Inspection on 18/04/08 for Follybridge House

This inspection was carried out on 18th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Follybridge House 18/04/07

Follybridge House 24/11/06

Follybridge House 07/02/06

Follybridge House 06/10/05

Follybridge House 28/02/05

Follybridge House 29/06/04

Follybridge House 24/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Follybridge House Bulbourne Road Tring Herts HP23 5HF Lead Inspector Jane Handscombe Unannounced Inspection 18th April 2008 11:15 Follybridge House DS0000022972.V361087.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 Follybridge House DS0000022972.V361087.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. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Follybridge House Address Bulbourne Road Tring Herts HP23 5HF 01442 828285 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) alan.wilson@turning-point.co.uk www.turning-point.co.uk Turning Point Limited Mr Alan Bruce Wilson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 6 residents with a learning diability and mental illness Date of last inspection 18th April 2007 Brief Description of the Service: Follybridge House is situated in a quiet rural area, backing on to a nature reserve accessible to Service Users. The home has large, attractive and well-maintained grounds, which contain a sensory garden, a trampoline, and swings. The home is part of the charitable organisation Turning Point, which provides residential accommodation for people with learning disabilities and mental health problems. Follybridge House accommodates up to six male Service Users with behavioural problems and learning and communication difficulties. The current fees for this service are £127.85 per week, though this relates only to the residential contribution by the resident, and is only part of the overall fees, with the remainder being paid by the referring authority. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection, which took place over one day and carried out by one inspector. The visit took place on the 18th April 2008 over a time span of 8.45 hours. The purpose of the visit was to see how the home is meeting the National Minimum Standards. The home was currently providing care and support to 6 service users. All the users were sent questionnaires, which were completed by their family members/advocates in order to ascertain their views upon the care they receive, and responses were received from four. Likewise surveys were forwarded to four health and social care professionals to gain their feedback, however at the time of writing this report we have not received any response. Any responses received will however, be considered as part of CSCI’s ongoing regulatory responsibilities for registered services. The CSCI Inspecting for Better Lives (IBL) involves us requiring the service to complete an Annual Quality Assurance Assessment (AQAA), which enables them to evaluate the quality of their service and forward to ourselves when asked. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. The document was not completed within the required timescale, although it was received prior to this visit. This document is referred to throughout the report. Results of this inspection report are derived from feedback gained from the service users, discussions with some staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. The registered manager was not available on the day of this inspection due to long-term sickness, however the service is being managed and supported by an acting manager who also manages another project within the organisation. Comments received from those using the service and from family members include: ‘always found follybridge very informative….my (relative) receives adequate attention when needed at all times by caring staff…I think the care home does well by maintaining a high standard of care, attention and kindness to the residents, with individual attention and concern to everyone’ Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 6 ‘…I am always kept in touch with what is happening and feel involved in his life. This means a lot to me’ ‘General care of the 6 residents is very good. The garden /outside space is well set up and well used by the residents when the weather is favourable’ ‘the remote location of follybridge and no public transport to it, makes staff recruitment a constant problem. Staff sickness has added to their problems recently. The inspector would like to thank all those who assisted in this inspection in any way for their time and cooperation. What the service does well: What has improved since the last inspection? Since the last inspection the service has been working more closely with family members and other professionals in updating some of their guidelines and information in developing their care plans to ensure service users needs are met fully. Where staff shortages have resulted in the use of agency staff, the service has been mindful in ensuring continuity for those using the service and all attempts are made to ensure that bank/agency staff are regular and familiar to those using the service. Person centred planning has been implemented and service user documents are more service user friendly using picture formats and simplified language. Some decoration of service users bedrooms has been undertaken as have the stairs and landing. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 7 A physical intervention policy is now in place to protect service users, staff and the public from harm. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Follybridge House DS0000022972.V361087.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 Follybridge House DS0000022972.V361087.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): 1 and 2 Quality in this outcome area is good. There is a system in place to ensure that all prospective users of the service are provided with information about the service and have an assessment of their needs prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home, since the previous inspection undertaken in 2007, so it was not possible to judge the current assessment system in operation, although the process was discussed with staff, which informed us that an appropriate system is in place. From viewing files of current users of the service, it was evident that the service deals with a number of diverse care needs and always ensures to offer a personalised service to meet all the needs of their clients. There is a very real commitment to ensure that all clients, however diverse their needs may be, receive a person-centred package of care and support, which meets their needs appropriately. Whilst visiting the home, it was noted that the service users handbooks were dated 2004 and the contact details for the Commission were out of date. The Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 10 acting manager informed us that there is a newer edition and assured us that all six service users would be provided with a copy. Follybridge House DS0000022972.V361087.