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Inspection on 20/11/08 for Florence Villa and Independent Unit

Also see our care home review for Florence Villa and Independent Unit for more information

This inspection was carried out on 20th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service has a well established and extensive curriculum that provides learners with a wide range of opportunities. The needs of prospective learners are assessed prior to admission and support plans reflect the needs of individuals. lndependence is promoted. Learners say, "I can go to any of the staff if I have a problem and I know my key worker will help me to sort things out." The service carries out regular audits of the quality of care it provides by seeking the views of learners and other interested parties. Staff say, "I feel supported by the service and my induction to the home was good." Staff have been trained to recognise and report suspected abuse. Staffing levels are sufficient for the needs of learners.

What has improved since the last inspection?

The management structure has improved over the last twelve months. The registered manager takes responsibility for all three of the services that form the college, each of the services has an allocated deputy manager. The house has been refurbished and there are further plans for improvement. The staff training schedules have improved. The college has regained Investor in People status in May 08 .

What the care home could do better:

Learners at the college say, "I`d like to have a key to my bedroom door." " Sometimes it`s not warm enough, but my room gets really hot." There are areas in the home that have been refurbished and the service has an ongoing programme of improvements. We asked the manager to ensure that the service is maintained at an ambient temperature and where the surface temperature of radiators is high, action is taken to ensure that learners are not at risk. We asked the service to check that the current controlled drug cupboard meets the recommended specifications and that the practice of decanting medication should be reviewed, we also recommended that the service looked at how staff currently record medication for those learners who self medicate. We recommended that the service demonstrates how it involves learners in the implementation and review of their support plans. We also asked that the service makes sure that relatives know how to complain if they want to do so. We have asked to be told about the outcome of the Safeguarding referral that hasbeen made and the action the home has taken to ensure that well being of the learners involved. We have suggested that the service considers the introduction of Health Action Plans. Staff trained to National Vocational Qualification at level two should be improved and staff should have access to Autism training. The frequency of staff supervisions should also be improved and all staff should be involved in fire drills. The service must ensure that recruitment records are properly maintained.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Florence Villa & Independent Unit 107 Trentham Road Dresden Stoke-on-Trent Staffordshire ST3 4EG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Jones     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Florence Villa & Independent Unit 107 Trentham Road Dresden Stoke-on-Trent Staffordshire ST3 4EG 01782596850 01782596850 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) MS Karen McMillan Type of registration: Number of places registered: Strathmore College Limited care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 4 of whom may be LD, minimum age 16 years. Staffing levels will be reviewed to represent the increase in numbers Date of last inspection Brief description of the care home Florence Villa is part of a specialist residential College registered to care for 18 people with a learning difficulty/disability aged 16 to 25 years, of both genders. The home is a detached, domestic-style property with 4 double bedrooms and 4 single bedrooms. There are two other small buildings in the grounds; the Independent unit that has 1 double and 2 single bedrooms and the Annexe that has two single bedrooms. Only the Annexe has ensuite facilities, the remaining 16 bedrooms all have washbasins. From the home it is a short walk to Longton town centre and a bus ride from other city amenities. The purpose of the home is to provide support to enable Learners to develop independence skills, to enable them to progress into a supported living environment. The Learners have a full programme of activity, which takes into account Care Homes for Adults (18-65 years) Page 4 of 31 18 Over 65 0 Brief description of the care home personal choice. Learners stay at the college for a maximum of three years and attend for between 38 and 52 weeks per year, depending on their contract. The Learners are able to access other college facilitates, which include Jasmine a retail outlet in Wostanton and two other residential premises in the local area. All three homes are part of the Strathmore College Group, operated by Craegmoor Health Services. All three homes are also registered with the DfES. Prospective learners and their supporters should contact the provider for the costs and fees of the home, as these are not yet included in the Learner Guide. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good, quality outcomes. This was a key inspection site visit of this service undertaken on 20 and 21 November 2008 and included formal feedback on 26 November 2008. In total the visit took approximately 10:00 hours. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous inspection visit of 21 November 06 have been acted upon; looking at Care Homes for Adults (18-65 years) Page 6 of 31 information the service provides for prospective learners, their carers and any professionals; looking at information that the service provides to learners using the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menus, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The manager, deputy manager, staff and learners were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided its own assessment of its performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent out to learners, relatives, staff and any professional that has involvement in the service. We received 5 staff surveys, 3 relatives surveys and 6 learner surveys, the main points are included in this report. Since the last key inspection visit we have carried out an Annual Service Review (ASR). We do an ASR when there has been no major inspection of the service (we call this a key inspection) in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review. The outcome of that review concluded that we considered that Florence Villa had continued to provide good quality outcomes for students. What the care home does well: What has improved since the last inspection? What they could do better: Learners at the college say, Id like to have a key to my bedroom door. Sometimes its not warm enough, but my room gets really hot. There are areas in the home that have been refurbished and the service has an ongoing programme of improvements. We asked the manager to ensure that the service is maintained at an ambient temperature and where the surface temperature of radiators is high, action is taken to ensure that learners are not at risk. We asked the service to check that the current controlled drug cupboard meets the recommended specifications and that the practice of decanting medication should be reviewed, we also recommended that the service looked at how staff currently record medication for those learners who self medicate. We recommended that the service demonstrates how it involves learners in the implementation and review of their support plans. We also asked that the service makes sure that relatives know how to complain if they want to do so. We have asked to be told about the outcome of the Safeguarding referral that has Care Homes for Adults (18-65 years) Page 8 of 31 been made and the action the home has taken to ensure that well being of the learners involved. We have suggested that the service considers the introduction of Health Action Plans. Staff trained to National Vocational Qualification at level two should be improved and staff should have access to Autism training. The frequency of staff supervisions should also be improved and all staff should be involved in fire drills. The service must ensure that recruitment records are properly maintained. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective learners can be confident that they receive information about the service they will receive and that their needs will be assessed this means they can sure that it is suitable for them. Evidence: The service told us in the AQAA that, All learners interested in coming to the college are invited to attend an initial visit accompanied by parents and/or professionals involved, during the visit they are given a tour of the different sites and are shown what we have to offer. If the provision is deemed suitable and the learner is interested in a placement we ask that an application form is completed and returned. The learners are then offered an assessment week at the residential site of the college, this week enables an assessment to take place, covering all areas of the curriculum. We saw the Statement of Purpose and the Service User Guide for the service these documents provide prospective learners and their families with information about the type of service it is, what they can expect if they decide to move in and the terms and Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: conditions of residency. We expected to see the costs and fees of the service in the guide but they have not been included, and we spoke to three learners about both documents, one knew about the Guide saying, My keyworker has spoken to me about it i think. Another didnt know what the documents are and the third wasnt sure. We looked at assessment information in a sample of the learners files and saw detailed information, evidence of assessments and of visits to the college prior admission. In a survey one learner said, I was shown round by staff who told me about Florence. During the visit a learner said,My social worker talked to me and my mum about Florence and we came to have a look, Ive been here for a few weeks now but miss home. Another said, I hope to move into my own place eventually but my key workers says I need more time. Another learner said, it is a nice college I like the people and the staff We met one learner who was at the service for a period of assessment, we saw that she had a guide in her room, but we couldnt be sure that it is in a form that she could understand. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Learners can be confident that plans are in place that meet their needs but should be sure that they can be fully involved with their implementation and review. Evidence: The service told us in the AQAA that, The learners are involved in all aspects and supported to identify their long term aims. Learners are also supported to identify short term goals. Hamilton Road, the independent unit and the flat are seen as a progression route for learners who need support to learn more independent skills. The review process and learner feedback enables us to make decisions on which learners want to progress to other locations. The learners needs are continually evaluated during their three year course using different methods, which include weekly ILP meetings, reviews and review of the working documents. We looked at sample of three Individual Learning Plans and spoke to three learners about them. One learner confirmed that she knew about her plans and had met to talk Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: about things with her key worker. Another said, My key worker tells me about the plans. Learners meet regularly with their key workers and participate in tutorials to talk about their progress. From the sample of plans we saw, there is evidence that they have been reviewed and amended as necessary. There is a focus on promoting independence and independent living skills. Risk assessments are in place where necessary although we saw in one example that a learner had been reported to be verbally aggressive and couldnt see that there was a support plan or risk assessment relating to this. We felt that plans should be more user friendly and accessible to people and they should be more actively involved in the evaluations and reviews of their support plans and risk assessments. