Inspection on 22/03/07 for Flaxpits House

This inspection was carried out on 22nd March 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 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 15/06/06

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 22nd March 2007 09:00 Flaxpits House DS0000003383.V323539.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.V323539.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.V323539.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.V323539.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 15th June 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. More recently there has been a further extension to the property. This includes a one-bedded bungalow and an additional two bedrooms and one bathroom. 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 ten adults with learning and physical disabilities. The registered manger is Dionne Browne, who has been in post since June 2003. Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day; time was spent examining a number of records including care documentation, maintenance records and health and safety documentation. Staff training records were reviewed however staff recruitment, selection and supervision records were not available and therefore will be fully examined at the next inspection. Individuals living at Flaxpits house have some complex communication methods with spoken language not always used. The inspector spent some time in communal areas and one individual sat in the office with the inspector. The inspector observed staff interaction with individuals throughout the day and comments about this are recorded within this report. Unfortunately the manager was, again, not present at the inspection. A senior member of staff and staff on duty assisted the inspector through the process, staff were informative and engaged fully with the process. Eleven requirements and seven recommendations were made at the last inspection that was undertaken on June 15th 2006. Information about these are referred to within the main body of the report, with four requirements continuing to be outstanding since January 2006. Due to the manager not being present two requirements were not able to be fully assessed and the manager has been asked to forward evidence of progress in these areas. As no information had been received prior to the completion of this draft report the requirements will remain. Due to the outcomes of this inspection a meeting will be held with representatives of the home in order to discuss a required improvement plan for the home, furthermore a pharmacy inspector from the commission will be requested to visit the home in order to review medication administration and practices at the home. What the service does well: Staff spoken with appear to have a sound understanding of the individual and diverse needs of those living at the home. The admission processes are sound with full assessment of individuals needs in place. Individuals aspirations and needs are assessed prior to admission into the home with individuals being able to visit the home and to complete a ‘trial’ stay at the home to ensure that the home is able to meet their needs. Individuals are given a ‘licence agreement’ outlining the terms and conditions with the home. The building is well located within the local community and is close to amenities, the building is well suited for its intended purpose. Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: In order to ensure that those living at the home are supported safely and staff are working in line with manual handling regulations it is required that manual handling assessments for service users are completed. Individuals living at the home must be treated with respect at all times. In order that individuals can be assured that their money and property are clearly accounted for the home must ensure that individuals monies held for safekeeping must correspond with records held, furthermore individuals inventories of personal property should be in place and updated when required. In order that individuals can have access to equipment which ha been provided for them it is required that the track ceiling hoist is repaired for an individuals use in accordance with their assessed need. Service users would be better supported and feel confident in staff skills if staff are provided with both positive response training. Also if all staff have undertaken protection of vulnerable adults training, and also, as noted at the Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 7 last inspection, it is further required that all staff must receive sufficient amounts of training in order to fulfil their role and records of staff training must be better maintained. In order to demonstrate that individuals have been supported appropriately and that the home is working in accordance with the Care Homes Regulations 2001 the manager must ensure that the Commission is notified of incidents, which affect the well-being of those living at the home. In order to fully demonstrate that individuals have been consulted, that their views had been sought and listened to and where needed acted upon a requirement was made at the last inspection that the home must develop a quality assurance monitoring system based on seeking the views of service users. |No evidence was available at the inspection to demonstrate that this requirement had been met. In order to ensure that individuals are safe, evidence must be provided to show that all staff at the home that administer medication have undertaken appropriate training to demonstrate their competency. A requirement made at the last inspection was that stock medication must tally with records held, this had not been met and the potential for error is high and raises cause for concern. Also there are a number of recommendations, which have been made at this inspection in order to ensure that medication administration records are better maintained. Individual’s action plans should contain photographs or pictures in order to enable individuals to make choices. