Inspection on 01/10/08 for Pathfinders Neurological Care Centre

This inspection was carried out on 1st October 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOME ADULTS 18-65 Forest Care Village Darwin Drive New Ollerton Nottinghamshire NG22 9GW Lead Inspector Andrew Bailey Unannounced Inspection 1st October 2008 09:00 Forest Care Village DS0000071840.V372431.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 Forest Care Village DS0000071840.V372431.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. Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Care Village Address Darwin Drive New Ollerton Nottinghamshire NG22 9GW 07896 110193 TBA we.bridge@btinternet.com www.forestcarevillage.co.uk Pathfinders-Care (Ollerton) Ltd 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) Wendy Bridge Care Home 22 Category(ies) of Learning disability (22), Physical disability (22) registration, with number of places Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Physical Disability - Code PD The maximum number of service users who can be accommodated is: 22 n/a 2. Date of last inspection Brief Description of the Service: Forest Care Village is registered as a care home for people of either sex with learning disability and/or physical disability. The first phase of the development saw 22 of a total of 44 beds ready for occupation. The provider achieved registration for an initial 22 places in March 2008. The second phase of the development is now ready for occupation and the provider has submitted an application to vary the registration to increase the total number of people who can be accommodated at the care home. At the time of our inspection there were twenty-one people accommodated. The premises are set in sizeable grounds on the outskirts of Ollerton. The home has level entrance access directly into the reception area. There is a passenger lift that is accessible to wheelchair users. The accommodation is on two floors. There is a large communal room with access to the main kitchen. In addition, there are kitchen/diners on each wing and the building is well served with dedicated areas for activities, therapies and social function. There is underfloor heating with thermostatic control in each room. Bedrooms have TV points; satellite TV is also available at an additional charge. Bedrooms have telephone points and people have the option to have their own telephone with responsibility for the line. There are views from all windows overlooking the grounds. Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 5 Up to date information regarding fees charged was obtained at the time of the inspection. Standard fees range from £550 to £875 per week, with extra fees costed on an individual basis (for example, specialist therapies such as physiotherapy, special outings and events, hairdressing and toiletries). Information about the care home is available on the website: www.forestcarevillage.co.uk Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 6 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. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This was the first inspection visit by The Commission for Social Care Inspection since the home opened in March 2008. The inspection was unannounced and took place over a period of nine hours. Prior to the visit an analysis of the home was undertaken from information we hold about the service including information gathered from the Annual Quality Assurance Assessment (AQAA) that they recently completed. At this inspection there were twenty-one people using the service. We used case tracking as part of our methodology. This means that we looked more closely at the care and services that four of those people receive. We did this by talking with those people (where possible) and by looking at their written care plans and associated health and personal care records. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records and observed some of the staffs’ interactions and approaches with people who use the service. We spoke with the registered manager, the responsible individual and members of the management and administration team about their role and responsibilities for the running of the home and examined associated records available. What the service does well: People live in a modern, purpose built home, which offers a high standard of facilities. People who use the service report that they feel that their needs are met and that the care that they receive is discussed and agreed with them. Before they are admitted to the home they are encouraged to visit and if possible experience short stays before choosing to live there. Staff appear enthusiastic and committed and develop good relationships with the people who live there. People using the service say that staff respect Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 7 people’s rights to privacy and dignity. A person using the service that was spoken with said that staff are ‘kind’. People enjoy the quality and the choice of food provided. A person who uses the service described the food as ‘very good’. Comments from people living at the home about the activities arranged by the home included ‘good’ and ‘good range of activities’. What has improved since the last inspection? 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. Forest Care Village DS0000071840.V372431.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 Forest Care Village DS0000071840.V372431.