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 and 9 Quality in this outcome area is good. Service users assessed needs, any changing needs and personal goals are documented in an individualised plan of care and support and documents how these needs and goals are to be met. They and/or their representatives are consulted with and have involvement in the care planning and review process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service have an individualised plan of care and support detailing their health, social and personal care needs. The two service users, whose care and support was case tracked during this visit, both had individualised files detailing their likes and dislikes, how they communicate with others, their spiritual, social and personal care needs. The files viewed evidenced that they had been drawn up with the involvement of the service user together with their link worker, family, friends and/or advocate as appropriate, and professionals who have an involvement with the Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 12 service user. Likewise, regular reviews had been undertaken and their care plans updated accordingly, to ensure that any changes in needs is addressed appropriately. Relevant risk assessments had been undertaken detailing any risks and the actions to be taken to minimise the risks, whilst retaining each users’ independence although some of these were clearly out of date, some being dated 2005 and others dated 2006. We are informed that all staff have received SCIP, behaviour management training which helps identify various interventions to try to prevent any negative behaviour escalating. We noted that physical intervention plans had been drawn up with relevant professionals such as the persons’ social worker and community nurse. However, these had been drawn up in April 2007 and the community nurse who had been involved had not yet signed these. Likewise, five staff signatures had not been sought to evidence that they have read and understood their content. The acting manager assured us, that the five remaining staff that had not yet signed, would be directed to read them and sign them accordingly. Follybridge House DS0000022972.V361087.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 and 17 Quality in this outcome area is good. Arrangements for service users to meet with friends and family members are flexible and support is given to maintain personal relationships where required. A varied menu is provided and special dietary needs are catered for those who require. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service are encouraged to engage in activities both within and outside of the home. Such activities include attending a local day centre, shopping trips in the local community, picnics, visits to local restaurants and bars and trips to places of interest. The levels of staffing and challenging behaviours of residents do have an impact on activities and require good planning. The closure of one day centre has meant that one particular service Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 14 user no longer has access to day centre activities three days of the week, although the service are actively seeking to find a replacement to which he can attend in the meantime he attends day care services for one day of the week. Within the home, staff engage users of the service in activities such as games, puzzles and music and are seeking to engage the services of community musicians to provide music sessions on a monthly basis. On the day of this visit, staff took some residents out for a picnic and another had enjoyed a morning’s drive out on a one to one basis with his key worker. Evidence of activities enjoyed by those using the service is documented in their care plans and photographs of events are displayed within the home. Information provided to us in the AQAA (Annual Quality Assurance Assessment) recognises that there is room for some improvement in the variety of activities provided and plans are in place to access more activities to allow for this. However, given the behavioural issues presented by residents, and their general dislike of large crowds, any increase in community access will need be gradual and well planned. Residents enjoy spending time in the large garden which is equipped with swings, a trampoline, a sensory garden and sand/water equipment. Since the last inspection, the wood chippings have been replaced underneath the swing and some new fence panelling has been erected. Families and friends are welcomed into the home and are always invited to any events held in the home and to their family members review of care. Service users can choose whom they see and can see visitors in their own rooms, in private, if they wish. There are no restrictions about family and friends visiting. Users of the service are provided with a healthy diet with all meals provided at the home being freshly cooked on the premises. Peoples likes and dislikes are documented and the meal planning takes these into consideration. There are two users of the service who have specific dietary needs, which the service manages well. Individual menu and recipe cards have been developed by the key worker to assist staff with one service users particularly complex dietary needs, which have had input from the dietician. Service users have a limited role in the domestic routines of the home, due to their dependency levels, however, they are actively encouraged to take part where able to do so. Follybridge House DS0000022972.V361087.