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Flaxpits House DS0000003383.V323539.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.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ aspirations and needs are assessed prior to admission into the home with individuals being able to visit the home and to complete a ‘trial’ stay at the home to ensure that the home are able to meet their needs. Individuals are given a ‘licence agreement’ outlining the terms and conditions with the home. EVIDENCE: Since the last inspection there have been two new people admitted into the home, one person was at the home for an assessment period at the time of the inspection in order that a full evaluation of this person needs, wishes, choices and aspirations were made and also to determine if the home was an appropriate placement for the individual. There are no individuals living at the home who are privately funded, respite care is not provided at the home and emergency placements are avoided where possible. The home’s practice makes sure that an assessment is undertaken for all admissions to the home so that an informed decision can be made about the ability of the home to meet identified health and social care needs. Daily records showed that individuals had visited the home prior to their admission and this had been tailored to individual’s wishes. Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 10 The inspector saw that each individual had in place a ‘licence agreement’ that outlines the rights and responsibilities of all parties and also the terms and conditions of the placement. These documents had been produced in pictorial format with the use of easy to use phrases. These documents had been explained to individuals who had signed to confirm this. The document had also been signed by a representative of the home and dated. Flaxpits House DS0000003383.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals assessed and changing needs, identified risks and personal goals are reflected within their individual care plan. Individuals are well supported with aspect of their life by staff, however service users would be supported more safely with aspects of manual handling if individual assessments in this area were completed. EVIDENCE: A requirement was made at the last inspection that individuals care plans and risk assessments must be reviewed and updated where required. The records of four individuals were fully reviewed at this inspection and it was found that all care plans and risk assessments contained clear up to date information. Two recommendations were made at the last inspection that consideration should be given to a review of individuals’ care files and personal information sheets to be updated. Both of these recommendations had been met. All four files viewed were of a consistent standard, files were well ordered and contained information about individual’s daily support needs, essential lifestyle information, social, leisure and educational support. Regular reviews are taken with appropriate individuals involved with ensuring the individuals assessed Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 12 needs are being met and reviewed on both an informal and formal basis. It was further noted that an individuals care plan had been developed following a care management assessment and covered how current and anticipated specialist requirements would be met. Care plans in place showed that service users had been assisted to make decisions about their life and individuals preferences and choices and how these would be met were well recorded. A requirement, which has been outstanding since January 2006 was that manual handling assessments, must be completed. It was found that this requirement had not been met. The home had in place ‘generic’ manual handling risk assessments which focussed on staff ability and their competence rather that the assessed needs and support requirements of individuals living at the home. Assessments should include information about the ability of individuals to respond, staff skill and the possible use of equipment. It was further noted that there is an individual at the home who has regular falls (three within the last six weeks) and is supported by staff to raise from the floor yet the appropriate techniques or support of the service users and their understanding of the situation is not assessed or recorded. A requirement was made at the last inspection that Identified risks at the home must be recorded and assessed, following the inspection undertaken in June 2006 a number of risk assessments were forwarded to the Commission and these were seen in individuals’ files, risk assessments were comprehensive and covered areas such as obsessive compulsive disorder, support with personal care tasks and accessing the community. Flaxpits House DS0000003383.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of individuals are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable individuals to exercise choice and have control over their lives. EVIDENCE: Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. On the day of the inspection service users were busy partaking in activities of their choosing and were being supported by both staff at the home and staff from external agencies. Activities included visiting Snuff Mills, a local walk, attending a music group and going out for a drive and shopping. Records showed that the day before individuals had attended hydrotherapy and a day centre. Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 14 It was recommended at the last inspection that individual’s action plans should contain photographs or pictures in order to enable individuals to make choices, a review of four service users records found that this had not been completed for two of them, it is acknowledged that one of these is not a permanent resident and therefore this will be reviewed at the next inspection. One of the service users lives within a purpose built section of the home and lives semi independently with support from the staff they have their own bathroom, kitchen and lounge/dining area in order that they can continue with mainlining their privacy and independence skills. The manager of the home helps service users with benefits and acts as an appointee on individual’s behalf. Individuals are well supported to integrate into local community life and visit shops, pubs and the church. The home maintains a neighbourly relationship with the community and recently when refurbishment of the home was taking place neighbours were kept informed of how this may affect them. Family and friends are welcomed to the home and service users can choose whom they wish to see; they can see visitors in their room and in private. Four comment cards were received from relatives of those who live at the home and all confirmed they are welcomed at the home at any time, that they are kept informed of important matters affecting their relative and that they are satisfied with the overall care provided at the home. Two individual did comment there are sufficient staff members on duty however that ‘sometimes there are too many bank/agency staff on duty who know less about my relative than permanent staff, particularly in area such as communication.’ this is an area which should be monitored by the manager in order to ensure continuity of care and consistency for service users. The kitchen was clean and staff were enthusiastic about their work. Menus were seen to indicate a varied and good diet. Likes and dislikes were known and responded to. Fresh fruit and vegetables are part of the menu Flaxpits House DS0000003383.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are supported with their personal care, however individual’s dignity is not always respected. There are a number of concerns of medication practices within this home and these have not been addressed since the last inspection. EVIDENCE: Individuals records outline the manner in which they wish to be supported within their life, information included being supported both inside and outside of the home with very specific individual information being recorded, however the inspector was concerned to see that on two separate occasions with two different service users when they were being supported to use the toilet the door was left open. The door leads out onto the main corridor leaving no privacy at all for the person concerned, the staff member appeared to have a total lack of respect and disregard for the individual. It is required that individuals must be treated with dignity and respect at all times. A requirement was made at the last inspection that that the home must ensure that individuals health needs are met and also that healthcare records at the home must be maintained. A review of records, including health action plans, Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 16 daily and health support records found that individuals are fully supported to access services when a need has been identified. These have included investigative treatment at hospital, visiting the dentist, psychiatry and medication review and support from the intensive community support team. A requirement, which has been outstanding since January 2006, was reviewed at this inspection, the requirement was that stock medication must tally with records held. At this inspection it was found that two service users records were not accurate and did not reflect medication that was being given and had the potential for dangerous practices to take place. A requirement was made at the last inspection that staff administer medication must undertake competency training by an accredited trainer. Following the inspection in June 2006 the manager forwarded confirmation of the training they had undertaken, however no information was given about training, which other staff members have received. One staff member spoken with during this inspection confirmed they had completed some training, however records to confirm this for them or other staff members could not be found. Therefore the inspector requested that evidence to confirm that this training had been undertaken be forwarded to the Commission. This has not been received and therefore the requirement remains. A recommendation was made at the last inspection for excess medication to be returned to the pharmacist. There was no excess medication found at this inspection and records for recording returned medication were clear. Due to records seen and practices which are in place at the home three recommendations were made at this inspection in respect of medication administration at the home. • It is recommended that the home must obtain written advice/confirmation from the prescribing general practitioner in respect of the homes method of administering medication which has been crushed and put covertly into food in order to ensure that this practice is safe and has been administered in the best interests of the individual. A number of individuals medication profiles contained outdated information of medication, which was no longer in use. These should be updated. It was further noted that printed medication administration sheets supplied by the pharmacist did not correspond with medication that was being administered by the home, these should be checked and amended where required in order to reduce and/or eliminate the likelihood of error. • • Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 17 Due to the number of ongoing concerns about medication administration at the home the inspector has requested that a pharmacy inspector for the Commission visit and meet with the manager in order to address practices at the home in order that those living at the home can be confident that staff are working in line with the Trust’s policies and procedures. A recommendation was made at the last inspection that the home should seek methods of obtaining the views of individuals in the event of their death, these must be recorded. A review of records found that progress had been made in this area and two individuals are being supported in undertaking a pre paid funeral plan. Flaxpits House DS0000003383.