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Learners are involved in making decisions about their educational, occupational and recreational activities, but would benefit from more opportunities to be involved in the local community. Evidence: The service told us in the AQAA that, Our extended curriculum offers the learners the opportunity to pursue their personal interests during evening and weekend sessions. There is an extended curricular activities rota, enabling the learners to experience various activities and ensures that their time is structured. Four learners said in their surveys that they cant always do what they want to do during the day. We talked to learners, staff and the deputy manager about this. We are told that learners agree their programme of education, occupation, social and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: recreational activity at the start of the term this is subject to regular review with both the key workers and as part of a tutorial and can be changed if agreed. The service offers a wide range of activities and experiences. In the sample of learners timetables we saw things such as the Duke Of Edinburgh scheme, swimming, Basket Ball, Daily living and Sports. Within these sessions we are told that learners also learn about social skills, health and safety, rules of engagement and other topics related to the activity. Relatives said , I feel the college could teach more reading writing and basic maths and enourage people to use the library. We looked at these matters and saw that literacy and numeracy form part of the basic package of education available to learners. The deputy told us that the majority of learners have library cards and a trip to the library is built into most learners weekly schedule. One relative said that service can improve by, helping my relative keep in touch so that I know what she is doing. We recommend that the service looks at this and ensures that it maintains regular contact between the service and relatives or guardians so that they are kept informed of their relatives progress. We talked to learners about what they do in their spare time, one learner said, I like to play on my computer games when I havent got anything else to do. Another said, I watch tv sometimes. We talked to learners about the food choices they have and dined with them during the evening meal. We are told that the food, is okay. We saw that the meal was well presented and hot. There is a choice of main meal provided at each meal time and saw that the times of meals are flexible dependent on the planned activities for the day. We saw that the dining room can just about accommodate all of the learners at one sitting. We have been told that learners are involved in food preparation and cooking as part of their planned programme of activities. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Learners can be confident that the service will make every effort to ensure that their health, personal care and medication needs this should give them assurances in the services ability to support them. Evidence: The service told us in the AQAA that, On commencement of their residential college placement the learners are registered with a local GP, this enables positive working relationships to be forged between staff and the local GP and affords them the opportunity to gain an insight, knowledge and understanding of the learners from the start. The college, to ensure all the following areas are met, (personal, physical, mental and emotional, sexual health and continence) have access to local external facilities, these include Community Nurses, local Psychiatrist, Dentists and Chiropody. We observed staff communicating with learners appropriately and sensitively dealing with potential conflict or difficulties. We observed staff usually knocking on bedrooms and waiting to be invited in before entering, but on one occasion a member of staff entered an occupied bedroom without knocking at all. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: In a survey, one relative said, there should be more help with teaching personal cleanliness. We saw plans in the records we looked at, that gave an account of the support individual learners need with personal care and hygiene. We did not observe any concerns relating to this area during our visit. We looked at a sample of health records and saw that learners are registered with a GP and are supported to attend health appointments and checks. We suggested that the service considers Health Action Plans for each learner. A Health Action Plan (HAP) is an individual plan, belonging to a particular person, that explains that persons health needs. It also describes what has to happen for those needs to be met and is accepted as good practise in services for people who have a learning disability. We looked at a sample of medication records and saw that they are adequately maintained, we discussed the current regime of staff signing for the medication of learners who self medicate and suggested that this should be revised. We also asked that the service confirms that the current controlled drug cupboard meets recommended specifications. We talked to the deputy manager about what happens with medication if a learner is off site and are told that staff decant the medication into another container. We asked the service to review this practise and to contact the dispensing Pharmacist about how this matter can be more safely managed. By the time we revisited the service on the 26th November, the service had done this. We are told that staff responsible for the administation of medication have received the training to do so. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Learners can be sure that if they make a complaint it will be taken seriously and action taken to resolve it and any concerns about suspected abuse will be properly reported and staff have received training in this. Evidence: The service told us in the AQAA that, Learners are able to discuss any concerns or issues they may have with their keyworker using the monthly discussion or tutorial process. They have designated time and support to have these discussions. We saw a complaints procedure is on display in the service and noted that our address details need to be updated. Learners told us, If I have a problem I will go to the staff. My keyworker helps me if I need to sort anything out. In the surveys we received, most learners said they knew how to make a complaint. A relative said, They sometimes respond appropriately to concerns. Another relative said, Im not sure how Id make a complaint. We looked at the record of complaints that the service has received and saw that they are dealt with properly. We havent received a complaint about this service since the last inspection visit. We talked to a member of staff about safeguarding learners, she confirmed that she had received training in recognising and reporting abuse. The records show that all Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: staff are provided with this training. We are aware that a safeguarding referral has been reported and is being dealt with, we saw that the service has taken appropriate action to ensure the welfare and well being of the learners involved and all relevant people have been contacted. We have asked that we are informed of the outcome of the referral. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Learners must be confident that the home in which they live is safe and properly maintained. Evidence: The service told us in the AQAA said that, Florence Villa is going through the process of being refurbished; we have had costing for a new kitchen in the main house. The independent unit has had a new kitchen in the summer 08 and also a new bathroom. Bedrooms have been decorated. We are currently in the process of renewing the carpets in the communal areas. Florene Villa consists of the main house, a seperate Independent Unit that provides accommodation for up to four people and two single person self contained flats. We only visited the main building during this visit. The service has a high number of double bedrooms that are located as follows, three double bedrooms in the main building and one double in the independent unit. A learner showed us around the building and pointed out that some areas of the home are not adequately heated while others are too hot. We saw that this was the case and Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: spoke to the manager about it. She agreed to have the maintenance person check the radiators and where the surface temperature was high take action to protect learners from the risk of being burnt on them. Where radiators did not appear to be working, she will also ask that these are checked. When we went back to the service on 26 November 2008 we saw that this had improved and radiator guards have been requested where there is a potential for harm. During our visit we saw four bedrooms, two were double rooms and two were single. In one single we saw that although occupied, it was quite bare and free from ornaments or pictures. The bed base still had its plastic wrapping around it and the legs hadnt been put on it. The plug was missing from the handbasin. We spoke to the deputy manager about this, she told us that she had asked that the room be properly prepared for the learner who is currently on a weeks assessment. But as this hadnt happened she would ensure that all concerns are addressed. We saw that both of the double bedrooms dont have a privacy curtain, learners told us they dont have a key to their bedroom. One learner said, I cant have my freeview box on because the ariel isnt good enough. We saw that there is no fixed ariel point or phone line in these bedrooms. Learners confirmed that they have been supported to personalise their bedrooms, we saw evidence of this, and where bedrooms were being shared learners said that they got on well with the person they shared with. The deputy manager told us that the rolling programme of improvement for the home is continuing and we saw evidence of work that has been carried out. We noted that the standards of cleanliness are good and have been told that staff have received infection control training. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Learners can be confident that staff are properly recruited and are provided in sufficient numbers to meet their needs, but need to be sure that they have been trained to a good standard. Evidence: The service told us in the AQAA that, The management structure has changed in the last twelve months. We have one Residential Services Manager who oversees all sites, and three Deputy Managers, one based at each residential site. This has improved and strengthened the management team and utilised to a good potential. Staff have been promoted within the college following all equal opportunity policies. Staff training has been rigorous over the last year, this has included NVQ 111, Teacher training, Mandatory training and Induction programmes. NVQ training to be improved. We looked at the staff roster and saw that staff appear to be provided in sufficient numbers to support learners. There is some flexibility in the shift patterns to allow for the programme of activities learners participate in. In a survey a member of staff said, I have only worked for Strathmore for 13 months. I feel I have been well treated as an employee. another said, more staff training in Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Autism and complex needs as part of the induction maybe. This is currently not statutory training. We looked at a sample of three staff files and saw that the service has a robust recruitment procedure but in one example we couldnt find written references although all other pre employment checks carried out. We interviewed one member of staff who confirmed that she had completed an application form had been asked to provide a full work history and two references, and had a Criminal Records Bureau check (CRB) carried out. During interview the member of staff confirmed that she had completed a basic induction and had received training in the Protection of Vulnerable Adults, health and safety, infection control and fire safety. She commented, Throughout the induction I felt supported by the management and the staff team. The deputy manager told us she has yet to receive training to be able to undertake one to one supervision, although she has assisted with some, by shadowing the manager. We saw that the staff arent receiving supervision as often as we recommend which should be a minimum of six times per year. In the surveys we received from staff, one said I often meet with the manager to discuss my role, two said I sometime meet with the manager, and two others said, I rarely meet with the manager. We have been told in the AQAA that two of the twenty staff are trained to National Vocational Qualification (NVQ) at level 2, this is lower than the recommended 50 of the workforce. The deputy stated that a number of staff have been enrolled on the training and an induction session took place during this visit. We have been provided with the records of staff training and can confirm that mandatory training has taken place and updates are scheduled. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Learners can be sure that the service operates to good standards and regularly monitors and tries to improve the quality of the service it provides. Evidence: The service told us in the AQAA that, Strathmore College have a well established management team which consists of, Principal, Deputy Principal, Residential Manager, Finance Manager, Systems Manager and three Deputy Managers. The management team meet on a fortnightly basis to discuss operational issues, work on the development plan and review the quality assurance cycle. There is an administration staff member dedicated purely to administration. We received the AQAA when we asked for it and saw that it contains clear and relevant information that is supported by a wide range of evidence. The manager is registered with us and has the necessary skills and experience to manage this type of service. Since the last key inspection visit a deputy manager has Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: been appointed, there are plans for her to undertake NVQ level 4. We saw that the service carries out quality audits and also seeks the views of learners, relatives and other interested parties about the quality of service delivered. The outcome of this information is used to calculate how well the service performs and an action plan is then developed from the information. We saw copies of the reports of the monthly visits to the home on behalf of the provider, the last record is dated 31 October 2008 We looked at fire safety records and saw that they are well maintained we checked records of fire drills and saw that they are held regularly but the manager must be vigilant to ensure that all staff are involved, we have contacted the fire safety officer to alert him to this. A fire safety risk assessment has been carried out and is dated 09/03/08. We spoke to a member of staff who confirmed she had received mandatory training and looked at the training records for the service to confirm that a good standard of training programme is being delivered. We have concerns about the service relating to the lack of written references in one recruitment file, the deficits in the environment we found and the potential for learners to be placed at risk because of these issues. We have highlighted areas of concern about how some areas of medication is managed and about the lack of regular staff supervision. Although the service has demonstrated that it reguarly audits the quality of the service it provides we cannot be sure that the audits are effective. We saw that the requirements of the last key inspection report have been addressed. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 13 The provider must ensure that the home is properly heated at all times. So that learners are not placed at risk from hot surface temperatures of radiators. 26/02/2009 2 34 17 The service must ensure that staff records include two written references. To ensure that they can be confident that staff are suitable to be employed and learners are protected. 26/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Learner Guide to contain the fees as indicated in CSCI guidance so the learners know the fees and costs of the service. The Learner Guide and Statement of Purpose to be freely available in the home to ensure that existing learners and prospective learners have access to this information. Page 28 of 31 2 1 Care Homes for Adults (18-65 years) 3 6 Support plans should be more user friendly and accessible to people and they should be more actively involved in the evaluations and reviews of their support plans and risk assessments. The service should ensure that risk assesments are in place for every known area of risk. Community participation and integration should be improved, by encouraging students in more socially valued opportunities. The service should ensure that family contact is regularly maintained. Health Action Plans should be introduced. The practise of decanting of medication should be revised as this is not considered to be best practice and is potentially unsafe. The service should revise how staff currrently record medication that is self administered, because at the moment they are signing for medication that they dont give. The service should check and confirm that the controlled drugs cabinet meets the recommended specifications. The service should monitor the room temperature where medication is stored to ensuer that it doesnt exceed the recommended maximum temperature. The correct contact details for us, the Commission for Social Care Inspection should be included in the complaints procedure currently on display in the home. The service should ensure that all relatives know how to make a complaint should they need to. The service should inform us of the outcome of the safeguarding referral and confirm that any recommendations have been acted upon. The service should continue with rolling programme of environmental improvements for the benefit of learners. The service should ensure that learners sharing bedrooms are provided with equipment that promotes their privacy where possible. The service should ensure that bedrooms are suitably furnished. The service should provide learners with a bedroom door key if they want one. 4 5 6 13 6 7 8 15 19 20 9 20 10 11 20 20 12 22 13 14 22 23 15 16 24 25 17 18 25 26 Care Homes for Adults (18-65 years) Page 29 of 31 19 20 21 22 23 32 35 36 36 42 The service should ensure that 50 of the workforce are trained to NVQ level 2. The service should ensure that staff receive Autism training. The service should ensure that the deputy manager has received training in staff supervision. The service should improve the frequency of staff supervisions to the recommended six times a year. The service should ensure that all staff are involved in two fire drills per year. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. 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