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 and 20 Quality in this outcome area is good. The home ensures that peoples personal healthcare needs are met in a way that respects their privacy and maintains their dignity at all times. The home’s policies and procedures for dealing with medication serves to protect those using the service, although care needs to be taken to ensure that staff adhere to these at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has an individualised plan of care detailing their individual needs, preferences and goals and how these needs are to be met. Service Users records viewed during the inspection indicated evidence that their views, preferences and needs are taken into account when providing care and support. Of those service users being case tracked during the inspection it was evident that the carers spoken to were aware of their individual needs and had a good Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 16 understanding of how to address their needs whilst independence and were effective in their key working roles. promoting their Healthcare records were in good order and included separate records of contact with various healthcare professionals. The records indicated appropriate regularity of appointments and appropriate one-off consultations where necessary. An increasing number of incidences of the behavioural support needs of an individual have presented challenges to the service and staff. A review of the behavioural support needs of the individual resulted in additional staff training and support. The services has been proactive in recognising that they can no longer meet this individual’s needs and continue to provide appropriate support whilst an alternative placement is found. Medication is securely stored at the home and all required policies and procedures are in place. Staff are provided with training in safe medication practice and the policies and procedures for dealing with medication serve to protect the service users health, safety and welfare. Whilst viewing service users medication administration records, it was noted that whilst these are generally well recorded, there was one instance in which on one particular day one service users medication had not been signed for and gaps were present on the administration records, staff had not signed the records appropriately to acknowledge that the medication had been administered as prescribed No reasoning had been documented and the coding system, which is used to explain why medication has not been administered, had not been used. A requirement has been made within the report to address this shortcoming. The home works well to meet the diverse needs of the resident group. None currently come from a minority ethnic or cultural background, but their needs in terms of support around their disabilities and their differing personal situations and aspirations are well understood by staff and appropriately met. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Generally users of the service are protected from abuse, neglect and self harm, however the homes policy and procedures around the safeguarding of service users monies is not adhered to and poor practices and recording could pose risk to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a written policy/procedure in place on the protection of vulnerable adults and staff are provided with relevant training both in their induction training and regularly thereafter, enabling them to recognise the signs of abuse and how to respond if an allegation or incident is brought to their attention. Since the last inspection undertaken in April 2007, we have been notified from the service itself, of a safeguarding issue in which an individuals challenging behaviours posed as a risk to users of the service and to that of staff members on a couple of occasions. The service followed appropriate guidelines and made appropriate referrals under the local interagency safeguarding policies and procedures and behavioural support plans were drawn up with relevant care managers and health professionals and put into place detailing strategies to be undertaken to deflect any such challenging behaviours. Whilst there are policies and procedures in place to safeguard those using the service from any form of abuse and staff are provided with safeguarding training to ensure they have the appropriate knowledge and skills to recognise Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 18 and respond to any allegations or incidences, there is a question as to staff competencies in their understanding and the putting of the procedures around service users’ monies into practice; The homes Annual Quality Assurance Assessment (AQAA) informs us that improvements have been made in the last 12 months to check service users monies on a regular basis to ensure that their monies are correct. However, this visit highlighted serious shortcomings around the handling and recording of service users monies and highlighted that whilst there is a policy and procedure around safeguarding service users monies this is clearly not being adhered to. The organisations policy dated December 2006 and entitled ‘Service Users’ Money’ gives clear guidelines on how staff are to handle cash transactions. However, discrepancies were evident during the visit whilst undertaking an audit trial of the service users monies and there was no evidence of any personal finance sheets (mentioned in the policy) being used. Individualised receipts for meals were not being sought, instead in instances in which more than one service user had brought meals one receipt was sought and photocopied and staff had then written on each receipt the amount that related to each particular individual service user and placed these in their cash tins. This is poor practice; individual receipts detailing their individual purchases should be sought for each service user. The same policy states that “home managers must carry out a full check on each service users money balances at least once a week” and that “service managers should carry out an audit monthly, randomly checking service user accounts” and “Locality managers, finance managers, business directors and internal auditors must also carry out spot checks”. There was no documentation to evidence that these checks were being undertaken at least once a week. The acting manager informed us that monthly audit checks were undertaken however, the evidence presented to us informed us that no check had been undertaken the month prior to this vist. Monthly audits had been undertaken in February and March of this year and prior to these no monthly audit checks had been undertaken since September 2007. I.O.U. notes were found in two service users petty cash tins; one related to a sum of £50, which we were informed, was for the purchase of some clothing for the said service user. During the inspection it became apparent that the said service users cash tin was short by this amount of cash and a member of staff was holding the cash with the aim of purchasing clothing for the service user and had been holding the cash for 8 days. A further service users tin contained an IOU for £50 for birthday gifts, however this did not tally with the receipt detailing birthday gifts that had been purchased and whilst an audit trial did not highlight that this amount of money was missing from the petty cash tin, the IOU note remained in the tin implying that £50 was owed. Although there are specific policies and procedures it was apparent during the inspection that staff members were unaware of the policy and thus the organisations procedures are not being followed. An immediate requirement was made during this inspection to investigate these matters. We received confirmation, following the visit, informing us that an investigation had been undertaken and the issues dealt with appropriately. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 19 There were discrepancies in two further service users’ balances, in which one users balance was short of that recorded and another users balance over that of which was recorded. An immediate requirement was made during the visit to investigate the discrepancies found relating to the two users to which the IOU notes related and ensure that the monies be returned within 24 hours. Confirmation was received by us that this had been addressed within the timescale and a further requirement has been made within this report to ensure that staff are familiarised with the organisations policy and procedures for safeguarding service users monies and adhered to it at all times to ensure that service users monies are protected at all times. People using the service and /or their representatives tell us that they know how to make a complaint should the need arise. There have been no complaints received by the service during the last 12 months and neither has the commission been alerted to any complaints. Follybridge House DS0000022972.V361087.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, 25, 27 and 30 Quality in this outcome area is adequate. Service users are provided with a clean, homely, comfortable environment in which to live and appropriate laundry facilities are provided to meet the service users’ needs. Some equipment needs attention to ensure the health, safety and welfare of those using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home evidenced that the home was clean and hygienic throughout and any hazardous substances were stored safely and securely. The home provides a physical environment, which meets the specific needs of those people who live there. The home is pleasantly decorated and furnished in a domestic style. There are limited ornaments, plants etc. in the communal areas owing to aspects of the challenging behaviour of some of the residents. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 21 There are two bedrooms and a shower room on the ground floor, with three further bedrooms, a bathroom and staff sleeping in room on the first floor. All bedrooms were found to be decorated and furnished to service users own personal tastes and containing their own possessions. However, it was noted that one service users en-suite was being used to store the home’s Hoover, whilst another bedroom contained a broken radiator guard, for which requirements have been made within this report. It was further noted that the shower seat, in the shower room, was broken and out of use and service users had been provided with a garden seat and frame to use when showering, whilst awaiting the repair of the shower seat. Upon enquiry it was ascertained that the shower seat had been out of use for three months. A requirement has been made within this report to ensure that the seat be repaired within a timely manner to ensure the health, safety and welfare of those using the service. There is a large enclosed, well-maintained rear garden, with swings, a trampoline, garden tables and benches and umbrellas and a sensory area, as well as textured paved paths and areas of lawn, which is used and enjoyed by service users and their visitors during the warmer months. Most of the pathways are provided with handrails. Since the last inspection, the service has partly addressed the safety issues highlighted in the last report regarding the trampoline although it still remains to pose as a risk to the safety of those using the service. Whilst the trampoline has been sunken at ground level around the perimeter of the trampoline there is a gap, which has not been filled to make it level and prevent people slipping into the hole in which the base of the trampoline sits. This should be addressed to ensure that people using the trampoline are free from any unnecessary risks to their safety. Follybridge House DS0000022972.V361087.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 and 36 Quality in this outcome area is good. Recruitment procedures are designed to ensure only appropriate people are appointed to work in the home. Training support for staff is good ensuring they are suitably equipped to meet service user needs. Competent and qualified staff provide care to service users, ensuring that care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes policies and procedures around the recruitment and selection of staff are robust and serve to protect service users health and welfare. It was not possible to examine any recruitment records, as these are not held on site but at head office. The acting manager informed us that face-to-face interviews are undertaken, references sought and all the necessary checks are undertaken to ensure prospective staff’s suitability to work with vulnerable Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 23 adults within the care field. Evidence of relevant CRB Disclosures was seen on the staff personnel files viewed. All new staff are provided with an induction period and undergo all the necessary training to ensure they have the skills and knowledge to undertake their roles competently. Staff training is recorded in individual staff files and those viewed demonstrated the home’s commitment to staff development and training. There has been some progress in providing staff with the opportunity to undertake the National Vocational Qualification in care. Of the nine permanent care staff, four have obtained their NVQ in care at level 2 or above and a further three are working towards it. None of the agency staff have an NVQ in care and are not presently working towards it. Staff are provided with regular supervision and support and regular staff meetings are held within the home all of which are minuted. Staff spoken with demonstrated a good understanding of their roles and described a supportive