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Processes are in place in order that individuals are able to raise issues of concern however individuals money and personal property is not clearly accounted for and not all staff have undertaken protection of vulnerable adults training. EVIDENCE: The Trust has ensured that there is an effective complaints procedure in place, which included the timescales, and stages of the process. It was noted that all individuals’ files contained a copy with details of how ‘they would be supported to make a complaint and this had been produced in a pictorial format. All four-comment cards received from relatives of those who live at the home had no complaints and all knew how to make a complaint if needed. The cash records for four individuals were checked at this visit, three individuals monies corresponded with records held, one however did not. It is required that the home must ensure that service users monies held at the home for safekeeping is fully accounted for. A recommendation was made at the last inspection that Individual’s inventories must be updated, a review of five individuals records found that two individuals had no inventories, another had not been dated and another was dated 2005. This recommendation remains and should be acted upon by the home in order to demonstrate its commitment in ensuring the security and accountability of individuals property. Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 19 The daily records, care plans and accident/incident records were viewed at this visit, it was found that there were five incidents which should have been reported to the Commission, these included individuals involved in accidents, an allegation of staff misconduct and injuries to service users from others living at the home. Staff were able to discuss specific incidents and explain how issues had been dealt with. In order to demonstrate that service users have been supported appropriately and that action has been taken to minimise the likelihood of further recurrence it is required that the Commission must be informed of incidents that affect the well-being of those living at the home. One staff member said they have not yet received protection of vulnerable adults training, the records of another were not in place and no evidence was to show that this training had occurred. For other staff at the home it was evident that they had received this training, however for some it was many years ago. Flaxpits House DS0000003383.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a safe, comfortable, well-maintained and hygienic environment for the service users and staff. The home has not maintained equipment, which is essential for an individuals assessed needs. EVIDENCE: A requirement was made at the last inspection that attention be given to the rear garden in order to make it more accessible for service users. The area had been grassed over and raised flowerbeds were place ready to be planted in order that service users can enjoy this area in the summer. The garden and areas of the home are fully accessible for service users. There are two lounge areas for service users along with a dining area. The kitchen is accessible to service users. It was noted that aids have been provided for individuals at the home and these include rails, bathing and toileting aids, One individual has recently been supplied with a new wheelchair following and assessment of their mobility. It was noted that one individual has a ceiling track hoist fitted in their room, this Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 21 was not working at the time of the inspection and staff said that this had been the case for sometime. Staff said that the contractors had been contacted to repair the equipment but were unsure of why it was still not in use. Maintenance records for this equipment were unable to be found during the inspection. In order that individuals can be moved safely and to have access to specialist equipment, which has been obtained for them, it is required that the ceiling hoist must be repaired. Since the last inspection the home has employed a part time cleaner, this person spoke with enthusiasm about their role and said they enjoyed working at the home. The home was clean and tidy. Flaxpits House DS0000003383.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no evidence in place to demonstrate that staff have undertaken sufficient amounts of required training in order to fulfil their role. EVIDENCE: A requirement was made at the last inspection that staff must receive sufficient amounts of training in order to fulfil their role. Three staff members, including two recently appointed members of staff spoke positively about the support they had been given by the organisation in respect of their induction and initial core training. One staff member confirmed, as seen in their records that they have not undertaken any training since 2005. Other staff members records showed that they have not had any training other than fire training since the last inspection. This requirement must be met in order to ensure staff are given the guidance, information and knowledge to fulfil their role in line with the needs of individuals living at the home. It was recommended at the inspection undertaken in January 2006 that Staff training records be updated. It was found again at this inspection that this had not been completed, for two staff members, no records had been maintained at all and therefore the inspector could not see evidence that staff have received a sufficient amount of training and therefore this requirement Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 23 remains. It is understood that there are staff