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): NMS 2, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service receive information to help them decide whether the service can meet their needs, and have the opportunity to visit the home before choosing to live there. EVIDENCE: In the annual quality assurance assessment (AQAA) self-assessment document that we received before this visit to the service said that they invite the person to visit the home before deciding to live there. They also stated that the home receives assessment documents from placing authorities before making decisions about placements. They said that they could improve the way that information is presented by looking at making audio and visual tapes, pictorial documentation and providing documentation in Makaton. We consider that it would be beneficial for documentation to be reviewed so that is it inclusive to all people. Two of the four people who were case tracked were able to confirm to us that they had visited the home before deciding to live there. One had found information about the facility on the internet and then spoken with the social worker about it. One of the people spoken with had visited more than once Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 10 before deciding to live there, and had visited for a period of respite. Both felt that they had received sufficient information to make their choice. For all four of the case tracked people there was detailed assessment documentation compiled by the placing authorities. There was also evidence of assessment by staff from the home, but some of the assessment information was not detailed. The registered manager said that new pre-admission assessment documentation was now in use, which provided a more detailed assessment of people proposing to use the service. Forest Care Village DS0000071840.V372431.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): NMS 6,7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning processes do not ensure that the needs of people using the service are reflected in their care plans, and there is insufficient guidance for care staff to follow, which places people who use the service at potential risk. EVIDENCE: In the annual quality assurance assessment (AQAA) the service state that the care plan documentation is comprehensive. They stated that the care plans need closer monitoring to ensure that all information is recorded and all forms are being completed properly. Four people who use the service were case tracked, which included a detailed analysis by us of the standard of care plan documentation records compiled for each of the four people. Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 12 At this inspection, people said that they receive the care that they need. Two of the people case tracked were able to tell us that they knew what was written about them in their care plans and that the plans had been discussed with them. One person said that their parent would sign to say that they agreed with the plans. When we looked at a selection of care plans, including those of people who we were case tracking, we found that there was generally no documentary evidence to confirm that care plans had been agreed with people using the service (or with their representative). There was also nothing documented to identify when the care plans had been compiled, who had compiled them or when they were last reviewed or updated. Record keeping good practice is that entries should be signed, dated and there should be evidence of on-going review and revision of plans (where this is appropriate). The care plans that we observed generally failed to detail the specific care that people required. For example, there are several people who require the use of a lifting hoist to transfer. There were no detailed manual handling assessments and no detailed plans for staff to follow in order to safely transfer people. There was no evidence to suggest that people have suffered as a result, but there is potential risk to people using the service when staff do not have adequate written guidance to follow or refer to. Some of people using the service have learning disability. We looked for evidence within care plans that consideration had been given to the capacity of people to make some or all decisions for themselves. There was little reference to individual capacity to take decisions or make choices. The registered manager confirmed that staff had not received training on the Mental Capacity Act 2005. This indicates that staff may not be aware of their duties and responsibilities under the Act and how the code of practice affects their work. Therefore, there is the potential for this to not be in the best interest of people. Feedback from people suggested that staff promote and enable them to lead as independent a life as possible. Again, the care plans did not detail the assessment processes undertaken to help people to take ‘responsible risks’ within a risk management framework. Forest Care Village DS0000071840.V372431.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): NMS 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to lead a lifestyle of their choosing, which ensures their recreational expectations and preferences are met. EVIDENCE: The annual quality assurance assessment (AQAA) document that we received before this visit to the service said that the daily routines promote independence and choice, and the rights of service users are upheld. The catering facility is developing the menu around the likes and dislikes of service users. The service felt that they could get more people out working within the community and more people involved in the running of the home. Care plans did generally contain information about the life histories of people. A key worker that we spoke with confirmed that they had learned a lot about people using the service through the process of documenting life histories and recording peoples likes, dislikes and ambitions. Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 14 We spoke with a support worker (employed to specifically concentrate on activities). The person was booked on a course focussing on ‘activities in a care setting’. The person stated that some people who use the service are able to engage in education and training by attending a community facility. Examples included courses for reading, writing and cookery classes. In-house activities include pottery, Boccha (a bowls type activity) and outside visits. Contract transport is currently booked to facilitate outside visits; the establishment has a minibus, but this is not currently utilised for the transport of people using the service. People who use the service make payments towards the costs of contracted transport. Since opening there have not been any holidays arranged for people using the service, but management stated that they are looking at options for holidays now that the service is developing. Comments from people living at the home about the activities arranged by the home included ‘good’ and ‘good range of activities’. Two of the people using the service participated in a visit to the cinema on the day of the inspection. Two people described the flexible routines at the home. One stated that decide when they go to bed, when they get up and exercise choice in what activities they get involved with. We spoke with one of the catering staff. She explained the checks that are made to ensure that the service operates safely and meets the requirements set by the Environmental Health Officer. A varied diet is on offer with choices identified on the menus. The catering facilities are of a good standard, with the main kitchen having a servery opening onto the main dining area. We observed the midday mealtime on the day of the visit. Staff were on hand to support people who needed assistance with feeding. The mealtime was unhurried and people seemed to enjoy the food served. We spoke with people about the catering and feedback was positive about the quality and choice available. Forest Care Village DS0000071840.V372431.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): NMS 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and emotional needs of people who use the service are not always assessed fully, placing them at possible risk. However, people using the service say that staff are competent and they feel safe and supported by the staff. Some aspects of poor recording of medications have the potential to adversely affect people who use the service. EVIDENCE: The home’s self-assessment states that personal care is provided in rooms that allow privacy. Flexibility is encouraged in relation to getting up, baths, activities etc. People are given choices in what they do, when and with whom. Other care professionals are utilised and the service takes advice and support from them e.g. physiotherapist, occupational therapist. The service tries to place staff of the identified gender with clients where a preference is stated. People said that they felt supported by staff. They described staff as kind and considerate, and said staff listen and act on what people say and treat people Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 16 with respect. One person stated that staff are ‘very competent’. People who use the service confirmed that staff ensure their privacy and dignity. One person said that they usually receive the care they need when they want it, but that there are not always enough staff, which can mean that there may not be enough staff to assist with showering for example. Another person that we spoke with said that agency staff are sometimes used and that they did not know the people at the home as well as regular staff. This meant that the person had to explain things to the agency staff, whereas often the regular staff instinctively knew what the person needed. The person said that staff ‘look out for you’. This person also confirmed that outside professionals visit the home, in this instance a District Nurse. Notwithstanding that people said that they felt supported by staff, when we examined the care plan records of people living at the home we found serious deficiencies in the assessment and recording systems, which could potentially place people at risk. Generally, there was insufficient use of recognised assessment tools to measure the risks to people using the service. Examples include lack of detailed assessment in the areas of tissue viability (risk of developing pressure ulcers), nutritional assessment, continence, manual handling and risk of falls. One person that we case tracked had been admitted many weeks ago and yet the very basic detail recorded about any possibility of pressure area risk had a date about eight weeks following the admission date. A significant period had ensued during which there was no documented recognition of risk to this person with a significant physical disability. The homes’ written policy and procedure on tissue viability states that a risk assessment form will be completed within two hours of admission. Where there was clearly use of pressure relieving devices to reduce the risk of pressure ulcers to people, there was usually no mention of these within the care plan documentation compiled by staff at the home. One care plan we examined merely stated that whole body hoisting was needed. There was no detailed manual handling assessment of written guidance for care to follow in order to safely transfer the person. Where simple risk assessment had been documented in care plans, not only was there no evidence of the use of risk assessment tools to inform decisions, there was also no evidence of periodic reassessment of risk factors. With the exception of the ‘daily logs’, there was frequently no date, and signature of the person compiling the care plan summary. We discussed the shortfalls in care planning with management during the inspection visit. Some members of the management team recently became aware of the need to improve the care planning systems and they stated that improvements are imminent, including the use of revised documentation and introduction of a system to monitor quality standards on an ongoing basis. Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 17 The medication records of some of the people who use the service were examined during the inspection. This was not an in-depth examination of medication systems, but inspection of the medication administration records identified two main areas for improvement. The home utilise pre-printed administration records that are prepared by the community pharmacy. Where the prescribed medication details need to be amended it is good practice for the changes to be signed or initialled by two members of staff. It was noted that some changes were unsigned. Where a variable dose medication is administered, the records should identify the actual dose administered; this was not always recorded. Accurate record keeping is needed to ensure people are not placed at risk. Forest Care Village DS0000071840.V372431.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): NMS 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are not fully protected because some staff have not received training in safeguarding adults. Response times to complaints do not act in the best interests of people using the service. EVIDENCE: In our annual quality assurance assessment questionnaire completed by the home they say that there is a complaints policy and procedure that is followed. They say that they listen to all concerns raised, acknowledge them and respond by taking actions if possible. They say that they could react quicker and take action quicker. They aim to be proactive and ensure complaints do not arise in the first place. As of 26 September (date the self-assessment was received by us) the service state that there have been 9 complaints received, of which 73 were resolved within 28 days and four complaints were upheld. Three complaints were awaiting an outcome. The Commission received three complaints and concerns about this service in the period from opening (March 2008) up to the inspection date. One concerned feeding issues and non-adherence to specialist feeding guidelines. Dignity and supervision issues were also raised. At this inspection the manager of the home stated that the specialist guidance had not been received at the time of the concerns, although this was said to have been sent to the home by special delivery. The professional who raised the concerns was recently contacted again by the Commission and has not raised further Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 19 concerns, but has also not had the opportunity to observe staff practices since the initial concerns were raised. At this inspection, staff interactions were observed over the mealtime period and people seemed to be well supported by the staff. An anonymous complaint was received about fire safety at the home. This was referred to the provider and a response received. Recently, a third complaint was received by the Commission from an outside agency relating to inadequate care records, with insufficient record of fluid intake and pressure risk. The complainant stated intent to raise other concerns via the safeguarding procedures mechanism. Outcomes from these concerns are not yet available, but this inspection has found significant shortfalls in care planning standards. The manager also confirmed that fluid balance monitoring had not been satisfactory. We spoke with people about how staff respond to any concerns they may have. People said that they felt safe and supported by staff. They felt that staff listen to people and deal with concerns. One person said that they would speak to their keyworker about anything that concerned them. When we spoke with staff about safeguarding adults training (relates to recognition and actions to address allegations of abuse) we found that some staff said that they had received training, but some had not received any training on safeguarding. This means that there are staff that have not received training on how to recognise the various types of abuse and people using the service may not be fully protected as a result. The manager stated that all staff would receive training via the on-going training programme. Forest Care Village DS0000071840.V372431.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): NMS 24, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have the benefit of living in a purpose built home that has a high standard of facilities. Adaptation to the alert system would promote independence and promote the privacy of some of the people using the service. EVIDENCE: The self-assessment completed by the home identifies that the home is brand new, with ample sized rooms. There is under floor heating, individually controlled. There are lots of areas to relax and unwind. A therapy room, medical room, relaxation room, large garden and plenty of outside space are present. They describe the home as light, clean and free from hazards. Designed for disabled people, the building allows freedom of movement. Infection control is reported to be easy to control because of the design of the building. The self-assessment says that alcohol gel could be used more and that people using the service could be involved more in identifying any Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 21 changes. The assessment identifies that they could provide a hydrotherapy area, an automatic door opener, and a better call bell system with add-ons like speech activation and environmental control systems. People that we spoke with were very satisfied with the facilities. One person commented that their room is ‘very good’. Another appreciated having the kitchenette on the unit, in addition to the main dining area. We undertook a brief tour of the building at this visit and it was apparent that the facilities are of a very good standard. It was noted that the alert system/emergency call system is not specifically designed for people with certain types of physical disability. It could benefit to the independence and safety of people using the service if there is further consideration to specialist adaptation, rather than the alternative and supplementary use of ‘baby alarm’ units, which may intrude on the privacy and dignity of people using the service. Additionally, there were no written risk assessments in place for situations where persons are unable to use the standard alert system. A more in-depth assessment has recently been undertaken by the Commission as part of the application by the provider to increase the number of places to accommodate people at the home. Forest Care Village DS0000071840.V372431.