environment and a good sense of teamwork. Information provided to us by the service, prior to this visit informed us that there is a diverse team of staff; which consists of nine permanent staff and three regular agency staff. Observations of the support given and staff interaction with people using the service demonstrated the staffs dedication and their ability to work well together as a team, offering each other appropriate support. There have been two staff members who have left employment in the home during the last 12 months and the registered manager has over the last six months been on long-term sickness. Feedback from questionnaires completed by relatives/carers/advocates of the users of the service informs us that there are some concerns around staff stability, likewise documentation seen within the service, raises questions as to whether there are sufficient numbers of staff employed to address the needs of service users appropriately and a requirement has been made within this report to ensure that the service users full range of needs are met by appropriate staffing levels. Discussions with staff highlighted that there have been difficulties with the lack of a permanent manager and support to people who live in the home coupled with high levels of challenging behaviour, which has had an impact on staff morale. However, it is recognised that the current temporary management arrangements provides for some level of consistency. Follybridge House DS0000022972.V361087.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, 41 and 42 Quality in this outcome area is adequate. There are poor procedures taking place, which do not act in the best interests of those using the service and could compromise their health, safety and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) sent out prior to the inspection was not returned within the appropriate timescale, although it did arrive prior to our visit to the service and contained detailed information. The AQAA informed us of changes they have made and where they still feel they need to make improvements and detailed how they are going to do this. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 25 The manager was not present on the day of inspection, due to long-term sickness but is appropriately experienced and qualified to manage the home and feedback from staff informs us that he is very approachable and supportive as is the acting manager who is supporting the service and staff during his absence. Discussions with staff highlighted that there have been difficulties with the recent lack of a permanent manager and support to people who live in the home coupled with high levels of challenging behaviour and this has had an impact on staff morale. However, it is recognised that the current temporary management arrangements provides for some level of consistency. Well-maintained health, safety and welfare records are kept in the home and were made available for inspection. There have been regular monitoring visits undertaken by the provider with reports of these visits held within the home, which were made available to the inspector during the inspection. The manager obtains feedback from residents and visitors when talking to them in the home, and has an ‘open door’ policy that encourages people see him without the need to make an appointment. Likewise, feedback is sought from service users and their representatives when reviewing their care needs and via an annual quality assurance system in which surveys are sent to relatives to gain feedback on their views of the service provided. A reccommendation has been made to include family members, advocates, health and social care professionals who visit the home and other stake holders in the quality review of the service to gain a more ‘rounded picture’ of the service, collate the findings and feedback to those taking part. operates an ‘open door’ policy that encourages people see him without the need to make an appointment. Evidence of poor practices taking place namely around the poor recording of medication, failings in the appropriate management and recording of service users monies, the practice of using service users personal space for the homes storage purposes and failing to ensure that provision of equipment is kept in a good state of repair do not serve the service users best interests and could compromise their health, safety and well being. Follybridge House DS0000022972.V361087.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 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 2 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x 1 1 x Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 27 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 YA20 Regulation 13(2) Requirement Ensure that accurate records are maintained for the administration of service users medication using the coding system where necessary. Ensure that appropriate staffing levels meet the service users full range of needs. Ensure that service users bedrooms are not used for the storage of the services domestic electrical equipment. Suitable provision is to be made for the storage for the purpose of the service. Ensure that staff are familiarised with the organisations policy and procedures for safeguarding service users monies and adhered to it at all times to ensure that service users monies are protected at all times. Ensure that the shower seat be repaired within a timely manner to ensure the health, safety and welfare of those using the service. Timescale for action 31/05/08 2 YA33 18(1)a 30/06/08 3 YA25 23(2)l 31/05/08 4 YA23 13(6) 31/05/08 5 YA27 13(4) 30/06/08 Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 28 6 YA40 13 7 YA14 13 Ensure that staff have access to up-to-date copies of, and understand and apply, all policies and procedures and codes of practice to ensure that service users rights and best interests are safeguarded at all times. Ensure that any equipment, provided for service users use is free from any unnecessary risks to their health, safety and welfare. 30/05/08 30/06/08 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 YA39 Good Practice Recommendations It is reccommended that family members, advocates, health and social care professionals who visit the home and other stake holders be included in the quality review of the service to gain a more ‘rounded picture’ of the serviceand the findings be collated and fedback to those taking part. Follybridge House DS0000022972.V361087.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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