who have achieved a National Vocational Qualification and staff that are in the process of achieving this award, however as records were not in place the inspector was unable to fully evaluate this area. During the inspection it became apparent that there were occasions when staff found one individual’s behaviour difficult, staff were heard speaking harshly and making judgemental statements to the person. Records viewed about this individual further showed that their behaviour impacts on others living at the home. Staff spoken with said that others were ‘unsettled’ and that one client is ‘petrified’. In order that staff are given the knowledge and skills to undertake their duties and also to ensure that service users are supported appropriately it is required that staff undertake positive response training and also those staff, noted in previous standards, who have not undertaken protection of vulnerable adults training must do so. Staff recruitment and selection documents and staff supervision records were not available for inspection. There have been no previous concerns over these standards at previous inspections and appropriate documents have been in place. Flaxpits House DS0000003383.V323539.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were no concerns about the health and safety of individuals who live at Flaxpits House. There does not appear to have been any attempt to seek the views of service users in order to underpin the self-monitoring and development of the home. EVIDENCE: The Registered manager Dionne Browne has over two years management experience within this care setting and has extensive experience of working with adults who have learning disabilities. The manager Dionne Browne was not available at this inspection; full information throughout the inspection process was shared with the senior staff member on duty with written information about the requirements and Flaxpits House DS0000003383.V323539.R01.S.doc Version 5.2 Page 25 recommendations made at this inspection. It should further be noted that there were four requirements, which have been outstanding since January 2006. As detailed in standards 22 & 23, the manager must ensure that the Commission is notified of any incident, which affects the wellbeing of individuals living at the home. A requirement which has been outstanding since January 2006 was that the home must develop an effective Quality Assurance monitoring system based on seeking the views of service users, following the inspection the manager forwarded a ‘draft’ version of Aspects and Milestones Trust, Quality Assurance Audit Tool. These guidance notes are comprehensive. The inspector also acknowledges that the Trust has in place many methods of ensuring quality within the home such as regular quality monitoring visits which have been undertaken monthly on behalf of the registered provider, regular meetings, no recorded complaints and external monitoring systems in place. However, the manager does not appear to be able to provide any confirmation that the views of those living at the home have been sought. As the manager was not present at this inspection the inspector asked for information to be forwarded following the inspection. No information was received prior to the completion of this report and therefore no evidence has been provided to demonstrate this requirement had been met. It will therefore be reviewed again at the next inspection. The fire logbook showed that the appropriate fire safety/equipment checks are undertaken were required with staff training and drills being completed as required. No issues of health and safety were observed during this inspection visit. Flaxpits House DS0000003383.V323539.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 X 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 2 3 X 2 X X 3 X Flaxpits House DS0000003383.V323539.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 YA39 Regulation 24 Requirement Develop an effective Quality Assurance monitoring system based on seeking the views of clients. (Outstanding since 12th January 2006). Evidence to be forwarded to demonstrate that staff that administer medication have undertaken competency training by an accredited trainer. (Outstanding since January 12th 2006). Manual handling assessments must be completed. (Outstanding since January 12th 2006). Stock medication must tally with records held. (Outstanding since January 12th 2006). Staff must receive sufficient amounts of training in order to fulfil their role. DS0000003383.V323539.R01.S.doc Timescale for action 22/06/07 2. YA20 13(2) 22/05/07 3. YA9 13(5) 22/05/07 4. YA20 13(1) 2 22/05/07 5. YA35 18(1) c 22/06/07 Flaxpits House Version 5.2 Page 28 6. 7. YA18 YA23 12 (4) a 37 8. 9. 10. 11. YA32 YA23 YA32 YA29 YA23 13 (6) 13 (6) 23 (2) c 16(2) Service users must be treated with dignity and respect at all times. The Commission must be notified of incidents that have affected the wellbeing of those who live at the home. Positive response training to be provided for staff. Protection of vulnerable adults training must be provided for all staff. Ceiling hoist must be repaired. Service users money must be clearly accounted for. 22/03/07 22/03/07 22/07/07 22/07/07 22/04/07 22/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA11 Good Practice Recommendations Individual’s action plans should contain photographs or pictures in order to enable individuals to make choices. Individual’s inventories must be updated. Staff training records to be updated. Printed medication administration sheets must correspond with medication given. Written advice/confirmation to be obtained from the prescribing general practitioner in respect of the use of crushed/covert medication administration. Medication profiles to be updated. 2. 4. 5. 6. 7. YA41 YA35 YA20 YA20 YA20 Flaxpits House DS0000003383.V323539.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Flaxpits House DS0000003383.V323539.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!