was that staff that administer medication must undertake competency training by an accredited trainer. This has not happened, although the staff member was able to inform the inspector that they had received instruction Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 16 from their manager, who in turn had received instruction from a manager of another home. This method of ‘diluted’ training is not sufficient and the requirement has not been met. The staff member said that they are booked to undertake medication competency training, however the date for this had been changed, and therefore had not been undertaken. There are no residents at the home who self medicate and individuals are supported in this area by staff at the home. Records of medication given on a daily basis were clear with no omissions. Stock held medication was reviewed and the inspector was concerned to find that the requirement made at the last inspection which was that stock held medication must tally with records held at the home had not been met. One individual is prescribed ‘Haloperidol’ to be taken twice daily; this is recorded on their medication administration sheet yet they also had this medication held in stock with three staff members not able to give an explanation for the reason. One individual had two different doses of Diazepam, yet only one of these was recorded as being given. It was also recommended at the last inspection that excess medication should be returned to the pharmacist, this same medication dating to 2004 was still in place and this requirement has not been met. An unmet requirement made at the last inspection was that the home must ensure that healthcare records must be maintained. A review of these found no continuity in record keeping, individual monitoring of weight, visits to the general practitioner had been recorded, however daily records showed that an individual has experienced seizures yet these had not been recorded on the chart devised by the home. A requirement was also made at the last inspection that the home must ensure that healthcare needs are met; again there was a lack of consistency in this area. One of the clients had an accident and appropriate action to support them in a particular aspect of their health was dealt with promptly, the same individual had an identified mobility need and the appropriate service and equipment required were obtained, with the inspector noting that staff were promoting and supporting the individual with this piece of equipment. However records within the home of individuals’ accessing primary healthcare services such as the dentist, chiropodist and opticians did not show that services had been obtained, if required and therefore this requirement has not been met. A client living at the home has recently died, a staff member spoke of the terminal care support given to this individual and spoke of how this person was treated with dignity and respect. Staff are to be commended for supporting this individual at the end of his life in a caring and compassionate way. It has been recommended at three previous inspections that the home should seek methods of obtaining the views of individuals in the event of their death, and that these must be recorded. A review of three care records showed that correspondence had been sent to one relative with no evidence for the other two individuals reviewed. It is to be noted that there have been efforts to obtain this information as minutes of a recent staff meeting Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 17 evidenced that this area had been discussed. This information is important in order that the home can be sure that they are fulfilling the wishes and choices of individuals, this recommendation remains and will, again, be reviewed at the next inspection. All clients were dressed reflecting their individuality. Personal care was delivered behind a closed door ensuring the privacy of the individual. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality outcomes in this area are good. This judgement has been made using available evidence including a visit to this service. Client’s behaviours are observed and where they are able to express themselves, they are listened to and their views are acted upon. The home has appropriate measures in place in order to adequately protect clients from abuse. EVIDENCE: The home has clear and robust adult protection protocols, policies and procedures in place. These include a staff ‘whistle blowing’ document and South Gloucestershire Community Care Department’s Protection of Vulnerable Adults Policy. There are staff working at the home that have either achieved or are undertaking a National Vocational Qualification in Care, (promoting Independence) and this has a core unit that incorporates adult protection and staff responsibility should they have any suspicions or concerns. During the inspection staff spoken with were able to demonstrate a sound understanding of the diverse needs of individuals who live at the home and gave clear examples of the home’s intervention in order to ensure the safety and protection of those living at the home from potential dangers. The complaints logbook held at the home was viewed. Clear information was in place to demonstrate that issues are dealt with effectively to the satisfaction of those involved. The Commission for Social Care inspection has not received any complaints. No areas of concern were observed or raised during the inspection. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 19 It was found that all of the clients has a pictorial copy of the organisation’s complaints procedure that provides clear information for individuals and informs them what is a complaint, who can make a complaint, who to complain to and what will happen if they make a complaint. There is a form attached for them to complete if required. This procedure also contained the contact details of the Commission and also provided details of the timescales in which complaints would be responded to. The information given was an enabling and supportive document with good information. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 20 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 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Improvement must be made to the rear garden in order that those who live at the home may enjoy this area. EVIDENCE: Flaxpits House home is located within a residential area of Winterbourne. The home is in keeping with surrounding houses and close to local amenities and shops. Flaxpits House was found to be well furnished and with soft furnishings such as pictures, plants and photographs making for a homely environment. The home was found to be clean and tidy. Staff spoken with displayed a sense of pride in the environment and how they were able to engage with individuals to ensure their home was presented in a way, which reflected their personal tastes and choices. Since the last inspection the house has been significantly extended to provide three new bedrooms all with en-suite facilities, and bungalow accommodation, purpose built for one of the clients. The bungalow has kitchen, a lounge area, Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 21 bedroom and a bathroom with an electric bath. An existing bedroom has been extended with an en-suite and ceiling hoist tracking fitted. An additional bathroom has been added within the extended part of the home. All of the work has been completed to a high standard with light and electrical switches at waist level. Clients have chosen the décor of their new rooms. The home has increased its accommodation from 8 to 10 bedrooms. The manager’s office has been moved from upstairs to a previous bedroom on the ground floor. The extension provides a new main entrance to the home. Car parking has been extended to provide sufficient parking. The garden to the rear of the home has been extended however this has not been finished off and therefore would be unsafe access for clients due to it being uneven, it is required that attention be given to the rear garden in order to make it more accessible to clients. Staff spoke positively of the benefits of the extension for the clients and clients were seen making good use of their private areas and appear to have settled in well. In order that a clean, safe and better maintained property was provided for those who live at the home was in place a number of requirements were made at the last inspection: that toilet roll, soap and hand towels to be available for individuals use, that the boiler room to be cleared of clutter, that the carpet in individuals room to be cleaned or replaced if stains cannot be removed, that a urinal must be provided for an individual’s use and finally that the identified areas of maintenance within the home noted at the inspection must be undertaken. All of these areas were reviewed and the inspector was satisfied that all of these requirements had been met. The home has two substantial lounges and one dining room. These provide sufficient space to cover the communal and spatial requirements. The bungalow has it’s own lounge, kitchen and bathroom area. Upon discussion with staff it appears as if no clear decision has been reached for the long-term proposal for the upstairs area of the home to be separated from the main house. Should the future plans impact on the current registration of the home then the commission must be notified. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35. The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. There is an effective staff team employed at the home with varying levels of qualifications and experience however training records are not maintained and all staff are not receiving sufficient amounts of training. EVIDENCE: The duty rota showed that there are sufficient numbers of staff on duty with flexible working by staff in order to meet individual’s needs and aspirations. Staff on duty were familiar with individuals personal routines and were able to fully describe them as detailed in their care records. Staff recruitment, selection and training documents were not available and therefore will be fully reviewed at the next inspection. At previous inspections these have been viewed with no concerns, at those times, being identified. Staff meetings are held regularly at the home and these provide an opportunity to discuss issues and to ensure effective communication and continuity of service delivery; minutes of a recent staff meeting held in May showed that areas of discussion include; fire safety, individual needs of clients, activities and staff role. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 23 Staff spoken with provided detailed information on the clients that they support and spoke with a sense of pride within their role to ensure that the rights of individuals to lead a good quality of life were upheld and this was important to them. A staff member also said that due to a full staff team that those at the home were working well together ‘as a team’. Staff spoken with were clear and fully aware of their roles and responsibilities and how they incorporate this within their work to ensure that they work within the aims and values of the home. Training records for nine staff members were reviewed at this inspection, it was recommended at the previous inspection that training records should be updated in order to reflect what had been undertaken, this had not been completed. A review of the training records in place, discussion with those on duty, along with the certificates seen in staff files showed that staff have access to core and specialist training such as assertiveness, epilepsy awareness, person centred planning, values training and first aid. However not all staff have received sufficient amounts of training and a requirement in respect of this was made, one staff member had no records in place at all of either training completed or induction. A recently appointed staff member told of the ‘in house’ induction they had undertaken that had included fire training, safety awareness and care planning this staff member said they had been well supported by the manager and the staff team at the home. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41, 42 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals living at Flaxpits benefit from the ethos of the home and staff work within the aims and objectives of the organisation. EVIDENCE: The manager Dionne Browne was not present at this inspection. The following requirements were made at the last inspection, that emergency lighting must be checked every month and also that all staff to receive sufficient fire instruction. Upon a review of the fire logbook it was evident that these requirements had been met. The home has introduced a system of monitoring and recording when staff receive fire instruction and this appears to be working well. A requirement was made at the last inspection that the home develops an effective Quality Assurance monitoring system based on seeking the views of clients. As the manager was not present and staff were unable to give full Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 25 information about this the inspector was unable to fully evaluate this requirement and therefore it will be reviewed at the next inspection. At the previous inspection a requirement was made that CSCI must be notified of incidents, which affect those living at the home. Informed. Due to the home keeping the Commission informed of incidents and no further incident evident at this inspection this requirement was found to have been met. It was recommended at the last inspection that the home must ensure that individual’s inventories are maintained, although some attempts have been made to meet this recommendation this has not been completed for all and will again, be reviewed at the next inspection, this is to ensure that individuals valuables and property are clearly accounted for. Polices and procedures in place at the home were reviewed at this inspection. These reflected the structure of the home and the care needs of clients as outlined within the National Minimum Standards. Those in place included: equal opportunities, training, health and safety, complaints and processes for admissions into the home. Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 26 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 3 2 X 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 X 27 3 28 3 29 X 30 X STAFFING Standard No Score 31 3 32 X 33 3 34 X 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 2 X X 1 X 2 3 X Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4)b Requirement Individuals risk assessments to be reviewed and updated where required. Individuals care plans to be updated and reviewed. Develop an effective Quality Assurance monitoring system based on seeking the views of clients. Staff that administer medication must undertake competency training by an accredited trainer. The home must ensure that healthcare needs are met. Healthcare records must be maintained. Manual handling assessments must be completed. Timescale for action 15/08/06 2. 3. YA6 YA39 15 24 15/08/06 15/09/06 4. YA20 13(2) 12/08/06 5. 6. 7. 8. 9. YA19 YA19 YA9 YA9 YA20 13(1)b 17(1)a 13(5) 4 (c) 13(1) 2 15/07/06 15/07/06 15/07/06 Identified risks at the home must 15/08/06 be recorded and assessed. Stock medication must tally with records held. DS0000003383.V300096.R01.S.doc 15/08/06 Flaxpits House Version 5.2 Page 28 10. 11. YA35 YA24 18(1) c 23 (2) o Staff must receive sufficient amounts of training in order to fulfil their role. Attention to be given to the rear garden in order to make it more accessible for service users. 15/10/06 15/10/06 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 YA11 YA41 YA21 Good Practice Recommendations Client’s action plans should contain photographs or pictures in order to enable individuals to make choices. Individual’s inventories must be updated. The home should seek methods of obtaining the views of individuals in the event of their death, these must be recorded. Staff training records to be updated. Excess medication to be returned to the pharmacist. Consideration should be given to a review of individuals care files. Personal information sheets to be updated. 4. 5. 6. 7. YA35 YA20 YA6 YA6 Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Flaxpits House DS0000003383.V300096.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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