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): NMS 32, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment process is not fully robust, which could place people at risk. An enthusiastic and committed staff team support the people who live at the home. EVIDENCE: The self-assessment completed by the home states that staff have a job description, know the ethos of the home and are good at promoting independence. Staff complete a ‘skills scan booklet’ and attend regular training. There have been staff meetings and staff supervision to enhance communication. The self-assessment says that there is a sound recruitment policy and this is worked to at all times. The self-assessment says that all staff have a National Vocational Qualification (NVQ) or are waiting to register for training. The dataset identifies that five permanent care staff have NVQ level 2 or above in Care, or Health and Social Care (this is below the recognised ratio of staff who should hold this qualification, although a further ten staff are registered to undertake this training). Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 23 We sampled the recruitment files of staff employed at the home. It is a requirement that two written references are obtained before a person is employed at a care home. One of the files examined contained evidence of one written reference. Non-adherence to recruitment regulations could place people at potential risk. One member of staff that we spoke with had worked at the home since June 2008 and had not had supervision sessions. Other staff that we spoke with did confirm that they had supervision sessions and found these beneficial. There is a rolling programme of training, most of which is conducted by an external training company. Most staff that we spoke with had received mandatory training, but it is concerning that some staff had not been trained in safeguarding adults (see Concerns, Complaints and Protection section) and there had not been staff training in respect of the Mental Capacity Act 2005. The annual quality assurance assessment (AQAA) states that two people who live at the home have dementia, but there has not been training for staff specific to this condition. One member of staff spoken with (commenced employment in June 2008) has not yet had training on challenging behaviour). Overall, staff we spoke with had good awareness of the needs of people who use the service and people using the service consider staff to be competent and skilled, but there may be some potential risk to the welfare of people unless all staff receive comprehensive training. Forest Care Village DS0000071840.V372431.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): NMS 37, 38, 39, 40, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management systems are not developed to fully promote and protect the interests of people using the service. EVIDENCE: The AQAA self-assessment completed by the home states that the teams could be strengthened, that people could be supported more, that people could be involved more and that the service could listen more and implement suggestions. The self-assessment refers to a ‘slim’ management structure within the section entitled ‘Barriers to Improvement’. There are no reports in place in respect of required monthly visits to the home by the registered provider or their representative (required by Regulation 26 of Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 25 the Care Homes Regulations 2001). These visits are a component of the quality assurance monitoring measures that care homes are expected to undertake. Management stated that suggestion boxes are utilised, staff meetings held and residents meetings held. There was no indication that formalised methods of seeking feedback from people who use the service are in place, with mechanisms to provide structured feedback. However, it is recognised that the service has only been operating for a few months. Some of the staff we spoke with felt that relations with management were good, whilst others felt that there was poor communication between management and nurses/care staff, with too few meetings held. There are a range of policies and procedures in place. Unfortunately these do not always reflect what happens in practice. For example, the manual handling policy refers to moving and handling coordinators, when these are not in place. The tissue viability/pressure ulcer prevention guidance refers to the use of specific assessment forms on admission, whilst this practice is not currently followed. Safe working practices were examined on a sample basis, with consideration given to the information provided prior to the inspection in the AQAA selfassessment dataset. The following require management attention to minimise potential risk to people who use the service: An external fire safety consultant has undertaken a fire safety risk assessment and staff have received training. However, the risk assessment refers to ‘practice by holding fire drills’ and no drill had been carried out. Management plan to carry out a fire drill when a member of management has been on a relevant fire safety course (booked to take place the week after this inspection). Portable appliance testing has taken place for appliance belonging to the service, but there are no records in place for the testing of portable electrical appliances brought into the home by people using the service. A risk assessment had not been undertaken in respect to Legionella prevention (water system). Lifting equipment is still under warranty. However, it is necessary to establish whether the planned maintenance programme for the passenger lift and patient lifting hoists are in line with Lifting Operations and Lifting Equipment Regulations 1998 (LOLER). During the inspection the HR/Business Process Manager and the responsible individual discussed the organisational arrangements that are being introduced currently to strengthen the management systems and structure. There was recognition that there are service improvements to be made. The overall findings from this inspection confirm that there is a need to introduce robust management arrangements to monitor and support the delivery of care to people who use the service. Forest Care Village DS0000071840.V372431.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 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 2 3 2 2 X 2 X Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 YA6 YA19 Regulation 15(1) (2) Requirement Each service user must have a written care plan, which details how their needs are to be met in respect of their health and welfare. Care plans must include assessment of risks and identify strategies to minimise identified risks to an individual’s health e.g. prevention of pressure ulcers. There must be documentary evidence that the care plan has been developed in consultation with the person using the service, or their representative. Care plans must be kept under review and revised where necessary. This is to ensure: That people’s health, personal and social care needs are fully considered. That people are able to make Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 28 Timescale for action 14/11/08 2 YA20 13(2) decisions about their lives and are provided with the assistance they need. Records for the prescription/administration of people’s medicines must be properly recorded in accordance with safe and recognised practise. Where a variable dose has been prescribed, the dose administered must be recorded. Two members of staff must sign any changes made to prescribed medications. This is to ensure: That people are not placed at unnecessary risk of harm. 14/11/08 3 YA29 13(4) (c) 4 YA34 19 That there is evidence that people’s medicines are properly accounted for. Where a person using the service 14/11/08 is unable to use the standard alert call system activation devices there must be a risk assessment undertaken to identify and address any potential risks to their health and safety to ensure that they are safe. Staff must not commence 14/11/08 employment until all required checks and documentation are satisfactorily in place as detailed in Regulation 19 and Schedule 2. This is to ensure: That people are protected by the home’s recruitment policy and practices. In accordance with Regulation 26, the responsible individual (or representative) must visit the home unannounced and at monthly intervals in order to DS0000071840.V372431.R01.S.doc 5 RQN 26 14/11/08 Forest Care Village Version 5.2 Page 29 speak with people, inspect the premises, its record of events and complaints and prepare a written report as to the conduct of the home. This is to ensure: That there is quality monitoring of the service that meets with the Regulations That the provider takes account of the views of people living in the care home. Portable electrical appliances in the home must be tested in accordance with recognised practise (including testing of service users’ own electrical equipment). A competent person must undertake a Legionella risk assessment and any identified actions be taken to safeguard against Legionella infection. There must be a planned checking and maintenance programme for all lifting equipment that complies with Lifting Operations and Lifting Equipment Regulations 1998 (LOLER). Fire procedures must be tested in practice as identified in the home’s independent Fire Safety risk assessment (Point 13 – Escape Times). This is to ensure: That risks to service users are minimised. That the health, safety and Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 30 6 YA42 13(4)(a) & (c) 14/11/08 welfare of people using the service are promoted and protected RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 Refer to Standard YA1 YA7 YA9 YA22 YA23 YA29 YA36 YA39 YA40 Good Practice Recommendations Information for people who use the service should be provided in a range of formats e.g. audio-visual. Where appropriate, care plans should identify how an individual’s ability to take decisions as been assessed in accordance with the Mental Capacity Act. Care plans should show how staff enable individuals to take responsible risks as part of an independent lifestyle, whilst minimising identified risks and hazards. People who make complaints about the service should receive notification of the outcome within 28 days. All care staff should receive training in safeguarding procedures and be conversant with reporting pathways. Further consideration should be given to adapting the call/alert system so that it is accessible to all people using the service All staff should access the supervision system as recommended in the National Minimum Standards. Results of service user surveys should be published and made available to people using the service. Staff should receive training in the Mental Capacity Act and have access to related policies, procedures, and information on the Act so they are aware of how to support people to make decisions. Written policies and procedures should reflect the systems employed at the home e.g. Manual Handling arrangements (and/or where necessary practices should be changed to meet with the home’s written guidance). 10 YA40 Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Forest Care Village DS0000071840.V372431.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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